Preventing Fecal-Oral And Fecal-Aerosol Transmission Of Covid-19

Last year, I conducted an interview with a friend who traveled to Shanghai and was forced to quarantine in a hotel for 11 days under the supervision of local health authorities. He was brought hot meals, subjected to temperature checks twice daily, and charged not a cent for his stay—standard protocol in China and other countries that, prior to the widespread imposition of travel bans, isolated and accommodated visitors from abroad early on in the Covid-19 pandemic.

One detail, however, struck me as rather curious, if not startling. When my friend checked in, a woman handed them a blue bucket and a little bottle of disinfectant tablets. “For toilet,” she told him, then laughed when she saw the look of shock and horror on his face. “No, no, no, no. Not for that. Dissolve the tablets in water in the bucket, then dump the mixture into the toilet before you flush.” It didn’t matter whether it was number one or number two, my friend told me. He had to treat his waste as if it was potentially infectious and carrying the virus that causes Covid-19, SARS-CoV-2—using half a bucket of water and six tablets for urine, or a whole bucket and twelve tablets for feces.

Disinfecting toilets isn’t the only safety measure that addresses the possibility that SARS-CoV-2 can be transmitted through human waste. More recently, China has been heavily criticized, particularly by the Japanese government, for using anal swabs to test incoming travelers for Covid-19 either instead of or in addition to the traditional nasopharyngeal swabs. These interventions, like most China has implemented to contain further spread, may be extreme, but the rationale behind them isn’t. Evidence not just from the past year, but the original SARS pandemic, shows that SARS-CoV-2 infects the intestines and colon and from there spreads to others, traveling from the toilet to the sewer to the water we use and the air we breathe—one reason why sewage surveillance across cities and within neighborhoods has become so commonplace.

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Originally published on Forbes (March 22, 2021)

© William A. Haseltine, PhD. All Rights Reserved.