# Clinical symptoms and faecal shedding of SARS-CoV-2 RNA among hospitalized COVID-19 patients: Implication for transmission

## TL;DR

This study finds that nearly 30% of hospitalized COVID-19 patients shed SARS-CoV-2 in their stool, with male patients and those with specific symptoms more likely to do so.

## Contribution

The study identifies associations between clinical symptoms, CT values, and SARS-CoV-2 fecal shedding in hospitalized patients in Nigeria.

## Key findings

- 29.7% of hospitalized patients shed SARS-CoV-2 RNA in their stool.
- Male patients and those with symptoms like fever and fatigue were more likely to shed the virus in stool.
- Low and moderate CT values in nasopharyngeal swabs correlated with higher stool viral shedding.

## Abstract

SARS-CoV-2 shedding in human stool has been suggested as a probable route for faeco-oral transmission of the virus due to the availing evidence on the infectivity and pathogenicity of similar highly infectious respiratory viruses. Determining association of SARS-CoV-2 shedding in stools and presenting clinical status might be useful for prediction of the viral transmission spectrum and disease outcome. This study involved a descriptive cross-sectional survey of 91 consenting hospitalized, confirmed COVID-19 patients in Infectious Disease Isolation Centre, Oyo State, Nigeria. Socio-demographic characteristics and other ancillary data were collected from patient’s hospital records with the aid of a structured investigator administered questionnaire. The laboratory detection of SARS-CoV-2 RNA in the stool of patients was performed using RT-PCR method. 27 (29.7%) of the 91 COVID-19 patients shed SARS-CoV-2 in their stools. The frequency of male (38.3%) patients shedding the virus in stools was higher than female (12.9%) patients (P = 0.012). Higher proportion of patients who had symptoms (41.2%) at admission shed the virus in their stool (P <0.007); particularly, fever (0.001), fatigue (0.003), headache (0.003), catarrh (0.001), and loss of smell (0.009). The frequency of viral shedding in stool was higher among patients with loss of taste (p = 0.028). Viral shedding in stool was significantly associated with low CT values (47.2%) and moderate CT value (21.4%) (P<0.05). Multivariate analysis showed that patients with moderate CT-value (OR = 0.28, 95% CI: 0.08–0.94, P = 0.039) and high CT-value (OR = 0.08, 95% CI: 0.01–0.80, P = 0.033) were less likely to shed the virus in stool. The gastrointestinal tract could be a route of SARS-CoV-2 transmission irrespective of the patients’ clinical status. The low and moderate CT values of the nasopharyngeal swab is associated with shedding of the virus in patients’ stools, although infectivity will depend on viral activity obtainable from further laboratory test analyses, such as viral culture.