Infectious SARS-CoV-2 in feces of patient with severe COVID-19.

Infectious SARS-CoV-2 in feces of patient with severe COVID-19. Spencer EA, Heneghan C.

Published on July 8, 2020

Reference Xiao F, Sun J, Xu Y, Li F et al. Infectious SARS-CoV-2 in feces of patient with severe COVID-19. Emerg Infect Dis. 2020 Aug 2020
Study type
Country China
Setting Hospital
Funding Details The National Key Research and Development Program of China, the National Science and Technology Major Project, emergency grants for prevention and control of SARS-CoV-2 from the Ministry of Science and Technology and Guangdong Province.
Transmission mode Orofecal
Exposures Hospitalised patients

Bottom Line

This case series of 28 hospitalised patients for whom faeces samples were available indicated that infectious virus was present in faeces from two cases who also tested positive for viral RNA by RT-PCR.

Evidence Summary

Among feces specimens collected from 28 hospital patients, 12 were positive for viral RNA at least one-time point. 

SARS-CoV-2 virus was successfully isolated from two of the viral RNA–positive patients.

Viral particles that were visible were spherical and had distinct surface spike protein projections, consistent with a previously published SARS-CoV2 image.

Four serial feces samples from a seriously ill 78-year old patient with COVID-19 all tested positive for viral RNA; the patient subsequently died.

Viral antigen was also detected in gastrointestinal epithelial cells of a biopsy sample, from this 78-year old COVID-19 patient.

What did they do?

Feces samples were collected from 28 hospitalised patients, 12 of whom had tested positive for COVID-19. These samples were investigated for the presence of viral RNA and if SARS-CoV-2 could be isolated from these samples.

Study reliability

This is a case series and more studies are needed to understand the presence of SARS-CoV-2 in faeces.

Clearly defined setting Demographic characteristics described Follow-up length was sufficient Transmission outcomes assessed Main biases are taken into consideration
Yes No N/A N/A Unclear

What else should I consider?

“Isolation of infectious SARS-CoV-2 in feces indicates the possibility of fecal–oral transmission or fecal–respiratory transmission through aerosolized feces. 

During the 2003 severe acute respiratory syndrome pandemic, 329 residents of a private housing estate in Hong Kong were infected; 42 died (Yu et al 2004). Investigation of the building’s structure showed that faulty sewage pipelines led to aerosolization of contaminated feces, which was believed to be the source of infection.”

About the authors

Carl Heneghan

Carl is Professor of EBM & Director of CEBM at the University of Oxford. He is also a GP and tweets @carlheneghan. He has an active interest in discovering the truth behind health research findings

Elizabeth Spencer

Dr Elizabeth Spencer; MMedSci, PhD. Epidemiologist, Nuffield Department for Primary Care Health Sciences, University of Oxford.