The removal of phosphorus (P) from domestic wastewater is primarily to reduce the potential for eutrophication in receiving waters, and is mandated and common in many countries. However, most P-removal technologies have been developed for use at larger wastewater treatment plants that have economies-of-scale, rigorous monitoring, and in-house operating expertise. Smaller treatment plants often do not have these luxuries, which is problematic because there is concern that P releases from small treatment systems may have greater environmental impact than previously believed. Here P-removal technologies are reviewed with the goal of determining which treatment options are amenable to small-scale applications. Significant progress has been made in developing some technologies for small-scale application, namely sorptive media. However, as this review shows, there is a shortage of treatment technologies for P-removal at smaller scales, particularly sustainable and reliable options that demand minimal operating and maintenance expertise or are suited to northern latitudes. In view of emerging regulatory pressure, investment should be made in developing new or adapting existing P-removal technologies, specifically for implementation at small-scale treatment works.

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Antimicrobial resistance (AMR) is a major threat to global health. Understanding the emergence, evolution, and transmission of individual antibiotic resistance genes (ARGs) is essential to develop sustainable strategies combatting this threat. Here, we use metagenomic sequencing to analyse ARGs in 757 sewage samples from 243 cities in 101 countries, collected from 2016 to 2019. We find regional patterns in resistomes, and these differ between subsets corresponding to drug classes and are partly driven by taxonomic variation. The genetic environments of 49 common ARGs are highly diverse, with most common ARGs carried by multiple distinct genomic contexts globally and sometimes on plasmids. Analysis of flanking sequence revealed ARG-specific patterns of dispersal limitation and global transmission. Our data furthermore suggest certain geographies are more prone to transmission events and should receive additional attention.

Accurate surveillance of the COVID-19 pandemic can be weakened by under-reporting of cases, particularly due to asymptomatic or pre-symptomatic infections, resulting in bias. Quantification of SARS-CoV-2 RNA in wastewater can be used to infer infection prevalence, but uncertainty in sensitivity and considerable variability has meant that accurate measurement remains elusive. Here, we use data from 45 sewage sites in England, covering 31% of the population, and estimate SARS-CoV-2 prevalence to within 1.1% of estimates from representative prevalence surveys (with 95% confidence). Using machine learning and phenomenological models, we show that differences between sampled sites, particularly the wastewater flow rate, influence prevalence estimation and require careful interpretation. We find that SARS-CoV-2 signals in wastewater appear 4–5 days earlier in comparison to clinical testing data but are coincident with prevalence surveys suggesting that wastewater surveillance can be a leading indicator for symptomatic viral infections. Surveillance for viruses in wastewater complements and strengthens clinical surveillance, with significant implications for public health.