Detection of SARS-CoV-2 in stool samples of adult and pediatric patients

Our understanding of the signs and symptoms of COVID-19 have rapidly evolved. It is established that most patients with COVID-19 have fevers along with lower respiratory signs and symptoms, such as cough and dyspnea. However, several exceptions have been noted as the pandemic has evolved and broader case reporting has been shared.

There are at least three important clinical, and public health reasons for determining the prevalence of COVID-19 in stool. This study may also facilitate the development of molecular assays by our regional laboratory medicine program to support this.

1) Enhanced testing ability. An optimized testing strategy that involves stool samples may support lower costs and broader access to testing capabilities. Independently, or in combination with NPS swab results, this could also offer greater sensitivity and specificity for disease detection across disease course.

2) Evolution of GI symptoms relative to respiratory symptoms. It is unclear how the gastrointestinal symptoms of COVID-19 infection parallel its symptoms within the respiratory tract. It is also unclear what the true degree of infectivity is from SARS-CoV-2 isolated in stool. There is an imperative to understand whether stool may present a source of transmission.

3) Enhanced detection of disease. Our approach in this study may help us better define rates of “community prevalence,” particularly by analyzing those patients who have been presumed COVID-19 negative but still test positive for COVID-19 on stool samples.