Background
COVID-19 manifests with respiratory, systemic, and gastrointestinal (GI) symptoms.1,2
SARS-CoV-2 RNA is detected in respiratory and fecal samples, and recent reports demonstrate
viral replication in both the lung and intestinal tissue.3–5 Although much is known
about early fecal RNA shedding, little is known about the long term shedding, especially
in those with mild COVID-19. Furthermore, most reports of fecal RNA shedding do not
correlate these findings with GI symptoms.6
Methods
We analyze the dynamics of fecal RNA shedding up to 10 months after COVID-19 diagnosis
in 113 individuals with mild to moderate disease. We also correlate shedding with
disease symptoms.
Findings
Fecal SARS-CoV-2 RNA is detected in 49.2% [95% Confidence interval = 38.2%-60.3%]
of participants within the first week after diagnosis. Whereas there was no ongoing
oropharyngeal SARS-CoV-2 RNA shedding in subjects at and after 4 months, 12.7% [8.5%-18.4%]
of participants continued to shed SARS-CoV-2 RNA in the feces at 4 months after diagnosis
and 3.8% [2.0%-7.3%] shed at 7 months. Finally, we find that GI symptoms (abdominal
pain, nausea, vomiting) are associated with fecal shedding of SARS-CoV-2 RNA.
Conclusions
The extended presence of viral RNA in feces, but not respiratory samples, along with
the association of fecal viral RNA shedding with GI symptoms suggest that SARS-CoV-2
infects the GI tract, and that this infection can be prolonged in a subset of individuals
with COVID-19.