The COVID-19 pandemic has severely impacted public health and the worldwide economy. Converging evidence from the current pandemic, previous outbreaks and controlled experiments indicates that SARS-CoVs are present in wastewater for several days, leading to potential health risks via waterborne and aerosolized wastewater pathways. Conventional wastewater treatment provides only partial removal of SARS-CoVs, thus safe disposal or reuse will depend on the efficacy of final disinfection. This underscores the need for a risk assessment and management framework tailored to SARS-CoV-2 transmission via wastewater, including new tools for environmental surveillance, ensuring adequate disinfection as a component of overall COVID-19 pandemic containment. Converging evidence indicates that SARS-CoVs are present in wastewater for several days with potential health risks. This Review analyses knowledge about such risks as well as the potential spread of SARS-CoVs in waterborne, waterborne-aerosolized and waterborne-foodborne pathways during a pandemic.