SARS‑CoV2 in Different Body Fluids, Risks of Transmission, and Preventing COVID-19: A Comprehensive Evidence‑Based Review

Gurusaravanan Kutti‑Sridharan, Rathnamitreyee Vegunta, Radhakrishna Vegunta, Babu P. Mohan, Venkata R. P. Rokkam

Abstract


The world is combating a common and invisible enemy severe acute respiratory syndrome coronavirus 2 (SARS‑CoV2), a highly transmissible virus responsible for serious respiratory illness coronavirus disease‑2019 (COVID‑19). As with all respiratory viruses, public health measures are
focused on contact tracing, isolation, and treatment of affected individuals, who have respiratory symptoms. However, it is spreading efficiently, and it can be explained from its stealth transmission from presymptomatic and asymptomatic individuals. Droplet and contact precautions are followed
universally. Healthcare workers are at higher risk of acquiring infection and they are additionally required to follow airborne and eye protection. Recent studies indicate viral particles can be isolated from many body fluids including feces, saliva, semen, and tears, suggesting transmission could be possibly occurring through some of these routes as well. We have done an evidence‑based review of all potential modes of transmission and discussed preventive measures to stop the spread. There is an urgent need for educating the healthcare professionals, governments, and public regarding other potential modes of transmission. Strict preventive measures need to be used to stop the spread.


Keywords


COVID 19; novel coronavirus; Pandemics; SARS‑CoV2; transmission

Full Text:

PDF

References


Lu R, Zhao X, Li J, Niu P, Yang B, Wu H, et al. Genomic

characterisation and epidemiology of 2019 novel coronavirus:

Implications for virus origins and receptor binding. Lancet

;395:565‑74.

Gorbalenya AE, Baker SC, Baric RS, de Groot RJ, Drosten C,

Gulyaeva AA, et al. The species Severe acute respiratory

syndrome‑related coronavirus: Classifying 2019‑nCoV and

naming it SARS‑CoV‑2. Nat Microbiol 2020;5:536‑44.

Song F, Shi N, Shan F, Zhang Z, Shen J, Lu H, et al. Emerging

novel coronavirus (2019‑nCoV) pneumonia. Radiology

;295:210‑7.

Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR,

Nalla AK, et al. Covid‑19 in critically ill patients in the Seattle

Region‑Case series. N Engl J Med 2020;382:2012‑22.

Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection

of SARS‑CoV‑2 in different types of clinical specimens. JAMA

;323:1843‑4.

Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus

in tears and conjunctival secretions of patients with SARS‑CoV‑2

infection. J Med Virol 2020. doi: 10.1002/jmv. 25725.

To KK, Tsang OT, Chik‑Yan Yip C, Chan KH, Wu TC, et al.

Consistent detection of 2019 novel coronavirus in saliva. Clin

Infect Dis 2020:ciaa149. doi: 10.1093/cid/ciaa149.

Peng X, Xu X, Li Y, Cheng L, Zhou X, Ren B. Transmission

routes of 2019‑nCoV and controls in dental practice. Int J Oral

Sci 2020;12:9.

Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, et al.

SARS‑CoV‑2 viral load in upper respiratory specimens of

infected patients. N Engl J Med 2020;382:1177‑9.

Guo ZD, Wang ZY, Zhang SF, Li X, Li L, Li C, et al. Aerosol

and surface distribution of severe acute respiratory syndrome

coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerg

Infect Dis 2020;26. doi: 10.3201/eid2607.200885.

van Doremalen N, Bushmaker T, Morris DH, Holbrook MG,

Gamble A, Williamson BN, et al. Aerosol and surface stability

of SARS‑CoV‑2 as compared with SARS‑CoV‑1. N Engl J Med

;382:1564‑7.

Lindsley WG, Noti JD, Blachere FM, Thewlis RE, Martin SB,

Othumpangat S, et al. Viable influenza A virus in airborne

particles from human coughs. J Occup Environ Hyg

;12:107‑13.

Booth TF, Kournikakis B, Bastien N, Ho J, Kobasa D, Stadnyk L, et al. Detection of airborne severe acute respiratory

syndrome (SARS) coronavirus and environmental contamination

in SARS outbreak units. J Infect Dis 2005;191:1472‑7.

Olsen SJ, Chang HL, Cheung TY, Tang AF, Fisk TL, Ooi SP,

et al. Transmission of the severe acute respiratory syndrome on

aircraft. N Engl J Med 2003;349:2416‑22.

Braden CR, Dowell SF, Jernigan DB, Hughes JM. Progress in

global surveillance and response capacity 10 years after severe

acute respiratory syndrome. Emerg Infect Dis 2013;19:864‑9.

