New, disturbing way coronavirus spreads


Diarrhea may be a secondary path of transmission for the novel coronavirus, scientists said Friday following the publication of the latest study reporting patients with abdominal symptoms and loose stool.

The primary path is believed to be virus-laden droplets from an infected person's cough, though researchers in early cases have said they focused heavily on patients with respiratory symptoms and may have overlooked those linked to the digestive tract.

A total of 14 out of 138 patients (10 percent) in a Wuhan hospital who were studied in the new paper by Chinese authors in the Journal of the American Medical Association (JAMA) initially presented with diarrhea and nausea one or two days prior to development of fever and labored breathing.

The first US patient diagnosed with 2019-nCoV also experienced loose bowel movements for two days and the virus was subsequently detected in his stool, and there have been other such cases in China documented in the Lancet, albeit infrequently.

"Importantly, 2019-nCoV has been reported elsewhere in the feces of patients with atypical abdominal symptoms, similar to SARS which was also shed in urine, suggesting a fecal transmission route which is highly transmissible," William Keevil, a professor of environmental healthcare at the University of Southampton said in a comment to the UK's Science Media Centre.

The possibility is not totally surprising to scientists, given that the new virus belongs to the same family as SARS.

Fecal transmission of SARS was implicated in sickening hundreds in Hong Kong's Amoy Gardens housing estate in 2003. A rising plume of warm air originating in bathrooms contaminated several apartments and was transported by wind to adjacent buildings in the complex.

Based on the literature, "The 2019-nCoV virus found in stool may be transmitted through fecal spread," added Jiayu Liao, a bioengineer at the University of California, Riverside.

But, he added, "We still do not know how long this virus can survive outside the body -- HIV can only survive roughly 30 minutes outside the body -- and what temperature range the 2019-nCoV is sensitive to." Fecal spread could present new challenges to the virus's containment, but is more likely to be a problem inside hospitals, which can become "amplifiers" of epidemics, said David Fisman, an epidemiologist at the University of Toronto.

Benjamin Neuman, a virology expert at Texas A&M University-Texarkana, cautioned that while fecal transmission was "certainly worth considering," "droplets and touching contaminated surfaces then rubbing eyes, nose or mouth" were likely the main way the virus was transmitted based on current data.







Earlier, medical experts have warned the coronavirus can spread through the eyes and people - especially doctors - aren't doing enough to protect themselves.

According to a report in The Lancet, a peer-reviewed medical journal, Chinese pneumonia expert Guangfa Wang was infected by the 2019-nCoV virus while visiting Wuhan last month.

He wore a face mask during his visit, but did not wear any protective eyewear and later complained of "redness of the eyes".

"As ophthalmologists, we believe that transmission of 2019-nCoV through the eyes was ignored," the report said.

"Unprotected exposure of the eyes to 2019-nCoV in the Wuhan Fever Clinic might have allowed the virus to infect the body."


Medical experts say the novel coronavirus can be spread through the eyes. Picture: Kevin Frayer/Getty Images
Medical experts say the novel coronavirus can be spread through the eyes. Picture: Kevin Frayer/Getty Images

The report noted that SARS - another type of coronavirus - also spread via the "mucous membranes in the eyes, mouth or nose".

"All ophthalmologists examining suspected cases should wear protective eyewear," it said.


The report comes as Chinese scientists say the endangered pangolin may have been the animal that facilitated the spread of the virus across China.

Researchers have long suspected that the virus, which has now killed more than 630 people and infected some 31,000, was passed from an animal to a human at a market in Wuhan late last year.

Researchers at the South China Agricultural University have identified the scaly mammal as a "potential intermediate host," the university said in a statement, without providing further details.



The pangolin is considered the most trafficked animal on the planet. Picture: Mosman Daily
The pangolin is considered the most trafficked animal on the planet. Picture: Mosman Daily

The new virus is believed to have originated in bats, but researchers have suggested there could have been an "intermediate host" in the transmission to humans.

After testing more than 1,000 samples from wild animals, scientists from the university found the genome sequences of viruses found on pangolins to be 99 per cent identical to those on coronavirus patients, the official Xinhua news agency reported.

But James Wood, a veterinary medicine professor at the University of Cambridge, said the research was "not sufficient".

The results could have been caused by "contamination from a highly infected environment", he said.

"We would need to see all of the genetic data to get a feel for how related the human and pangolin viruses are," Jonathan Bell, a professor of molecular virology at the University of Nottingham, said.




The pangolin is considered the most trafficked animal on the planet and more than one million have been snatched from Asian and African forests in the past decade, according to the International Union for Conservation of Nature (IUCN).

They are destined for markets in China and Vietnam, where their scales are used in traditional medicine - despite having no medical benefits - and their meat is bought on the black market.

China in January ordered a temporary ban on the trade in wild animals until the epidemic is under control.



The country has long been accused by conservationists of tolerating a shadowy trade in endangered animals for food or as ingredients in traditional medicines.

"If we want to do everything in our power to prevent deadly disease outbreaks such as coronavirus, then a permanent ban on wildlife trade, in China, and around the world, is the only solution," said Neil D'Cruze, global head of wildlife research at World Animal Protection.

A price list that circulated on China's internet for a business at the Wuhan market showed a menagerie of animals or animal-based products including live foxes, crocodiles, wolf puppies, giant salamanders, snakes, rats, peacocks, porcupines, camel meat and other game - 112 items in all.

SARS was also traced to wild animals, with scientists saying it likely originated in bats, later reaching humans via civets.


On Friday, the head of the World Health Organisation (WHO) offered some "good news" about the virus when he pointed out the number of reported cases had declined over the past two days.



A sign reading
A sign reading "face masks are sold out" at a pharmacy in Shanghai, China. Picture: AP Photo/Fu Ting

But Tedros Adhanom Ghebreyesus warned the numbers "could go up again" and meanwhile, the world was facing "a chronic shortage of personal protective equipment".

Dr Tedros said he would be speaking to members of the supply chain network for protective gear to try and resolve "bottlenecks" in the production.

Earlier this week, the WHO said it had started sending masks, gloves, respirators, protective isolation gowns and test kits to countries requiring assistance.

"We have a common enemy which is dangerous and which can bring serious upheaval, social, political and economic. This is the time to fight it and in unison," Dr Tedros said.

-With wires

They warned doctors especially were not doing enough to protect themselves. Picture: Kevin Frayer/Getty Images
They warned doctors especially were not doing enough to protect themselves. Picture: Kevin Frayer/Getty Images

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