That's in addition to passing via droplets from coughs and sneezes, and possibly even blood.

By Leah Groth
Updated March 20, 2020

When the novel coronavirus outbreak was first discovered in December 2019, researchers scrambled to begin studying the deadly virus in hopes of figuring out how it works and how it can be eradicated. Now, Chinese researchers claim to have made a major breakthrough in understanding how the virus spreads—and why it's so infectious.

According to research from the Chinese Center for Disease Control and Prevention (CCDC), those with confirmed cases of the novel coronavirus (aka, COVID-19) have live virus in stool specimens. That means, in addition to spreading via close contact with the respiratory secretions of patients (aka, droplets produced by coughing or sneezing), COVID-19 can also be transmitted via a fecal-oral route.

Separately, two papers posted online in Gastroenterology on March 3 suggest that the virus sheds into the stool and that fecal-oral transmission is possible.

Essentially, COVID-19 can pass from person to person "if an infected person does not wash their hands properly after using the bathroom," Jeremy Brown, MD, director of the Office of Emergency Care Research at the National Institutes of Health and author of Influenza: The Hundred-Year Hunt to Cure the Deadliest Disease in History, tells Health. He adds that lots of infections—including Hepatitis, cholera, and viruses that cause gastroenteritis—are also transmitted this way. 

Another investigation, published February 17, 2020 in the journal Emerging Microbes & Infections found that rectal swabs may be the best method for testing for COVID-19. After testing oral swabs, anal swabs, and blood samples from patients at the Wuhan Pulmonary Hospital in central China, researchers found that anal swabs can detect novel coronavirus even when oral tests come up negative. The virus can also be detected via blood, per researchers.

Some symptoms of COVID-19 come into play here, too. While most agencies have reported coronavirus symptoms to mimic the flu, with fever, cough, and shortness of breath, a February 7, 2020 investigation published in the Journal of the American Medical Association (JAMA) found that, out of 138 patients in a Wuhan hospital, 14 of them experienced symptoms of diarrhea and nausea one or two days prior to development of fever and labored breathing.

Overall, these findings can help explain why COVID-19 seems to be spreading so rapidly—especially in situations where people are in close contact with each other, like cruise ships. "This virus has many routes of transmission, which can partially explain its strong transmission and fast transmission speed," explains the CCDC report. 

And from a public health standpoint, the researchers explain that their findings have “important public health significance”—that by practicing proper hygiene, the disease has a better chance of being kept at bay. Those practices include, "strengthening health publicity and education; maintaining environmental health and personal hygiene; drinking boiled water, avoiding raw food consumption, and implementing separate meal systems in epidemic areas; frequently washing hands and disinfecting of surfaces of objects in households, toilets, public places, and transportation vehicles; and disinfecting the excreta and environment of patients in medical facilities to prevent water and food contamination from patients’ stool samples,” according to the CCDC.

One caveat, though: While the virus has been detected in stool, it's still not clear whether the virus is acquired through fecal-oral transmission, according to a review posted online March 12 by Clinical Gastroenterology and Hepatology.

Overall, Dr. Brown says the findings underscore the importance of "good hand washing hygiene, as well as careful and hygienic food preparation" in preventing the spread of any disease—apparently now, COVID-19 included. 

The information in this story is accurate as of press time. However, as the situation surrounding COVID-19 continues to evolve, it's possible that some data have changed since publication. While Health is trying to keep our stories as up-to-date as possible, we also encourage readers to stay informed on news and recommendations for their own communities by using the CDC, WHO, and their local public health department as resources.

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