We don’t know for sure if coronavirus can spread through poo, but it’s possible



Shutterstock

Vincent Ho, Western Sydney University

While we most commonly associate COVID-19 with fever and cough, gastrointestinal symptoms including diarrhoea, vomiting and abdominal pain are not unheard of in people who contract coronavirus.

This is likely because SARS-CoV-2, the virus that causes COVID-19, is found in the gut as well as the respiratory tract.

Importantly, the gut’s involvement in coronavirus illness points to the possibility COVID-19 could spread through faeces.

At this stage we don’t know for certain whether or not that occurs – but we can take precautions anyway.




Read more:
How can I treat myself if I’ve got – or think I’ve got – coronavirus?


Coronavirus and the gut

SARS-CoV-2 gains entry into human cells by latching onto protein receptors called ACE2, which are found on certain cells’ surfaces.

Around 2% of the cells lining the respiratory tract have ACE2 receptors, while they’re also found in the cells lining the blood vessels.

But the greatest numbers of ACE2 receptors are actually found in the cells lining the gut. Around 30% of cells lining the last part of the small intestine (called the ileum) contain ACE2 receptors.

Coronavirus gets into our cells by latching on to ACE2 receptors.
Shutterstock

Clinicians have detected coronavirus in tissue taken from the lining of the gut (oesophagus, stomach, small bowel and rectum) through routine procedures such as endoscopy and colonoscopy, where we use cameras to look inside the body. They found abundant ACE2 receptors in those tissue samples.

While some researchers have proposed alternative explanations, it’s likely people with COVID-19 experience gastrointestinal symptoms because the virus directly attacks the gut tissue through ACE2 receptors.

How common are gastrointestinal symptoms?

Data from 55,000 COVID-19 cases in China has shown the most common gastrointestinal symptom, diarrhoea, occurs in only 3.7% of those affected.

But there’s emerging evidence gastrointestinal symptoms such as diarrhoea may actually be more common, particularly among patients who develop more serious disease.

In one study of 204 patients diagnosed with COVID-19 at three different hospitals in the Hubei province in China, almost 20% of patients had at least one gastrointestinal symptom (diarrhoea, vomiting or abdominal pain).




Read more:
Your poo is (mostly) alive. Here’s what’s in it


The researchers found gastrointestinal symptoms became more severe as the COVID-19 illness worsened. And patients with gastrointestinal symptoms were less likely to recover than those without gastrointestinal symptoms.

The reason for this is not clear but one possibility is patients with a higher density of virus, or viral load, are more likely to have coronavirus wreak havoc in their gut.

Coronavirus in our poo

The presence of coronavirus in the gut and the gastrointestinal symptoms associated with COVID-19 suggest coronavirus could be spread via faecal-oral transmission. This is when virus in the stool of one person ends up being swallowed by another person.

A recent study from China found just over half of 73 hospitalised patients with COVID-19 had virus in their faeces. Many of them did not have gastrointestinal symptoms.

While testing stool samples may not be an efficient way to diagnose COVID-19 in individuals – it’s normally slower than testing samples from the respiratory tract – researchers are looking at poo to detect population outbreaks of coronavirus.

More than a dozen research groups worldwide are collaborating on a project analysing wastewater for the presence of coronavirus in target populations.

But just because the virus is found in faeces, it doesn’t mean it’s necessarily infectious when shed from the stool. We need more research to ascertain whether this is the case.




Read more:
There’s no evidence the new coronavirus spreads through the air – but it’s still possible


The virus seems to last longer in faeces

One study in China followed 74 COVID-19 patients in hospital by taking throat swabs and faecal samples daily or every second day.

The researchers found in over half of patients, their faecal samples remained positive for coronavirus for an average of just over 11 days after their throat swabs tested negative. Coronavirus was still detected in one patient’s faeces 33 days after their throat swab had turned negative.

This suggests the virus is still actively reproducing in the patient’s gastrointestinal tract long after the virus has cleared from the respiratory tract.

So if coronavirus can transmit via the faecal-oral route, we’ll want to know about it.

Sewage could offer clues about coronavirus transmission.
Shutterstock

In order to prove coronavirus can transmit via the faecal-oral route we’d need to see larger cohort studies.

These studies would include gathering more information on how well the coronavirus survives in the gut, how it causes gastrointestinal symptoms like diarrhoea and how the virus survives in faeces at different temperatures.

Researchers have found live coronavirus in faecal cultures grown in the lab, but this was only in two patients, so other research teams will need to reliably confirm the presence of infectious virus in faeces.

Take precautions anyway

In one study, researchers collected samples from the bathroom of a COVID-19 positive patient with no diarrhoea. Samples from the surface of the toilet bowl, sink and door handle returned positive for the presence of the coronavirus.

So effective handwashing, particularly after using the toilet, is critical.

We know coronavirus can survive for up to three days on plastic and stainless-steel surfaces. So it’s sensible to regularly disinfect surfaces that will be touched when using shared toilets including doorknobs, door handles, taps, support rails and toilet control handles.




Read more:
We know how long coronavirus survives on surfaces. Here’s what it means for handling money, food and more


Finally, flush the toilet with the lid closed. This is particularly important for public toilets in communities where there is sustained transmission of coronavirus.

Flushing a toilet creates a phenomenon known as toilet plume where up to 145,000 aerosolised droplets can be released and suspended in the air for hours.

