On March 11, 2020, Chinese investigators published the relative presence of the novel coronavirus, COVID-19, in various specimens collected from patients with acute infection (Wang W, Xu Y, Gao R, et al. Detection of SARS-CoV-2 in different types of clinical specimens. Journal of the American Medical Association, published online on March 11, 2020. doi:10.1001/jama.2020.3786).

Samples were collected from inpatients in three hospitals in the Hubei and Shandong provinces and Beijing, China, from January 1 through February 17, 2020. Most patients presented to the hospital with fever, dry cough and fatigue. Pharyngeal samples were collected within three days of admission; blood, sputum, feces, urine, and nasal sample were collected throughout the admission. Bronchoalveolar lavage fluid and brush biopsy specimens were sampled only from patients undergoing mechanical ventilation. About 1,000 specimens were collected from 205 patients. COVID-19 genome was detected by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) in 93% of bronchoalveolar lavage fluids, 72% of sputa, 63% of nasal swabs, 46% of brush biopsies, 32% of pharyngeal swabs, 29% of feces, and 1% of blood specimens. None of the urine specimens contained viral genome. Live virus was found in the stools of two patients without intestinal symptoms.

The authors opened the possibility that COVID-19 might be spread by the oral-fecal route, making hand washing and surface decontamination important in curbing the spread of this infection.

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