key: cord-0958453-qq5udws5
authors: Dibner, Julia
title: Fecal‐Oral Transmission of COVID‐19: Could Hypochlorhydria Play a Role?
date: 2020-07-07
journal: J Med Virol
DOI: 10.1002/jmv.26265
sha: d6834ec61133f75322fcd4805c5069e935c43144
doc_id: 958453
cord_uid: qq5udws5

Coronavirus disease 2019 (COVID‐19) is caused by severe acute respiratory syndrome coronavirus‐2 (SARS‐CoV‐2) which emerged in Wuhan, China in 2019 (1). Respiratory symptoms remain the most common clinical manifestations of COVID‐19. However, non‐respiratory symptoms are increasingly being recognized. Gastrointestinal (GI) symptoms such as anorexia, nausea, vomiting, diarrhea, and abdominal pain are noted in COVID‐19 patients either alone or in association with respiratory manifestations (2). Stool viral RNA can be detected by up to 50% in patients with diarrhea (3). This article is protected by copyright. All rights reserved.

Given these gaps in our knowledge, we propose following hypothesis: hypochlorhydria may cause a loss of the protective effect of acidic gastric secretions. After the virus enters the small intestine, a direct cytopathic effect on the enterocytes can, at least in part, explain nausea, loss of appetite. This can often be overlooked by the infected individual. Viral replication continues to occur, and it can spread to different organs via the portal circulation, showing only later its life-threatening respiratory effects. Fecal shedding can explain due to ongoing enterocyte infection, and widespread stool testing might offer additional insights about the incubation period. This route of infection may explain the variability in the incubation period, ranging from 2 to 14 days or longer.

Understanding fecal-oral shedding is vital to assess SARS-CoV-2 at early stages and can be used as a tool to assess the variability in the incubation period in these individuals. Furthermore, it can offer insights into the mechanism of spread from infected to noninfected individuals. Hypochlorhydria can interfere with the protective effects of gastric acid on SARS-CoV-2, especially in the vulnerable populations. Hence stool sample testing may be critical for detecting SARS-CoV-2 at early and late in suspected COVID-19 cases.

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