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Several studies were conducted to evaluate the presence of COVID-19 in the GI track and eliminated with stools.
The first case report in the USA of COVID-19 was published in The New England journal of medicine (https://www.nejm.org/doi/full/10.1056/NEJMoa2001191).
The report showed, as early as day seven of clinical symptoms, elimination of COVID-19 in the stools of the patient that also had COVID-19 infection as demonstrated with positive nasopharyngeal and oropharyngeal swabs.
A second research letter from China reports evidence of COVID-19 infection in stools of asymptomatic pediatric patients. In this report, the nasopharyngeal and oropharyngeal swabs became positive around day 7 and the stool specimens was positive only a couple of days later.
What is very important, the nasopharyngeal and oropharyngeal swabs became negative after few days and that the stool specimen stay positive for about 10 days after nasopharyngeal and oropharyngeal swabs became negative.
The third publication on Nature Medicine (https://www.nature.com/articles/s41591-020-0817-4), reports about 10 pediatric patients that upon hospitalization were monitored for COVID-19 rectal and nasopharyngeal swabs. Data show that nasopharyngeal swabs stay on average positive up to 15 days following hospitalization, but rectal swabs stay on average positive for COVID-19 up to 27 days following hospitalization.
Taken together, these reports provide evidence:
- Infectious virions are secreted from the virus-infected gastrointestinal cells
- Fecal-oral transmission could be an additional route for viral spread
Prevention of fecal-oral transmission should be taken into consideration to control the spread the virus.
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