SARS‐CoV‐2 in 10 patients with COVID‐19 in Macau.

 SARS‐CoV‐2 in 10 patients with COVID‐19 in Macau. Heneghan C

Published on July 30, 2020

Reference Lo IL, Lio CF, Cheong HH et al Evaluation of SARS‐CoV‐2 RNA shedding in clinical specimens and clinical characteristics of 10 patients with COVID‐19 in Macau. Int J Biol Sci 2020;16: 1698–707.
Study type
Country Macau, China
Setting Hospital
Funding Details Non Reported
Transmission mode Orofecal

Bottom Line

SARS-CoV-2 can be shed in the stool and the assessment of both fecal and respiratory specimen is recommended

Evidence Summary

All ten patients were diagnosed using serial qRT-PCR for SARS-CoV-2 by espiratory specimens: nine by nasopharyngeal swab (NPS) and one by sputum. There were positive SARS-CoV-2 RNA signals in all ten stool specimens.

The average viral RNA conversion time in both NPS and feces were 18 days (SD:4.6) and 19 days (SD:3.4), respectively. In n patient 1, SARS-CoV-2 RNA was detected in feces until 14 days after the onset of symptoms. 

The most common symptoms were fever (80%) and diarrhea (80%) followed by coughing (50%), dyspnea (50%), sore throats (50%), nausea (50%) and myalgia (30%). 

What did they do?

A report of the clinical and microbiological features of ten COVID-19 patients in the Centro Hospitalar Conde de São Januário between January 21st to February 16th, 2020. Clinical samples including nasopharyngeal swab (NPS)/sputum, urine, and feces were collected form all patients for serial virus RNA testing by standard qRT-PCR assay. A cycle threshold value (Ct-value) less than or equal to 35 was defined as a positive test result, and a Ct-value of more than 38 was defined as a negative test result. A medium load, defined as a Ct-value of 36 to 38, required confirmation by retesting and was reported as inconclusive.

Study reliability

The number of patients was small and virus isolation from different specimens was not performed. Half of the enrolled patients were still hospitalized at the time of the submission of this paper.

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

What else should I consider?

Although virus RNA shedding in feces was common the question of potential transmission route deserves further evaluation since the viability of SAR-CoV-2 in feces was not assessed.

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