Testing Strategy

COVID-19 May Spread via Fecal Matter & Not Just Respiratory Droplets

It is a truism that almost nobody questions. Because COVID-19 is a respiratory disease, diagnosis and discharge of patients from hospitals is based on respiratory specimens. However, a new analysis published on June 10 in JAMA Network Open suggests that maybe we have things upside down. The reasoning: While few develop diarrhea from the virus, viral shedding from SARS-CoV-2 has been reported in stool samples of more than 40% persons diagnosed with COVID-19, suggesting that their feces may be spreading the disease.

The Study

The primary reported symptoms of COVID-19 are cough, fever and breathing problems. But; diarrhea is also commonly reported and is now among the symptoms U.S. Centers for Disease Control and Prevention (CDC) lists on its COVID-19 Self-Checker guidelines.

 With this in mind, Sravanthi Parasa, M.D., of Swedish Medical Center in Seattle, analyzed data from 29 different COVID-19 studies. More precisely, Parasa and her colleagues reviewed data from nearly 1,500 studies of COVID-19 and focused on the results from the 29 that included data on gastrointestinal symptoms. Those studies had a total enrollment of 4,805 participants.

 The Findings

Overall, the researchers found that 7.4 percent of the participants in the 29 studies reported diarrhea and 4.6 percent experienced nausea or vomiting. Eight of those studies reported fecal tests that were positive for SARS-CoV-2, with viral shedding—a measure of contagion—detected in feces in 40.5 percent of enrolled patients.

While just 12 percent of patients infected with SARS-CoV-2 reported that they experienced gastrointestinal symptoms, more than 40 percent shed virus via feces—meaning, they were contagious. The review also found that between 30 percent to 50 percent of COVID-positive patients may have positive fecal swab samples, which confirms that transmission is possible in other ways apart from respiratory droplets. The presence of live virus in stool and data showing fecal shedding continuing for days after hospitalization is “particularly concerning,” wrote the study authors.

 

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