Scientists believe the infectious viral gastroenteritis caused by norovirus can be transmitted in aerosol form through toilet plumes. Coronavirus may be able to do the same. Closing the lid when flushing can prevent around 80% of these infectious droplets from escaping into the air.The Conversation

Vincent Ho, Senior Lecturer and clinical academic gastroenterologist, Western Sydney University

This article is republished from The Conversation under a Creative Commons license. Read the original article.

SRI LANKA: RASH OF ATTACKS ON CHRISTIANS REPORTED


Assaults by local mobs, including Buddhist monks, surge.

COLOMBO, Sri Lanka, August 17 (Compass Direct News) – Attacks on Christians in Sri Lanka have surged noticeably in recent weeks, following the government’s defeat of Tamil separatists in May.

Attacks were reported in Puttlam, Gampaha and Kurunegala districts in western Sri Lanka, central Polonnaruwa district, Mannar district in the north and Matara district in the south, according to the National Christian Evangelical Alliance of Sri Lanka (NCEASL).

Most recently, attackers on July 28 set fire to an Assemblies of God church in Norachcholai, Puttlam district, destroying the building. The pastor received frantic calls from neighbors at about 8:45 p.m. reporting that the building was in flames, echoing a similar arson attack almost a year ago that destroyed the original building on the site.

Church members have registered a complaint with police, but at press time no arrests had been made.

When a pastor of a Foursquare Gospel church and his wife visited a church member in Radawana village, Gampaha district during the third week of July, a 50-strong mob gathered at the door and shouted that they would not tolerate any further Christian activity in the village, NCEASL reported. The mob then prevented the couple from leaving the house, hit the pastor with a rod and threw a bucket of cow dung at him.

The disturbance continued for two hours before police finally answered repeated requests for assistance and arrived at the house, arresting three people who were later released.

Earlier, on June 28, a mob consisting of more than 100 people, including Buddhist monks, surrounded the home of a female pastor of another Foursquare Gospel church in the village, according to the NCEASL. At the time the pastor, whose name was withheld for security reasons, and her husband were away. Their 13-year-old daughter watched helplessly as the mob broke in, shouted insults and destroyed chairs and other furniture.

Hearing that their home was under attack, the parents rushed to get police help, but the mob had dispersed by the time officers arrived. Police called the pastor into the Gampaha police station for questioning on July 9 and July 11; on the second occasion, protestors surrounded her and other pastors who accompanied her, spitting on them and initially preventing them from entering the police station.

Later, in the presence of Buddhist monks and other protestors, the pastor was forced to sign a document promising not to host worship services for non-family members.

Also in Gampaha district, a mob on July 14 destroyed the partially-built home of Sanjana Kumara, a Christian resident of Obawatte village. On receiving a phone call from a friend, Kumara rushed to the scene to find the supporting pillars of the house pulled down, damaging the structure beyond repair.

Villagers launched a smear campaign against Kumara on July 6, after he invited his pastor and other Christians to bless the construction of his home. As the group prayed, about 30 people entered the premises and demanded that they stop worshiping. The mob then threatened to kill Kumara, falsely accusing him of constructing a church building.

On July 8, Kumara discovered that unknown persons had broken into a storage shed on the property, stealing tools and painting a Buddhist blessing on the walls. Police were reluctant to record Kumara’s complaint until a lawyer intervened.

The Sri Lanka population is 69.1 percent Buddhist, 7.6 percent Muslim, 7.1 percent Hindu and 6.2 percent Christian, with the remaining 10 percent unspecified.

Sword Attack

In Markandura village, Kurunegala district, seven men wielding swords on July 12 attacked caretaker Akila Dias and three other members of the Vineyard Community church, causing serious injury to church members and church property. Dias and others received emergency care at a local hospital before being transferred to a larger hospital in the area for treatment.

Church members filed a complaint with police, identifying one of the attackers as the same man who had assaulted the church pastor and another worker with a machete in March; at that time police had arrested the man but released him on bail. Several other attacks followed, including one on June 29 in which the church premises were desecrated with human feces. Documents were also circulated on July 18 describing the church as a divisive force aiming to destroy peace in the local community.

On the night of July 12, attackers tore off roof tiles from the church building and threw them to the ground, leaving it exposed to the elements.

On July 5, a mob of around 100 people, half of them Buddhist monks, forcibly entered an Assemblies of God church in Dickwella, Matara district, warning church members to cease all Christian worship in the area and pasting notices on the walls declaring that “any form of Christian worship in this place is completely prohibited.”

The congregation has filed a complaint with local police.

On June 23, a Foursquare Gospel pastor from Polonnaruwa district was stopped by a group of men riding motorcycles as he drove home after attending a late evening prayer meeting. Three men wearing masks attacked him with knives and shouted, “This is your last day! If we let you live, you will convert the whole town!”

The pastor sustained severe cuts to his arms as he warded off blows aimed at his neck, before driving away to seek medical help. Police in Polonnaruwa have initiated an inquiry.

Finally, in Thalvapadu village, Mannar district, members of an Apostolic church were dedicating their newly constructed building on June 7 when a mob of about 300 people forcibly entered the premises, threatening the pastor and congregation. They demolished the new church building, throwing roofing sheets and bricks onto a plot of adjacent land.

When church members filed a complaint, police arrested seven of the attackers; a case has been filed with a local court.

Report from Compass Direct News