COVID-19 convalescent patient continues shedding SARS-CoV-2 RNA in stool for 24 days post-respiratory clearance.

Coronavirus disease (COVID-19) rapidly became a global pandemic, necessitating robust discharge criteria for infected patients to prevent further transmission. In China, standard discharge protocols for COVID-19 patients required two consecutive negative respiratory viral RNA tests, typically via RT-PCR, at least one day apart, with no routine testing of fecal samples. This approach, however, overlooked the potential for gastrointestinal viral persistence, creating a critical gap in understanding and mitigating post-discharge transmission risks from SARS-CoV-2. The current study highlights this overlooked pathway.

Researchers presented a single COVID-19 patient whose respiratory swabs became negative for SARS-CoV-2 RNA, but whose fecal sample remained positive. The patient's clinical course was monitored, with RT-PCR testing performed on both respiratory and stool samples. The primary objective was to track the persistence of viral RNA in different sample types following initial respiratory clearance. The study focused on the duration of SARS-CoV-2 RNA positivity in stool after the patient met the respiratory discharge criteria, providing a unique observation of viral shedding dynamics.

The patient's respiratory swabs for SARS-CoV-2 RNA became negative, meeting the standard discharge criteria. However, subsequent RT-PCR testing of stool samples revealed persistent viral shedding.

Stool samples collected on the 27th of February were still positive for SARS-CoV-2 RNA, a remarkable 24 days after the first negative respiratory swab result. This finding demonstrates that SARS-CoV-2 can persist and be shed via the gastrointestinal tract for an extended period, even after the respiratory system has cleared the virus. The continued presence of viral RNA in feces suggests a prolonged potential for environmental contamination and fecal-oral transmission, challenging the adequacy of respiratory-only discharge protocols.