SARS-CoV-2 viral shedding characteristics and potential evidence for the priority for faecal specimen testing in diagnosis

PLoS One. 2021 Feb 22;16(2):e0247367. doi: 10.1371/journal.pone.0247367. eCollection 2021.

Abstract

This study aimed to identify the specimen type that has high positivity and its proper sampling time for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing to promote diagnostic efficiency. All SARS-CoV-2-infected patients with a laboratory-confirmed diagnosis in Zhoushan City were followed up for viral shedding in respiratory tract specimens and faecal samples. Positivity was analysed both qualitatively and quantitatively by proper statistical approaches with strong testing power. Viral shedding in respiratory tract and faecal specimens was prolonged to 45 and 40 days after the last exposure, respectively. The overall positive rate in respiratory tract specimens was low and relatively unstable, being higher in the early-to-mid stage than in the mid-to-late stage of the disease course. Compared with respiratory tract specimens, faecal samples had a higher viral load, higher overall positive rate, and more stable positivity in different disease courses and varied symptomatic status. Faecal specimens have the potential ability to surpass respiratory tract specimens in virus detection. Testing of faecal specimens in diagnosis, especially for identifying asymptomatic carriers, is recommended. Simultaneously, testing respiratory tract specimens at the early-to-mid stage is better than testing at the mid-to-late stage of the disease course. A relatively small sample size was noted, and statistical approaches were used to address it. Information was missing for both specimen types at different stages of the disease course due to censored data. Our research extends the observed viral shedding in both specimen types and highlights the importance of faecal specimen testing in SARS-CoV-2 diagnosis. Healthcare workers, patients, and the general public may all benefit from our study findings. Disposal of sewage from hospitals and residential areas should be performed cautiously because the virus sheds in faeces and can last for a long time.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • COVID-19 Testing / methods*
  • COVID-19* / diagnosis
  • COVID-19* / virology
  • Child
  • Child, Preschool
  • China / epidemiology
  • Cross-Sectional Studies
  • Feces / virology*
  • Female
  • Humans
  • Infant
  • Infant, Newborn
  • Male
  • Middle Aged
  • Respiratory System / virology*
  • Specimen Handling
  • Virus Shedding*
  • Young Adult

Grants and funding

Authors A.TANG, Z.D.TONG and H.L.WANG got fundings from Zhoushan Municipal Science and Technology Project (grant No. 2020C31004, 2020C31005, and 2020C31006 respectively). Author X.W.YU got funding from China Spark Program (grant No. 2015GA700094). No sponsor or funder play any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript.