With inputs from Dr Monica Vasudev

 951: Four in 10 Patients with Coronavirus Infection Shed Virus in Stool

Reuters Excerpt: About 12% of COVID-19 patients experience gastrointestinal symptoms [diarrhea, nausea and vomiting]. Nearly 40.5% have viral RNA in their stool.

A meta-analysis of 29 studies including over 4,800 patients, revealed that gastrointestinal symptoms are common and fecal shedding may reflect an important transmission risk. The report is published in JAMA Network Open.

At present its not known if the virus detected in patients stool samples is infectious.

But if it is, a lot of exposure could happen via the fecal oral route through food handling or in public restrooms. If you use a restroom after someone who was pre-symptomatic or asymptomatic, there is a possibility that you could contract the virus (if it becomes aerosolized).

Researchers included 23 published studies and six preprint articles, with data on 4,805 patients with a mean age of 52.2 years.

Pooled data revealed that 12% of patients exhibited any GI symptoms, with 7.4% reporting diarrhea and 4.6% reporting nausea or vomiting.

Eight studies reported on fecal testing for the virus in 407 patients. Viral RNA was detected in feces in about 40.5% of the patients. Under electron microscopy, live virus was detected in two stool samples (1.3%).

Viral loads in stool samples were found to be lower than in respiratory samples (range, 550 copies per mL to 1.21 × 105 copies per mL versus 641 copies per mL to 1.34 × 1011 copies per mL).

A basic science question - is the virus coming out infectious? Will it survive the acidity of the stomach and affect the intestines?"

Unlike the norovirus, SARS-CoV-2 has a lipid envelope covering it. The lipid layer makes the virus more susceptible to stomach acid.

[SOURCE: https://bit.ly/3hp8UDZ JAMA Network Open, online June 11, 2020.]

Dr KK Aggarwal

President CMAAO