key: cord-0882085-6292n1ms
authors: Immanuel, Gifty; Singh, Manmohan; Khanna, Sahil; Kashyap, Rahul
title: Neutralization of fecal aerosol-laden SARS CoV-2: Public Health Implications
date: 2020-12-29
journal: Mayo Clin Proc
DOI: 10.1016/j.mayocp.2020.12.023
sha: 90465de8729852dcd68026d7dfd21d5b87a8488b
doc_id: 882085
cord_uid: 6292n1ms

nan

To the Editor: Emergence of SARS-CoV-2 presents an unprecedented challenge to global health. 1 The looming threat of socio-economic collapse, livelihood and human security needs to be intervened. 2 Action taken to disrupt the pathways of viral transmission can have positive outcomes with the COVID-19 disease burden.

The primary transmission route of the virion through respiratory aerosols remains well documented. 3 There is an emerging recognition of potential transmission of SARS CoV-2 through aerosolization of virus-laden stools. 4 Air sampling for SARS CoV-2 in hospital toilets used by patients has yielded positive results. 5,6 A recent study reports protracted presence of SARS CoV-2 viral RNA in fecal samples that were detected even after 22.3 ± 29.8 (mean ± SD) days from diagnosis. 7, 8 Another review suggested SARS-CoV-2 can be excreted in urine in addition to stool. 9 The phylogenetically related SARS CoV-1 virus transmission through fecal bioaerosols was well highlighted in the Amoy Garden residential complex incident in Hong Kong in 2003. 10 This outbreak lead to more than 300 confirmed cases and 50 fatalities. 10, 11 Clusters of fecal transmissions of SARS CoV-2 are being reported in hospitals and high-rise apartments in China. Epidemiological investigations using tracer studies point towards passage of virus laden fecal bioaerosols through exhaust fans and faulty sewage systems. 12 With the exponential rise in world infection rates, such a transmission modality poses a potential risk for countries with high population densities. While, lesser spatial separation of living spaces in concentrated areas presents a major risk for fecal aerosol infiltration. As evidence of transmission through lesser known pathways accumulates, innovative approaches may be needed. 

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