Infectious SARS-CoV-2 in Feces of Patient with Severe COVID-19

Abstract

Severe acute respiratory syndrome coronavirus 2 was isolated from feces of a patient in China with coronavirus disease who died. Confirmation of infectious virus in feces affirms the potential for fecal–oral or fecal–respiratory transmission and warrants further study.

Microbicidal actives with virucidal efficacy against SARS-CoV-2 and other beta- and alpha-coronaviruses: implications for future emerging coronaviruses and other enveloped viruses

“…Zang et al 34 , upon being unable to recover infectious SARS-CoV-2 from RNA-positive human fecal samples, have argued that the virus is rapidly inactivated by simulated human colonic uid. This conclusion is not consistent, however, with the ndings of Xiao et al 32 or Zhang et al 33 , who were able to recover infectious SARS-CoV-2 from human feces reviewed in 35 , or with the reports of Liu et al 20 and Chan et al 21 that SARS-CoV-2 remains infectious for hours in human fecal suspensions. The conclusion is also not consistent with results obtained for other coronaviruses, such as SARS-CoV and MERS-CoV 35 .…”

“…The indirect transmission pathway, envisioned as a patient's bodily uids-HITES-hands-mucous membrane nexus, is supported by experimental transmission studies in animal models 28 and by the results of investigations of the contamination of HITES with SARS-CoV-2 RNA in healthcare settings 25,[29][30][31] . The detection of infectious SARS-CoV-2 in patient feces 32,33 , together with the data on survival of SARS-CoV-2 in fecal suspensions 20,21 , suggest that a fecal/oral or fecal/respiratory route of transmission is possible. Zang et al 34 , upon being unable to recover infectious SARS-CoV-2 from RNA-positive human fecal samples, have argued that the virus is rapidly inactivated by simulated human colonic uid.…”

Pit latrines may be a potential risk in rural China and low-income countries when dealing with COVID-19

“…This suggests that there may be other potential routes of transmission, such as exposure to SARS-CoV-2 that survive in community environment. Given that the infectious SARS-CoV-2 was found to be secreted through the human urinary system ( Sun et al, 2020 ) and intestinal tract ( Wang et al, 2020d ; Xiao et al, 2020b ; Zhou et al, 2020a ), and SARS-CoV-2 RNA was detected in wastewater worldwide ( Randazzo et al, 2020 ), many studies have suggested the possibility of wastewater transmission of COVID-19 disease ( Adelodun et al, 2020 ; Arslan et al, 2020 ; Foladori et al, 2020 ). However, the direct use of untreated excreta as a fertilizer and the flushing of excreta from open cesspools into the waters on rainy days might lead to serious water pollution, including the SARS-CoV-2 within human excreta.…”

“…Infectious SARS-CoV-2 has been found in human excreta samples of COVID-19 patient in many previous studies ( Sun et al, 2020 ; Wang et al, 2020d ; Xiao et al, 2020b ; Zhou et al, 2020a ), and the SARS-CoV-2 embedded in stool particles in septic tanks could escape from disinfection and slowly release into aqueous phase, behaving as a secondary source of SARS-CoV-2 and potentially contributing to its spread through drainage pipelines ( Zhang et al, 2020c ). Former study has found that particles (kaolin clay, humic acid powder, and activated sludge) <2 μm in diameter were large enough to protect viruses from 254-nm ultraviolet (UV) light ( Templeton et al, 2005 ), suggesting that the protection of fecal particles might make the survival of SARS-CoV-2 more easier.…”

“…Notably, infectious SARS-CoV-2 was successfully isolated from the stool specimen of a patient with diarrheal COVID-19 ( Zhou et al, 2020a ) and 2 patients without diarrhea ( Wang et al, 2020d ). Another study showed that infectious SARS-CoV-2 virus were successfully isolated from 2 of 3 patients with viral RNA–positive, indicating that infectious virus in feces was a common manifestation of COVID-19 and confirmed the potential of fecal–oral or fecal–respiratory transmission ( Xiao et al, 2020b ). In addition, recent studies showed that human angiotensin-converting enzyme II (ACE2), which had been proved to be a cell receptor for SARS-CoV-2 ( Lu et al, 2020 ; Zhou et al, 2020b ), was highly expressed in glandular cells of human gastric, duodenal, and rectal epithelia, supporting the entry of SARS-CoV-2 into host cells ( Xiao et al, 2020a ).…”