Feco-Oral Transmission of SARS-CoV-2 (original) (raw)

Asia Pacific Journal of Public Health

The widely agreed upon routes of transmission of severe acute respiratory syndrome coronavirus 2 (SARS CoV-2) are droplet infection, aerosols, and close contact. However, the rate of spread, disease load, and the symptom pattern of the corona virus disease 2019 (COVID-19) have raised the probability of other routes of transmission, such as feco-oral. A significant proportion of persons infected with SARS CoV-2 had diarrhea. Similar to earlier coronaviruses, SARS CoV-2 has also been reported to be found in fecal samples. 1 Plausible explanation for its presence in stool is that the ACE-2 receptors to which SARS CoV-2 binds are present in gastrointestinal mucosa as well. 2 Hence, in order to ascertain whether transmission through feco-oral route of SARS CoV-2 does occur or not, we conducted a review of literature in PubMed and the World Health Organization's collection of COVID-19 literature. The search terms used were "COVID-19," "SARS CoV-2," "Fecal-Oral route," "FecoOral transmission," "Sewage," and "Wastewater." Literature search revealed the presence of infectious SARS CoV-2 in feces of COVID-19 patient. 3,4 Stool samples tested positive for SARS CoV-2 RNA even up to 5 weeks after the respiratory samples tested negative for COVID-19. 3 These findings establish the presence of SARS CoV-2 in stools. Feco-oral transmission, if it is happening, can be very significant in developing and underdeveloped countries, where open defecation is common, and poor water sanitation and hygiene (WASH) practices are followed. In addition, reports have attributed SARS transmission from aerosol plumes of SARS CoV-1 patient with diarrhea, in 2003. Hence, as a precaution, it should be ensured that COVID-19 patients are provided with separate toilets, cleaned at least twice daily. The lid should be down while flushing, to avoid bio-aerosolization or water splashes. If the feco-oral route contributes to transmission of COVID-19 cases, then it is an issue of serious consideration with regard to modifying or adding the public health recommendation for COVID-19 prevention. However, further research is warranted to confirm the feco-oral transmission. 4 Isolation of SARS CoV-2 in sewage water has also been demonstrated. 5 This raises the possibility of SARS CoV-2 transmission through sewage-contaminated water sources. The detection of the virus in sewage, even when the reported COVID-19 prevalence is low or none in the community, indicates that a considerable proportion of COVID-19 cases are asymptomatic, and a sewage surveillance could be used to monitor the circulation of the virus in the population. 5 They