2019-nCoV: Fecal-oral transmission of the new coronavirus? More research urgently needed

Dr. Daniel Lucey, who has responded to, and monitored information on outbreaks since 2001, has provided a series of updates and analysis on the outbreak, now an epidemic of 2019-nCoV, the novel coronavirus identified in Wuhan China, since Jan. 7. He continues to respond to developments and data on the outbreak here. In his 9th update on the outbreak, he reviews preliminary reports on nucleic acid in stool and/or rectal swabs.

SARS coronavirus was linked with the large and unusual outbreak, including a high proportion of patients with diarrhea, in the residential towers called Amoy Gardens in Kowloon, Hong Kong in spring 2003.

MERS coronavirus 2012-2020, to my knowledge, has not been proven to transmit by a fecal-oral mechanism. Although a 2019 paper in Emerging Infectious Diseases from the Kingdom of Saudi Arabia, authored by Saudi and US CDC investigators found some patients with positive nucleic acid tests, no infectious virus could be isolated: “We attempted but were unable to isolate live MERS-CoV from 5 stool specimens and 3 urine specimens with elevated MERS-CoV RNA levels.”

The 2019-nCoV was reported to be present in loose stool of the first patient in the United States, in a  Jan. 31 New England Journal of Medicine paper by Holshue et al: “On the afternoon of hospital day 2, the patient passed a loose bowel movement and reported abdominal discomfort. A second episode of loose stool was reported overnight; a sample of this stool was collected for rRT-PCR testing, along with additional respiratory specimens (nasopharyngeal and oropharyngeal) and serum. The stool and both respiratory specimens later tested positive by rRT-PCR for 2019-nCoV, whereas the serum remained negative. . . It is notable that we also detected 2019-nCoV RNA in a stool specimen collected on day 7 of the patient’s illness. Although serum specimens from our case patient were repeatedly negative for 2019-nCoV, viral RNA has been detected in blood in severely ill patients in China.⁴ However, extrapulmonary detection of viral RNA does not necessarily mean that infectious virus is present, and the clinical significance of the detection of viral RNA outside the respiratory tract is unknown at this time."

Similarly, today researchers from China including Wuhan in Hubei province and Shenzhen in Guangdong province reported finding preliminary evidence of 2019-nCoV in stool and/or rectal swabs in Xinhua News Agency and Beijing News. (Online translations are available for both.)