While the main approach of COVID-19 surveillance in a community is an individual testing via a low-cost ATK, the ATK has a critical delay in detecting COVID-19 infected persons since it will detect the SARS-CoV-2 in a person after the person being infected for 5 to 14 days.

Thus, the asymptomatically infected person may not realize that he or she is already infected and transmitted the virus to others during that period accelerating infection in community.

Sewage surveillance of SARS-CoV-2 RNA fragments via a special protocol of RT-qPCR detects any infection in the entire community without delay. Prompt detection of infected persons right after the infection followed by investigative ATK testing to separate or quarantine the patients is the most effective way to suppress the COVID-19 spreading wave in a community.

Early Flatten designs community surveillance program based on this most effective strategy and compute the benefit-to-cost ratio of using the sewage surveillance of SARS-CoV-2 in comparison to using individual ATK or RT-qPCR in community surveillance. It shows how to use the sewage surveillance to minimize not only the monitoring cost but also the lost of human life.

To save life and minimize monitoring budget, we must “EarlyFlatten”