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Infectious SARS-COV-2 persists in patients’ feces even after COVID-19 symptoms subside: Gut Journal

SARS-COV-2 EM photo courtesy NIAID

A pilot study published in Gut, a subsidiary of the British Medical Journal, on July 20, 2020, showed that 7 of 15 patients with COVID-19 had continued active SARS-COV-2 viral replication for about a week after respiratory symptoms had resolved, even in the absence of gastrointestinal (GI) symptoms.

The study evaluated viral ribonucleic acid (RNA) in the stool of patients who were hospitalized with COVID-19 and also looked at the bacterial deoxyribonucleic acid (DNA) composition of the stools. About half of the patients (7 of 15) had definite signs of the virus continuing to replicate after symptoms subsided. Continued virus replication was associated with changes in the bacterial population (known as the microbiome) of the stool as well.

Here are excerpts from the “conclusions” and “significance” portions of the text from the study:

Conclusion This pilot study provides evidence for active and prolonged ‘quiescent’ GI infection even in the absence of GI manifestations and after recovery from respiratory infection of SARS-CoV-2. Gut microbiota of patients with active SARS-CoV-2 GI infection was characterised by enrichment of opportunistic pathogens, loss of salutary bacteria and increased functional capacity for nucleotide and amino acid biosynthesis and carbohydrate metabolism.


Active and prolonged SARS-CoV-2 activity in the gut of patients with COVID-19, even in the absence of GI manifestations and after recovery highlights the importance of long-term coronavirus and health surveillance and the threat of potential faecal-oral viral transmission.

Therapeutic approaches including nullifying gut SARS-CoV-2 activity and modulating gut microbiome composition and functionality should be explored.

The most important finding from this study is that there is potential for spread of the virus through the fecal-oral route, that is by contact with an infected person’s stools– even after the patient no longer displays symptoms. Bathrooms, toilets, and sinks should be considered possible areas of contamination and precautions should be taken.

One suggestion that has gone around is that patients with the illness should shut the lid on the toilet before flushing. Other studies have shown that a “plume” of infectious material shoots up into the air when a toilet is flushed. This plume contaminates areas around the toilet, but this could be prevented by lowering the lid before flushing (assuming the toilet has a lid.)

(PS: the air quality index in the central San Joaquin Valley, where I am, read 299 this morning, in the “unhealthy for everyone” range– due to smoke from the Creek fire, which is about 100 miles north of Fresno. This afternoon it is “only” 205. I’m hoping that a reading of 299 isn’t actually off the end of the scale. They would tell us not to breathe if it were too dangerous, right? They wouldn’t let the Dear Leader visit us if it were too dangerous, right? Right?)

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