Molecular and serological investigation of 2019-nCoV infected patients: implication of multiple shedding routes

Emerg Microbes Infect. 2020 Feb 17;9(1):386-389. doi: 10.1080/22221751.2020.1729071. eCollection 2020.


In December 2019, a novel coronavirus (2019-nCoV) caused an outbreak in Wuhan, China, and soon spread to other parts of the world. It was believed that 2019-nCoV was transmitted through respiratory tract and then induced pneumonia, thus molecular diagnosis based on oral swabs was used for confirmation of this disease. Likewise, patient will be released upon two times of negative detection from oral swabs. However, many coronaviruses can also be transmitted through oral-fecal route by infecting intestines. Whether 2019-nCoV infected patients also carry virus in other organs like intestine need to be tested. We conducted investigation on patients in a local hospital who were infected with this virus. We found the presence of 2019-nCoV in anal swabs and blood as well, and more anal swab positives than oral swab positives in a later stage of infection, suggesting shedding and thereby transmitted through oral-fecal route. We also showed serology test can improve detection positive rate thus should be used in future epidemiology. Our report provides a cautionary warning that 2019-nCoV may be shed through multiple routes.

Keywords: 2019-nCoV; Wuhan pneumonia; epidemiology; intestine; swabs.

MeSH terms

  • Betacoronavirus / isolation & purification*
  • COVID-19
  • China
  • Coronavirus Infections / blood
  • Coronavirus Infections / transmission*
  • Feces / virology*
  • Humans
  • Pneumonia, Viral / blood
  • Pneumonia, Viral / transmission*
  • SARS-CoV-2
  • Virus Shedding*

Grants and funding

This work was jointly supported by the Mega-Project for Infectious Disease from Minister of Science and Technology of the People’s Republic of China (2018ZX10305409-004-001 to PZ), China Natural Science Foundation for excellent scholars (81822028 to PZ), Strategic Priority Research Program of the CAS (XDB29010101 to ZLS and XDB29010104 to PZ), Youth innovation promotion association of CAS (2019328 to XLY).