Fecal viral shedding in COVID-19 patients: clinical significance, viral load dynamics and survival analysis

Wang, Xiaoming; Zheng, Jingwei; Guo, Lei; Yao, Hao; Wang, Lingya; XiaoDong, Xia; Zhang, Weixi

BACKGROUND: To investigate the clinical significance, viral shedding duration and viral load dynamics of positive fecal SARS-CoV-2 signals in COVID-19. METHODS: COVID-19 patients were included. SARS-CoV-2 RNA was tested in stool and respiratory specimens until two sequential negative results were obtained. Clinical, laboratory and imaging data were recorded. RESULTS: Of the 69 COVID-19 patients, 20 (28.99%) had positive fecal viral tests who were younger, had lower C-reactive protein (CRP) and fibrinogen (FIB) levels on admission (all P < 0.05), and showed more improvement and less progression on chest CT during recovery. The median duration of positive viral signals was significantly longer in stool samples than in respiratory samples (P < 0.05). In spite of the negative oropharyngeal swabs, eleven patients were tested positive for viral RNA in stool specimens, with their fecal SARS-CoV-2 RNA Ct values reaching 25-27. 6 of these 11 patients' Ct (cycle threshold) values rebounded. CONCLUSION: SARS-CoV-2 RNA in stool specimens was associated with a milder condition and better recovery of chest CT results while the median duration of SARS-CoV-2 RNA persistence was significantly longer in fecal samples than in oropharyngeal swabs. The fecal viral load easily reached a high level and rebounded even though respiratory signals became negative.