Liu Y, Ning Z, Chen Y, Guo M, Liu Y, Gali NK, et al.

Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals.

Nature. 2020 Apr 27. doi: 10.1038/s41586-020-2271-3.

Leung NHL, Chu DKW, Shiu EYC, Chan KH, McDevitt JJ,

Hau BJP, et al. Respiratory virus shedding in exhaled breath and

efficacy of face masks. Nat Med 2020;26:676‑80.

Arons MM, Hatfield KM, Reddy SC, Kimball A, James A,

Jacobs JR, et al. Presymptomatic SARS‑CoV‑2 infections

and transmission in a skilled nursing facility. N Engl J Med

:NEJMoa2008457. doi: 10.1056/NEJMoa2008457.

Zhu Z, Liu Y, Xu L, Guan W, Zhang X, Qi T, et al.

Extra‑pulmonary viral shedding in H7N9 avian influenza

patients. J Clin Virol 2015;69:30‑2.

Peiris JS, Chu CM, Cheng VC, Chan KS, Hung IF, Poon LL,

et al. Clinical progression and viral load in a community outbreak

of coronavirus‑associated SARS pneumonia: A prospective study.

Lancet 2003;361:1767‑72.

Goh GK, Dunker AK, Uversky V. Prediction of intrinsic

disorder in MERS‑CoV/HCoV‑EMC supports a high

oral‑fecal transmission. PLoS Curr 2013;5:ecurrents.outbreaks.

b58675cdebc256dbe3c5aa6498b. doi: 10.1371/currents.out

breaks.22254b58675cdebc256dbe3c5aa6498b.

Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for

gastrointestinal infection of SARS‑CoV‑2. Gastroenterology

;158:1831‑3.e3.

Lo IL, Lio CF, Cheong HH, Lei CI, Cheong TH, Zhong X, et al.

Evaluation of SARS‑CoV‑2 RNA shedding in clinical specimens

and clinical characteristics of 10 patients with COVID‑19 in

Macau. Int J Biol Sci 2020;16:1698‑707.

Pan Y, Zhang D, Yang P, Poon LLM, Wang Q. Viral load

of SARS‑CoV‑2 in clinical samples. Lancet Infect Dis

;20:411‑2.

Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM, et al.

Epidemiological, clinical and virological characteristics of

cases of coronavirus‑infected disease 2019 (COVID‑19) with

gastrointestinal symptoms. Gut 2020;69:1002‑9.

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al.

Clinical characteristics of coronavirus disease 2019 in China.

N Engl J Med 2020;382:1708‑20.

Xu Y, Li X, Zhu B, Liang H, Fang C, Gong Y, et al.

Characteristics of pediatric SARS‑CoV‑2 infection and

potential evidence for persistent fecal viral shedding. Nat Med

;26:502‑5.

Xing YH, Ni W, Wu Q, Li WJ, Li GJ, Wang WD, et al.

Prolonged viral shedding in feces of pediatric patients with

coronavirus disease 2019. J Microbiol Immunol Infect

:S1684‑1182(20)30081‑5. doi: 10.1016/j.jmii. 2020.03.021.

Gu J, Han B, Wang J. COVID‑19: Gastrointestinal manifestations

and potential fecal‑oral transmission. Gastroenterology

;158:1518‑9.

Hindson J. COVID‑19: Faecal‑oral transmission. Nat Rev

Gastroenterol Hepatol 2020;17:259.

To KK, Tsang OT, Leung WS, Tam AR, Wu TC, Lung DC,

et al. Temporal profiles of viral load in posterior oropharyngeal

saliva samples and serum antibody responses during infection by

SARS‑CoV‑2: An observational cohort study. Lancet Infect Dis

;20:565‑74.

Belser JA, Rota PA, Tumpey TM. Ocular tropism of respiratory

viruses. Microbiol Mol Biol Rev 2013;77:144‑56.

Loon SC, Teoh SC, Oon LL, Se‑Thoe SY, Ling AE, Leo YS,

et al. The severe acute respiratory syndrome coronavirus in tears.

Br J Ophthalmol 2004;88:861‑3.

Raboud J, Shigayeva A, Mcgeer A, Bontovics E, Chapman M,

Gravel D, et al. Risk factors for SARS transmission from

patients requiring intubation: A multicentre investigation in

Toronto, Canada. PLoS ONE 2010;5:e10717.

Zhang X, Chen X, Chen L, Deng C, Zou X, Liu W, et al. The

evidence of SARS-CoV-2 infection on ocular surface. Ocul

Surf. 2020;18:360-2. doi: 10.1016/j.jtos.2020.03.010. Epub

Apr 11.

