Faecal Detection of SARS- CoV-2: Possible Weak link in the Fight against COVID-19

Abstract

COVID-19 is a systemic disease that often involves the respiratory system.  The majority of patients manifest with mild disease, while others progress to viral pneumonitis and develop acute respiratory distress syndrome. Some patients present with gastrointestinal symptoms such as diarrhea and vomiting. The speed and extent of transmission of COVID-19 in the ongoing pandemic has prompted ongoing research and review of the transmission dynamics of SARS-CoV-2 other than airborne or respiratory droplets. The viral load of SARS-CoV-2 in the gastrointestinal tract has been shown to be greater and last longer than that in the respiratory system. Viable SARS-CoV-2 has also been detected in environmental samples taken from the surface of toilet bowl and sink in infection isolation rooms, providing further insight for the viral transmission through contaminated fomites. Demonstration of SARS-CoV-2 RNA in both  stool and gastrointestinal mucosa  of patients raises the possibility that it may also be an enteric virus. However additional research is needed to examine the potential extent of transmission via fecal-oral route. The persistence of positive polymerase chain reaction (RT-PCR) fecal detection long after respiratory samples have turned negative among COVID-19 patients raises the possibility of fecal-oral transmission in addition to droplet transmission. SARS-CoV-2 virus isolated from stool could be infectious, therefore detection and shedding of viral RNA in stool has provided insight into additional route of transmission, and an opportunity to develop stool-based diagnostic test for SARS-CoV-2 infection.

Keywords: SARS-CoV-2; COVID-19; faecal detection; Gastrointestinal tract