EXP COVID-19 Offices White Paper

INTRODUCTION | 9

4. FECAL ORAL DISSEMINATION – The fecal-oral transmission route for SARS-CoV-2 infections is implicitly recognized by the World Health Organization. This aligns with an observation during the SARS 2003 outbreak. Open connections with sewage systems were found to be the likely transmission route in the Amoy Garden apartment building in Hong Kong during that outbreak. SARS-CoV-2 has also been detected in stool samples (reported in “Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples from the Hong Kong Cohort” and “Systematic Review and Meta-analysis” in Gastroenterology Journal). (9)

Figure 5. Timeline of results from throat swabs and fecal samples through the course of disease for 41 patients with COVID-19 (10)

When flushed with open lids, toilets create plumes containing droplets and droplet residue, referred to as a fecal cloud. These droplets can contain SARS- CoV-2 of an infected individual. The assumed conclusion is that fecal-oral transmission routes can’t be excluded as transmission routes and actions should be taken to protect our employees and office visitors.