Xia J, Tong J, Liu M, Shen Y, Guo D. Evaluation of coronavirus

in tears and conjunctival secretions of patients with SARS‑CoV‑2

infection. J Med Virol 2020;10.1002/jmv. 25725. doi: 10.1002/

jmv. 25725.

Wu P, Duan F, Luo C, Liu Q, Qu X, Liang L, et al.

Characteristics of ocular findings of patients with coronavirus

disease 2019 (COVID‑19) in Hubei Province, China. JAMA

Ophthalmol 2020;138:575‑8.

Sun CB, Wang YY, Liu GH, Liu Z. Role of the eye in

transmitting human coronavirus: What we know and what we

do not know. Front Public Health 2020;8:155. doi: 10.3389/

fpubh.2020.00155.

Dong L, Tian J, He S, Zhu C, Wang J, Liu C, et al. Possible

vertical transmission of SARS‑CoV‑2 from an infected mother to

her newborn. JAMA 2020;323:1846‑8.

Zeng L, Xia S, Yuan W, Yan K, Xiao F, Shao J, et al. Neonatal

early‑onset infection with SARS‑CoV‑2 in 33 neonates born

to mothers with COVID‑19 in Wuhan, China. JAMA Pediatr

;e200878. doi: 10.1001/jamapediatrics. 2020.0878.

Baud D, Greub G, Favre G, Gengler C, Jaton K, Dubruc E,

et al. Second‑trimester miscarriage in a pregnant woman with

SARS‑CoV‑2 infection. JAMA 2020;e207233. doi: 10.1001/

jama. 2020.7233.

Chen H, Guo J, Wang C, Luo F, Yu X, Zhang W, et al. Clinical

characteristics and intrauterine vertical transmission potential of

COVID‑19 infection in nine pregnant women: A retrospective

review of medical records. Lancet 2020;395:809‑15.

Li D, Jin M, Bao P, Zhao W, Zhang S. Clinical characteristics

and results of semen tests among men with coronavirus disease

JAMA Netw Open 2020;3:e208292.

Chinese Academy of Sciences. Wuhan coronavirus has strong

ability to infect humans. Press release. Jan 21, 2020. Available

from: https://view.inews.qq.com/w2/20200121A0M08X00?tbkt=

F&strategy=&openid=o04IBALMrLyGDxbWNOPoDM1If

G‑s&uid=&refer=wx_hot. [Last accessed on 2020 Apr 11].

Burrer SL, de Perio MA, Hughes MM, Kuhar DT, Luckhaupt SE,

McDaniel CJ, et al. Characteristics of health care personnel with

COVID‑19‑United States, February 12‑April 9, 2020. MMWR

Morb Mortal Wkly Rep 2020;69:477‑81.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical

features of patients infected with 2019 novel coronavirus in

Wuhan, China. Lancet 2020;395:497‑506.

Young BE, Ong SWX, Kalimuddin S, Low JG, Tan SY,

Loh J, et al. Epidemiologic features and clinical course of

patients infected with SARS‑CoV‑2 in Singapore. JAMA

;323:1488‑94.

Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID‑19

in Wuhan, China: A retrospective cohort study. Lancet

;395:1054‑62.

He X, Lau EHY, Wu P, Deng X, Wang J, Hao X, et al. Temporal

dynamics in viral shedding and transmissibility of COVID‑19.

Nat Med 2020;26:672‑5.

Kim D, Quinn J, Pinsky B, Shah NH, Brown I. Rates of

Co‑infection between SARS‑CoV‑2 and other respiratory

pathogens. JAMA 2020:e206266. doi: 10.1001/jama.

6266.

Chen C, Gao G, Xu Y, Pu L, Wang Q, Wang L, et al.

SARS‑CoV‑2‑positive sputum and feces after conversion of

pharyngeal samples in patients with COVID‑19. Ann Intern Med

:M20‑0991. doi: 10.7326/M20‑0991.

Wölfel R, Corman VM, Guggemos W, Seilmaier M, Zange S,

Müller MA, et al. Virological assessment of hospitalized patients

with COVID‑2019. Nature 2020;10.1038/s41586‑020‑2196‑x.

doi: 10.1038/s41586‑020‑2196‑x.

Tian S, Hu N, Lou J, Chen K, Kang X, Xiang Z, et al.

Characteristics of COVID‑19 infection in Beijing. J Infect

;80:401‑6.

Alizon S, Hurford A, Mideo N, Van Baalen M. Virulence

evolution and the trade‑off hypothesis: History, current state of

affairs and the future. J Evol Biol 2009;22:245‑59.