Research: Wuhan coronavirus also spreads via feces

Faeces (especially when it comes to diarrhea) could be a secondary route of transmission for the new 2019-nCoV coronavirus, Chinese researchers said after publishing their study of patients with abdominal symptoms and loose stools . Therefore, the first symptoms can be of intestinal origin, and not only respiratory.


The main routes of transmission are droplets of saliva and mucus ejected from an infected person's cough. During the early stages of the epidemic, researchers therefore focused particularly on patients with respiratory symptoms and, as a result, may have ignored those with digestive disorders.



In total, 14 of 138 patients (10%) from a Wuhan hospital who were studied in the new Chinese study initially had diarrhea and nausea a day or two before the development of fever and breathing. difficult. The cases were notably described in the new study, published in the Journal of the American Medical Association (JAMA).

The first American patient diagnosed with 2019-nCoV also had loose stools for two days, after which the virus was detected in them. Other cases of this type in China have been documented in the Lancet, although rarely.

This illustration, created by the Centers for Disease Control and Prevention (CDC), reveals the ultrastructural morphology exposed by the new coronavirus (2019-nCoV). Note the peaks that adorn the outer surface of the virus, which give the appearance of a crown surrounding the virion when viewed under an electron microscope. The protein particles E, S, M and HE, also located on the outer surface of the particle, have all been indicated. Credits: Wikipedia

"It is important to note that 2019-nCoV has been reported elsewhere in the feces of patients with atypical abdominal symptoms, similar to SARS which has also been excreted in the urine, suggesting a route of faecal transmission that is highly transmissible", said William Keevil at the UK Science Media Center, professor of environmental health at the University of Southampton.

Tomographic images of the chest of a 52-year-old patient infected with the new coronavirus (2019-nCoV). A: chest tomography images obtained on January 7, 2020, showing opacity in both lungs, on the 5th day after the onset of symptoms. B: images taken on January 21, 2020, showing the absorption of bilateral opacity after extracorporeal membrane oxygenation treatment from January 7 to 12, in the intensive care unit. Credits: Zhiyong Peng / Zhongnan Hospital of Wuhan University

This possibility is not really surprising for scientists, given that the new virus belongs to the same family as SARS. In 2003, faecal transmission of SARS contributed to the infection of hundreds of people in the Amoy Gardens subdivision in Hong Kong. A plume of warm air from the bathrooms had contaminated several apartments and had been blown by wind to the adjacent buildings of the complex.

According to the literature, "the 2019-nCoV virus found in stool can be transmitted by fecal spread," added Jiayu Liao, bio-engineer at the University of California at Riverside. "But we still don't know how long this virus can survive outside the body - for example, HIV can only survive for about 30 minutes - and what temperature range the 2019-nCoV is sensitive to," a he added.

The spread of feces could present new challenges for containment of the virus, but is more likely to be a problem inside hospitals, which can become “amplifiers” of epidemics, said David Fisman, epidemiologist at the University of Toronto.



Benjamin Neuman, a virology expert at Texas A&M University-Texarkana, warned that while fecal transmission was "certainly worth considering," "the droplets and touching contaminated surfaces and then rubbing them eyes, nose or mouth” were probably the main way the virus was transmitted based on current data.

Bibliography: Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China Dawei Wang, MD1; Bo Hu, MD1; Chang Hu, MD1; et alFangfang Zhu, MD1; Xing Liu, MD1; Jing Zhang, MD1; Binbin Wang, MD1; Hui Xiang, MD1; Zhenshun Cheng, MD2; Yong Xiong, MD3; Yan Zhao, MD4; Yirong Li, MD5; Xinghuan Wang, MD6; Zhiyong Peng, MD1 JAMA. Published online February 7, 2020. doi:10.1001/jama.2020.1585