Potential intestinal infection and faecal–oral transmission of SARS-CoV-2

Abstract

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread to more than 200 countries and regions globally. SARS-CoV-2 is thought to spread mainly through respiratory droplets and close contact. However, reports have shown that a notable proportion of patients with coronavirus disease 2019 (COVID-19) develop gastrointestinal symptoms and nearly half of patients confirmed to have COVID-19 have shown detectable SARS-CoV-2 RNA in their faecal samples. Moreover, SARS-CoV-2 infection reportedly alters intestinal microbiota, which correlated with the expression of inflammatory factors. Furthermore, multiple in vitro and in vivo animal studies have provided direct evidence of intestinal infection by SARS-CoV-2. These lines of evidence highlight the nature of SARS-CoV-2 gastrointestinal infection and its potential faecal–oral transmission. Here, we summarize the current findings on the gastrointestinal manifestations of COVID-19 and its possible mechanisms. We also discuss how SARS-CoV-2 gastrointestinal infection might occur and the current evidence and future studies needed to establish the occurrence of faecal–oral transmission.

Inactivation of SARS-CoV-2 in chlorinated swimming pool water

“…SARS-CoV-2 is transmitted in the air and also by direct inoculation. There is also a potential faecal-oral route of transmission for SARS-CoV-2 (Guo et al, 2021). Our findings on the susceptibility of SARS-CoV-2 to inactivation by swimming pool water underscore the importance for those who maintain swimming pools to adhere to UK guidelines for chlorination, and this should give confidence in the safety of bathers when in the water.…”

SARS Wars: the Fomites Strike Back

“…That said, SARS-CoV-2 does present clinical manifestations that might support fomite transmission, especially gastrointestinal involvement in many cases (30). Viral RNA has been detected in stool specimens from a number of patients, raising the possibility of a fecal-oral route of transmission.…”

SARS coronavirus outbreaks past and present—a comparative analysis of SARS-CoV-2 and its predecessors

“…Like the SARS-CoV, the primary mode of SARS-CoV-2 transmission was reported to be via respiratory droplets [ 3 , 4 ]. However, apart from the usual direct droplet transmission, multiple studies have also indicated the possibility of fomite transmission, as the stability of SARS-CoV and MERS-CoV in faecal waste for a considerable time has been shown [ 26 , 27 ]. A study suggests that the percentage of patients with positive faecal samples in SARS-CoV and MERS-CoV are 97% and 14.5% respectively [ 27 ].…”

“…However, apart from the usual direct droplet transmission, multiple studies have also indicated the possibility of fomite transmission, as the stability of SARS-CoV and MERS-CoV in faecal waste for a considerable time has been shown [ 26 , 27 ]. A study suggests that the percentage of patients with positive faecal samples in SARS-CoV and MERS-CoV are 97% and 14.5% respectively [ 27 ]. Similar to its beta-coronavirus counterpart, the SARS-CoV-2 also showed viability in stool samples albeit at a much lower percentage at 55% as compared to the previous SARS-CoV [ 27 ].…”