Viable SARS-CoV-2 in saliva, urine, and stool from COVID-19 patients

 Viable SARS-CoV-2 in saliva, urine, and stool from COVID-19 patients. Jefferson T, Heneghan C.

https://www.cebm.net/study/viable-sars-cov-2-in-saliva-urine-and-stool-from-covid-19-patients/

Published on July 30, 2020

Bottom Line

There was viable SARS-CoV-2 in saliva, urine, and stool from COVID-19 patients up until days 11 to 15 of the clinical course suggesting that viable SARS-CoV-2 can be secreted in various clinical samples as well as respiratory specimens.

Evidence Summary

All naso/oropharyngeal saliva, urine and stool samples collected between days 8 to 30 of the clinical course were positive. Viral loads in urine, saliva, and stool samples were almost equal to or higher than those in naso / oropharyngeal swabs. 

Viable SARS-CoV-2 was isolated from naso/oropharyngeal swabs and saliva of COVID-19 patients, as well as nasal washes of ferrets inoculated with patient urine or stool. Viable SARS-CoV-2 was isolated from 1 naso/oropharyngeal swab. 

Ferrets inoculated with patient urine or stool were infected. SARS-CoV-2 was isolated from the nasal washes of the 2 urine-treated ferrets and one stool-treated ferret. After symptom resolution, patients shed viable virus in their saliva and urine up to day 15 of illness.

What did they do?

Naso/oropharyngeal swabs, saliva, urine, and stool specimens from 5 patients positive by qPCR hospitalized in the Chungbuk National University Hospital, Taiwan from February 25, 2020, to March 5, 2020 were subjected to virus isolation in Vero cells.

Urine and stool samples were inoculated intranasally in ferrets and they evaluated the virus titers in nasal washes on 2, 4, 6, and 8 days post-infection (dpi). Specimens were taken at days 8, 11, 13, 15, and 30 of the clinical course. Immunofluorescence antibody  (IFA) assay was also done. Patients were aged around 63 years, 1 had mild disease, 3 severe and 1 was critical. Four had pneumonia and 3 had pre-existing conditions. All naso/oropharyngeal saliva, urine and stool samples were collected between days 8 to 30 of the clinical course.

Study reliability

Clearly defined setting Demographic characteristics described Follow-up length was sufficient Transmission outcomes assessed Main biases are taken into consideration
Yes Yes * Yes Yes Yes
* See table 1 in the paper

What else should I consider?

This is a small study and serial samples could not be collected so the course of disease is described patchily

About the authors

Carl Heneghan

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

Tom Jefferson

Tom Jefferson

Tom Jefferson is a senior associate tutor and honorary research fellow, Centre for Evidence-Based Medicine, University of Oxford.