Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes

TLDR

A novel coronavirus outbreak began in Wuhan in December 2019, was thought to spread via the respiratory tract and diagnosed with oral swabs, but coronaviruses can also be transmitted through an oral–fecal route. The study aimed to determine whether 2019‑nCoV infected patients carry virus in other organs such as the intestine. The authors examined patients at a local hospital infected with 2019‑nCoV, collecting anal swabs, blood, and serology samples. They detected 2019‑nCoV in anal swabs and blood, with higher anal swab positivity later in infection, indicating oral–fecal shedding, and showed that serology testing increases detection rates, warning that the virus may be shed through multiple routes.

Abstract

In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral–fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral–fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautious warning that 2019-nCoV may be shed through multiple routes.