As we know, GI diseases can be transmitted via the fecal-oral route. Now researchers looking at hospitals in Wuhan, China, that treated COVID-19-positive patients have provided valuable new data on its transmission. They found that although the intensive care units were good at containing the spread of the virus outside of the patients' rooms, there was a high concentration of the virus in the air samples taken from the patients' toilets.
What are the implications of that finding? Droplets of SARS-CoV-2, which causes the disease COVID-19, can be spread and live in the air for up to 3 hours, and be disseminated to hard surface areas where they can live up to 3 to 4 days. That is quite concerning when you consider that flushing a toilet can create an aerosolized plume of these viral particles, which can then spread elsewhere within proximity. We know that toothbrushes left in proximity to the toilet gain viral spread quite rapidly, mirroring levels observed in the toilet itself. That same thing can occur for cell phones, which many people take with them into the bathroom. However, this mode of transmission has not been well studied as it relates to COVID-19.
We do have available evidence with another coronavirus, the severe acute respiratory syndrome (SARS). Researchers looked at the Amoy Gardens apartment complex in Hong Kong, which experienced a large community outbreak of SARS during the 2003 epidemic. Using airflow dynamics studies, they were able to retrospectively track the spread of the virus from one individual patient—the index case—to other residents of the complex. They reported that the patient's toilet exhaust fan, which created a negative pressure effect, vented into the apartments above and also to the outside. They linked this to 187 cases in the complex with available data. This analysis suggests that the SARS virus was able to be transmitted by microdroplets through inhalation, touch, and potentially fecal-oral routes.
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