Could poo in the plumbing have caused a COVID-19 outbreak in China?

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Tiny bits of infected poo in the drainage pipe system of a high-rise apartment complex could be to blame for a cluster of COVID-19 cases in China, according to international researchers. The team studied throat swabs from infected patients, other building residents and building staff, as well as 237 surface and air samples from 11 of the 83 flats in the building, public areas, and building drainage systems. The researchers also released tracer gas into the bathrooms to simulate virus aerosols in the drainage system. Based on this, the team think the outbreak within the block may have been caused by fecal aerosols - tiny bits of poo released into the air - after toilet flushing by infected patients. While the evidence for now is only circumstantial, the researchers say adequate hygiene and bathroom ventilation could prevent this kind of transmission.

Journal/conference: Annals of Internal Medicine

Research: Paper

Organisation/s: University of Hong Kong

Funder: Key-Area Research and Development Program of Guangdong Province and the Research Grants Council of Hong Kong.

Media release

From: American College of Physicians

Fecal aerosol from pluming system may be to blame for COVID-19 spread in China high-rise
The presence of SARS-CoV-2 in fecal material has raised the possibility of viral transmission via a fecal–oral route. Researchers from the University of Hong Kong investigated whether SARS-CoV-2 transmission via fecal aerosols in the drainage pipe system may have been the cause of COVID-19 infection in a cluster of three families living in a high-rise apartment building in Guangzhou, China. The team studied throat swabs from infected patients, other building residents, and building staff; 237 surface and air samples from 11 of the 83 flats in the building, public areas, and building drainage systems; and tracer gas released into bathrooms as a surrogate for virus-laden aerosols in the drainage system. Based this circumstantial evidence, the researchers concluded that the outbreak within the block may have been caused by fecal aerosol transmission that occurred after toilet flushing by infected patients. The researchers suggest ways to prevent such transmission, such as adequate hygiene in sanitary drainage, and bathroom ventilation and hygiene. Read the full text.

The author of an accompanying editorial from Heriot-Watt University, Edinburgh, United Kingdom, discusses the researchers’ findings and why wastewater systems, particularly those in high-rise buildings, deserve closer investigation as a reservoir for harmful pathogens. Read the full text.

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