Evolving #COVID19 data, please share: Could COVID19 spread through stool? In this thread, I will summarize what our editorial team at #AmJGastro knows about the risk of fecal spread. I will start by emphasizing that we do *not* yet know, for sure, if it spreads though... (1/10)
...stool. But we do know the following: (1) #COVID19 genetic material is frequently found in stool. This study found 53% of stool samples were positive: gastrojournal.org/article/S0016-…. (2) The virus sheds into the stool for weeks, even after respiratory symptoms subside. This... (2/10)
...report found that for >50% of patients, fecal samples remain positive for ~11 days after respiratory samples are negative: thelancet.com/journals/langa…. The authors suggests the virus replicates in the GI tract even after viral clearance in the lungs. (3) The virus can be... (3/10)
...found on the surface of toilet bowls. In this report from JAMA, #COVID19 was found in both toilet & sink samples: jamanetwork.com/journals/jama/… See their conclusion in pic, below. (4) Intestinal symptoms such as diarrhea are not uncommon with #COVID19. Our editorial team at...(4/10) 
... #AmJGastro just released this pre-print study from Wuhan indicating that around 1 in 5 #COVID19 patients presents with a GI symptom: journals.lww.com/ajg/Documents/…. Another study showed that the virus causes direct damage to the intestines: gastrojournal.org/article/S0016-…. Still... (5/10)
... none of this definitively proves that #COVID19 spreads through stool. It is possible the viral particles are dead when they shed from the intestines. But there is accumulating evidence the possibility exists, particularly given the rapid spread of the virus which... (6/10)
... could reflect modes of transmission beyond respiratory and droplet spread. If #COVID19 is in the stool, what does that mean for public health? It still means we should social distance and clean our hands. But it also means that when using the restroom...(7/10)
... take special care to *always* wash your hands (which you should do anyway), especially when using public restrooms. Try not to touch your face after reaching for toilet paper or touching toilet handle unless and until you have thoroughly washed your hands. If you... (8/10)
... have a new-onset fever & diarrhea after potential #COVID19 exposure, best practice would be to self-isolate & call a doctor. This is recommendation for any infectious diarrhea, COVID19 or otherwise. If we later learn that COVID19 is not spread via fecal-oral...(9/10)
...route, then worst is we're cleaner and take toilet hygiene more seriously, which is a good thing either way. In the meantime, we need more data to investigate the potential of fecal-oral spread. For more, see this @LancetGastroHep article: thelancet.com/journals/langa… (10/10)
