With COVID-19, you want to place barriers between you and the coronavirus at every possible source. That includes masks, physical distance … and toilet lids? It’s clear that respiratory droplets containing COVID-19 particles can transmit through coughing, sneezing and even talking or singing. It’s possible that gastric secretions – from stool or diarrhea – containing active virus can spread COVID-19, as well.
Fecal-oral spread means coronavirus-infected stool or diarrhea coming into contact with a person’s mouth. It’s being evaluated as a potential risk by researchers. Toilet plumes containing aerosolized coronavirus, released by flushing and lingering in the air or possibly landing on surfaces, may pose another concern.
Scientists are currently investigating these areas for their potential to spread COVID-19 from virus in stool:
- Gastrointestinal shedding or release of active coronavirus through feces.
- Fecal-oral transmission through inadequate hand-washing.
- Aerosolized virus released into the air by toilet plumes.
- Exposure risk from infected stool in hospitalized patients with COVID-19.
- Ventilation systems that might spread aerosolized virus in hospitals, high-rises and building complexes.
- Air hand-dryers propelling virus in public restrooms.
Here’s what experts are learning about coronavirus risk from infected stool.
It’s possible that COVID-19 could also spread by fecal-oral contact or toilet plumes. “We in the GI community have been expressing concern about this for months, since the beginning of the pandemic, but didn’t have objective evidence yet that infectious virus could pass in stool,” says Dr. Brennan Spiegel, director of health services research at Cedars-Sinai Medical Center in Los Angeles. “But now we do have a few lines of evidence that are concerning.”
Active or “live” coronavirus has been identified in stool of patients with severe COVID-19. Diarrhea is a gastric symptom of COVID-19. Among new concerns is a report from China, published by the Centers for Disease Control and Prevention, in which investigators recovered evidence of live virus in stool. “Not just genetic material, but infectious virus,” says Spiegel, who is also the co-editor-in-chief of the American Journal of Gastroenterology and a professor in the David Geffen School of Medicine at UCLA.
Fecal-oral transmission is known to spread viral infections like hepatitis A. “COVID is a new illness from a new virus,” says Dr. Carmen McDermott, an internal medicine physician, hospitalist and a faculty member in the residency program at Providence Sacred Heart Medical Center in Spokane, Washington. She is also a clinical instructor at University of Washington School of Medicine and co-author of a recent evidence review on potential hospital exposure. “But, extrapolating from other experience with closely related viruses, it was worth exploring the question and we proposed that it needed further research to clarify whether it was a concern.”
Flushing the toilet can release a plume of virus-containing aerosols. “If infectious virus can come out of the stool, how can that spread to another person?” Spiegel asks. “One worry is fecal-oral, where, let’s say, a restaurant worker didn’t clean his or her hands and passes it into the food.” However, he says, “It’s