SARS-CoV-2 detected in respiratory, fecal, and serum specimens

1. A small number of individuals with confirmed COVID-19 were found to have viral RNA in their feces (29%) and blood (1%). No individuals had detectable viral RNA in their urine.

2. Bronchoalveolar, sputum, and nasopharyngeal specimens were positive for viral RNA in the majority of samples from patients with COVID-19.

Evidence Rating: 2 (Good)

Study Rundown: Real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) of nasopharyngeal swabs has typically been used to confirm infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes COVID-19. However, it remains unclear whether the virus can be detected and potentially transmitted via other mediums. To examine this, rRT-PCR was performed on blood, urine, oral, nasal and sputum samples from 205 SARS-Cov-2 positive patients from three hospitals in China.  Nearly all patients had detectable viral load in lower respiratory tract samples. Close to one-third of patients also had detectable viral RNA in their fecal matter.  Additionally, a small percentage of blood samples were positive for the virus.  No individuals had detectable viral RNA in their urine.  These results indicate that SARS-Cov-2 (COVID 19) may be transmissible via the fecal-oral route, in addition to the previously known respiratory droplet route, a finding that has major public health implications. This study was limited by a small sample size, limited geographic and racial diversity of subjects, and failure to collect the same samples across all patients.

Click to read the study in JAMA

Relevant Reading: Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus–infected pneumonia in Wuhan, China

In Depth [cross-sectional study]: SARS-CoV-2 (COVID-19), is a highly transmissible virus originating in Wuhan, China. Its spread has global, economic and public health ramifications.  COVID-19 is known to be transmitted via respiratory droplets and is typically tested by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) of nasopharyngeal swabs for the virus’ ribonucleic acid (RNA).

In an effort to further elucidate the virus’ route of transmission, Wang and colleagues performed rRT-PCR on biologic samples (bronchoalveolar lavage, brush biopsy, sputum, nasal, pharyngeal, fecal, blood, urine) from 205 confirmed COVID-19 positive patients in three hospitals in Beijing and the Hubei and Shandong provinces of China.  Patients ranged from 5 to 67 years of age (mean 44 years). Nineteen percent had “severe illness”, and 68% were male.

Bronchoalveolar lavage specimens were positive in 93% of patients, followed in sample positivity by sputum (72%), nasal swabs (63%), fibrobronchoscope brush biopsy (46%) and pharyngeal swabs (32%). Fecal samples were positive for viral RNA in 29%.  Of these patients, two were confirmed to have live RNA in their stool.  Finally, 1% of these patients had viral RNA in their serum.  No urine samples were positive for viral RNA. These results indicate that SARS-Cov-2 (COVID 19) may also be transmissible via the fecal-oral route, in addition to the previously known respiratory droplet route.

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