Infectious SARS-CoV-2 in Feces of Patient with Severe COVID-19

A number of research papers have now reported the detectable presence of SARS-CoV-2 RNA oligotides in the faeces of infected patients. Some of these have previously been summarised on this blog here.

But the presence of RNA should not be misinterpreted to imply the presence of viable infectious virus particles (as has been pointed out many times on this blog, including here). Nonetheless, the evidence for some presence of infectious virions in faeces does appear to be slowly growing.

One example is this “Research Letter” published in Emerging Infectious Diseases. In this study, the authors describe the inoculation of Vero E6 cells from a human faecal sample and an observed cytopathic effect. This was followed by recovery of SARS-CoV-2 RNA from the inoculated cell culture, and then visualisation of recognisable viral particles by electron microscopy.

The authors of this study reported that they were able to isolate SARS-CoV-2 virus for 2 out of 3 patients that had previously tested viral RNA–positive from faecal specimens. They state that this indicates “infectious virus in feces is a common manifestation of COVID-19”.

The authors surmised that “isolation of infectious SARS-CoV-2 in feces indicates the possibility of fecal–oral transmission or fecal–respiratory transmission through aerosolized feces”. They concluded that “our findings indicate the need for appropriate precautions to avoid potential transmission of SARS-CoV-2 from feces”.


Fei X, Jing S, Yonghao X, Fang L, Xiaofang H, Heying L, Jingxian Z, Jicheng H and Jincun Z (2020) Infectious SARS-CoV-2 in Feces of Patient with Severe COVID-19. Emerging Infectious Disease journal, 26(8).

Published by Stuart Khan

Professor of Civil & Environmental Engineering, University of New South Wales

One thought on “Infectious SARS-CoV-2 in Feces of Patient with Severe COVID-19

  1. Hi Stuart
    This is the paper that required 2 rounds of cell culture passage before CPE was visible. They used a freeze thawed lysate of the first round cells to infect fresh cells. The number of infectious virus in the faecal material must be low if they didn’t observe CPE in the first 6 days of culture. For risk assessment, it is important to understand the number of infectious virus present

    Of interest, it has been recently shown that transfection of cells with the virus RNA genome (it was a modified reporter SARS-COV-2) was enough to establish infection / production of infectious virus. I wonder if there are in vitro conditions that could promote uptake of viral RNA (rather than active infection mediated by Spike and ACE2 interactions)


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