Out of the Doldrums's video: Are diarrhea nausea and vomiting signs of COVID-19

Join Dr. Van Dyken as she discusses the characteristics of COVID-19, its link to gastrointestinal issues like diarrhea, nausea, vomiting. and the possibility of fecal-oral spread. Information accurate as of: 3/17/20 As the COVID-19 pandemic grows worldwide, New studies are working on answering questions on how the virus is shed, which gives us more information on routes of viral transmission. We all know that the main route of transmission is respiratory droplets, but could there be other routes of transmission? Current studies revealed that the majority of COVID-19 symptoms are respiratory: things like fever, dry cough, shortness of breath. The way we test for COVID-19 is by swabbing the nasal or oral passage with a Q-tip type device called a swab -in other words we get a respiratory swab. In addition to respiratory symptoms though, we are also seeing G.I. symptoms like diarrhea, nausea, vomiting and abdominal discomfort in some patients. Interestingly, these G.I. symptoms seem to appear early in the course of the disease, even before respiratory symptoms appear. Scientists describing the Wuhan experience state that about 10% of patients presented with diarrhea and nausea 1–2 days before the development of fever and respiratory symptoms. A research paper outlining the clinical course of the first twelve Covid-19 patients in the United States shared that ten of the twelve experienced GI symptoms. They then detailed the very first case in the United States, which BEGAN with a two day history of nausea and vomiting, and then hospitalization. The patient also supposedly had a loose bowel movement after admission. So about two days AFTER this is when the respiratory symptoms appeared.They tested the patient’s respiratory secretions and stool, and found that there were viral RNA particles in both. In a separate paper, it is described that two independent laboratories from China declared that they have successfully isolated LIVE SARS-CoV-2 virus from the stool of COVID-19 patients. Why do we care about this? Taken together, there’s a growing number of clinical evidence that suggests that the digestive tract may serve as an alternative route of infection. That means this virus may also spread by the fecal oral route. What is THAT you might ask? Fecal oral transmission is defined as a particular route of transmission of a disease where pathogens in fecal particles pass from one person to the mouth of another person. I know it sounds gross but it’s actually quite common in the spread of many diseases, especially the G.I. bugs. A classic example of fecal oral spread is cholera. Most of the time, this spread happens because there is not adequate sanitation meaning no adequate sewers or there’s poor hygiene practices, like lack of handwashing after using the bathroom. So in order for fecal oral transmission to occur, we have to prove that the SARS-CoV-2 virus actually infects the G.I. tract and comes out in the stool in live form. We know that SARS-CoV-2 is a coronavirus, so it has these little spike proteins all around it. The spike proteins bind to specific receptors in our body tissues called the ACE-2 receptors. Once the virus binds to the receptor it gets into the cell and infects it. Well, it turns out we have these ACE-2 receptors in both our respiratory tract and our G.I. tract. This means the virus is binding to the receptor and invading cells in both places, and this explains the viral shedding that we saw on stool tests. Finding the virus in a stool test raises the question of a fecal-oral transmission route. What does this mean for us? We are still learning so much about the novel coronavirus, and one of the things we are learning is that there is a likelihood that one way Covid 19 can spread, in addition to the main mechanism of respiratory droplet spread, is via the fecal oral route. This is critically important. If we are aware that this is a potential way of spread, we can hopefully slow it down from that standpoint. What could we do to slow down the spread? Here are strategies we can do today. 1st, work on washing our hands after going to the bathroom and before eating or touching your face. 2nd,make sure our bathrooms and toilets are regularly and appropriately disinfected 3rd,keep the toilet lid down at all times to minimize potential spread 4th, if possible, try to avoid public restrooms which may contain viral particles from others. Other COVID-19 Videos: https://youtu.be/UmF3v2Cze9s https://youtu.be/tfaEqTuCbHo 6 Papers referenced: https://www.gastrojournal.org/article/S0016-5085(20)30281-X/pdf https://www.gastrojournal.org/article/S0016-5085(20)30282-1/pdf?referrer=https%3A%2F%2Fwww.medpagetoday.com%2Finfectiousdisease%2Fcovid19%2F85315 https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30607-3/fulltext https://www.thelancet.com/journals/langas/article/PIIS2468-1253(20)30048-0/fulltext https://www.medrxiv.org/content/10.1101/2020.03.09.20032896v1.full.pdf