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Gastrointestinal (GI) manifestations and transmission of SARS-COV-2 in COVID-19: evidence of GI infection and transmission of the novel coronavirus.

2020-04-10
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image courtesy of Christian Dorn via pixabay.com

Studies in BioRxiv are reporting that the GI route is a potential site of infection and possible transmission to others.  One study reports on the presence of virus entry receptors on enterocytes (cells lining the GI tract).  Others say that patients have complained of abdominal pain, vomiting, or diarrhea even prior to other symptoms of COVID-19.  Even the initial US case reported GI symptoms at the onset of his illness.

If these reports are borne out, then the implications for diagnosis, treatment, and prevention of infection with the new virus are significant.  GI symptoms should be added to the checklist of potential diagnostic signs: fever, headache, sore throat, runny nose, cough, tightness or pain in the chest, and difficulty breathing (dyspnea).

Sanitary precautions may be added to the public health workload.  Fortunately, since the removal of the pump handle from the Broad Street well in London in 1854, we have made broad strides in the prevention of enteric (GI) infection spread.

By the way, I have been doing a little light reading in the evenings: “Ghost Map” (2007) is a book on the epidemic of cholera in London in 1854.  John Snow was a pioneering anesthesiologist and experimentalist who gave a new anesthetic, the first ever, to Queen Victoria during her confinement with her eighth child. He discovered and proved that cholera was spread by water.  The water in question was contaminated with stool from infected patients.

Despite having proven the water-borne nature of cholera, Snow was unable to see the offending bacterium under his primitive microscope.  An Italian scientist had been studying the disease, and he was the first to find Vibrio cholera in his microscope.  To do so, he took intestinal specimens from dead cholera victims and stained them to increase the bacteria’s contrast (make them stand out from unstained tissue).  He found a series of small, comma-shaped dots in the intestinal mucosa which he did not find in the intestines of patients who had died from other causes. He wrote a report, which was in Italian and was generally ignored.  John Snow died without ever hearing that the actual bacteria causing the infection he had successfully controlled had been seen.

At the time of the story, the “water closet” (the toilet as we call it in the US) was an innovative fashion which helped reduce the odor problem in English households of means.  To make a long story short, open pit latrines (outhouses) had been the standard practice for disposal of solid waste from human defecation (taking a shit).

The cost of emptying cesspools (the open pits) made for a perverse incentive for London landlords: rather than pay the removal crews, they simply allowed the cesspool overflow to accumulate in the cellar.  Once removed from the cesspool, the piles of stool were carted out to farms outside of London.  The length of the trips and the noisome exposures of the removal crews made for a good rate of pay, too good for the penny-pinching landlords.

The solution was almost worse than the problem: the new water-closets emptied into sewers which were originally designed for storm water runoff, not human waste disposal.  The sewers drained into the Thames river.  Once the new water closets were hooked up, the drainage of human waste into the river destroyed what had been a productive fishery and created a foul, nasty-smelling river Thames.

I haven’t yet reached the point in the book where the solution to the Thames pollution problem is laid out.  I can’t wait to go back to my recreational reading.

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