Enhanced Government Response

Initiative: Precision Pandemic Public Health Surveillance

Domain: Health


As community transmission of the Sars-nCov-2 virus appears in India, new means of detecting its presence in the population and evidence-based local response are required. International and national efforts have indicated that testing sewage can be an effective tool for monitoring the spread of the Sars-nCoV-2 virus. However, an ‘Indian’ protocol is needed that takes into account the poor quality of sewage systems and challenges in transportation and testing of samples, and ensures that the results of the sample testing supports city and state governments to effectively take necessary measures and communicate with the public on COVID-19 incidence. 


Both symptomatic and asymptomatic COVID-19 patients shed SAR-CoV-2 in their stools. The virus can be detected in stools much before it is detected from nasal swab testing of an individual. Recognizing these points, CAC has developed a protocol to detect the presence of Sars-nCoV-2 virus  from sewage water coming out from the community, with the help of partners in health (Swasti, CMS), testing (Molecular Solutions and Neshaju Envirotech), research (St John’s Research Institute and Indian Institute of Science) and water and sanitation engineering (STUP Consultants and CDD Society). 


The sample from each ward will be collected from the community sewage plant and designated open sources and delivered to a designated laboratory for processing and testing, maintaining a desirable cold chain. Then the sample will be processed and tested to understand the prevalence of the virus. The findings will be shared online on a publicly accessible surveillance dashboard to review the situation. The SARS-CoV-2 sewage surveillance data can serve as an Early Warning System, and inform resource deployment and mitigation measures, thereby helping state and local health departments detect, understand, and respond to the COVID-19 pandemic. This is the first of its kind initiative in India, and probably in Asia. This initiative, known as the Precision Pandemic Public Health Surveillance Initiative, is covering 45 most populous wards of Bangalore city and is looking for scaling and endorsement partners in other cities and states of India.


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