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Is there a Potential Fecal Transmission of COVID-19? What are the Public Health Implications?

Early studies show evidence of COVID-19 genetic material in fecal matter, but more work is needed to determine if the virus can be spread through stool, according to a new review paper from a Rice University epidemiologist. This article looks at the recent evidence for fecal transmission of COVID-19 and the public health ramifications.

Potential Fecal Transmission of SARS-CoV-2: Current Evidence and Implications for Public Health” will appear in an upcoming edition of the International Journal of Infectious Diseases and is available online. The paper reviewed an ever-changing body of literature on detection of the novel coronavirus in fecal matter of COVID-19 patients.

“Most of the studies that have been done so far are picking up viral RNA in the feces rather than infectious virus,” said E. Susan Amirian, an epidemiologist with Rice’s Texas Policy Lab and the study’s lead author. “However, a few studies have showed that infectious virus may be present in stool samples.”

Amirian said the mere presence of genetic material is less worrisome than if infectious amounts of viable virus are found in stool in future studies, as that would imply it is possible for it to be transmitted to others through feces. She said if future research continues finding viable virus in stool, this could have important implications, especially for those working in the restaurant industry, nursing homes, day cares, etc.

“Ultimately, more research is needed to determine whether exposure to stool is spreading this virus and making the pandemic worse,” Amirian said. “But given this possibility, it behooves us to be more careful, especially in settings where people have an increased risk of morbidity and death due to COVID-19.”

Amirian said there’s no downside to exercising an abundance of caution in following good personal hygiene practices until we know more.

“There are plenty of other diseases out there that are transmitted through fecal contamination, including hepatitis A and norovirus,” she said. “Following a high level of precaution will help just in case COVID-19 can be spread this way.”   

Conclusion/ ” Potential fecal transmission of SARS-CoV-2: Current evidence and implications for public health. Our understanding of COVID-19 is advancing rapidly, and future research on all possible modes of transmission are strongly justified given the scale of this pandemic. Current knowledge on whether fecal transmissibility (either orally, through fomites, or by aspiration of fecally contaminated droplets) is likely to be an important mode of COVID-19 spread is still limited. In particular, evidence about whether infectious virions can be found in stool is based on a small number of patients whose specimens were collected at different times over the course of illness or convalescence. Further research is warranted to elucidate whether SARS-CoV-2 is present in stool at potentially infectious doses, and if so, to assess the duration of viral persistence in fecal matter. These questions are of public health significance and should be examined in larger studies to help inform future disease mitigation guidelines. Efforts to test for the presence of SARS-CoV-2 in sewage are already underway in some cities, and very preliminary evidence suggests that viral RNA may be detectable in sewage samples in certain circumstances (, 2020; Medema et al., 2020). Additional research on whether the virus is consistently detectable in other bodily fluids, such as breast milk, sweat, or semen, would also help fill some important gaps in the current literature.”

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Source: Amirian ES. Potential fecal transmission of SARS-CoV-2: Current evidence and implications for public health. Int J Infect Dis. 2020 Apr 23;95:363-370. doi: 10.1016/j.ijid.2020.04.057.

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