Diarrhea can be the first symptom of someone who is exposed to the COVID-19 corona virus. Research published in The American Journal of Gastroenterology says diarrhea symptoms are experienced by some COVID-19 patients.

The study involved 206 patients at Union Hospital, Tongji Medical College, in Wuhan, China. Where the virus first appeared. Patients were classified as having a mild case of COVID-19 because they did not have shortness of breath or respiratory distress.

In addition, patients also have a relatively high level of blood oxygen saturation. The patients were sent to health facilities even though their symptoms were mild. As a result they can be monitored and quarantined during the peak of the outbreak that occurred in Wuhan.

As summarized News Week, Friday (3/4/2020), 48 people infected with COVID-19 only have digestive symptoms such as diarrhea. 69 other people with digestive and respiratory symptoms, while 89 others only with respiratory symptoms.

On average, the patients, who live in Wuhan, are 62 years old, and 55.8 percent are women. Of the 67 people with diarrhea, 19.4 percent considered it the first symptom of COVID-19.

While other patients appear diarrhea in the first 10 days after respiratory symptoms. Diarrhea lasts between one to 14 days. 52.2 percent of patients said their stools were runny.

Others say their stools are soft but not runny. Stomach aches are also rare in this condition. Approximately 62.4 percent of patients with digestive symptoms also experience fever.

While 73.1 percent of other patients experience diarrhea and fever simultaneously. Of these 20.4 percent of patients experienced stomach disorders before fever. 10.2 percent of patients after a fever, and others experience stomach disorders and fever simultaneously.

Those who also feel sick and feel nauseous due to having a fever. The condition is more severe than patients who only have lower digestive symptoms.

The research team found that patients who have digestive symptoms might seek treatment more slowly than those who have respiratory problems. The period between the onset of symptoms and the patient’s body free of viruses also tends to be longer.

Patients are also more likely to have a virus in their stool, which is up to 73 percent. Compared with 14.3 percent of patients who have respiratory problems. The researchers tested the stool of 22 COVID-19 patients.

The result was they found RNA, or genetic material, from the new corona virus in 12 samples. Some COVID-19 patients may experience problems such as diarrhea because the receptors that are bound by the virus are expressed at levels that are almost 100 times higher.

The problem occurs in the upper and lower digestive tract rather than in the respiratory organs. According to Johns Hopkins University, nearly 1 million COVID-19 cases have been confirmed worldwide. A total of 47,522 people have died, and at least 195,929 people have recovered.

Most studies have focused on seriously ill patients. But because 80 percent of patients experience minor illnesses, it is very important to show their symptoms. As a result those who are mildly ill can be treated at home and quarantined themselves.

Patients with mild symptoms can unwittingly spread the virus. Patients with mild symptoms are a major driver of the COVID-19 pandemic.

“The longer course of the disease in patients with digestive symptoms may reflect a higher viral load in these patients compared to those with only respiratory symptoms,” the authors wrote.

The team highlighted their relatively small sample size, while larger studies need to be conducted to further explore digestive symptoms in mild COVID-19 patients.

“This study does not directly confirm that the virus particles in the stool are infectious and capable of transmitting disease. But our results offer more evidence that COVID-19 can present with digestive symptoms,” the researchers wrote.

In addition the COVID-19 virus was also found in the stools of patients with diarrhea. And did not rule out the possibility that they could transmit the virus in the form of feces. Further research is very important to determine whether COVID-19 can spread through the stool-oral route.

According to the CDC, symptoms of COVID-19 generally include fever, coughing, and shortness of breath. The World Health Organization (WHO) states the risk of COVID-19 from the feces of infected people appears to be low.

While initial investigations indicate the virus may be present in feces in some cases. But spreading through feces is not the primary method of the COVID-19 pandemic.

“WHO is assessing ongoing research on how COVID-19 is spreading and will continue to share new findings. But because this is a risk, this is another reason to clean hands regularly, after using the bathroom and before eating,” the researchers wrote.

The authors of another study, which conducted research on nine COVID-19 patients in Munich, found no form of viral replication in stool samples. This happened even though they identified a high level of viral load.

“Therefore, further research should discuss whether SARS-CoV-2 is scattered in the stool made not transmitted through contact with the intestinal environment,” they wrote.

Brennan Spiegel, Professor of Medicine and Public Health at Cedars-Sinai, said that the main symptoms of COVID-19 are not just coughs.

“Obviously we focus on coughing and respiratory symptoms because it can be serious, it can cause death. So it is natural that our initial focus is on patients who arrive at the hospital with shortness of breath, coughing and pneumonia,” he said.

Spiegel said the symptoms were the main manifestation of this disease. But doctors began to learn from their colleagues in China and throughout the world. That there is a large group of people who may never report COVID-19 or be at home with digestive symptoms – diarrhea, nausea, vomiting, stomach ache.

There are also people who have low appetite and struggle to determine whether they have COVID-19 or not. Spiegel stressed one must, try to be hygienic. Mainly when they use the bathroom to prevent the spread of disease.

You do this by closing the toilet lid when flushing to stop the particles released into the air. Professor of Microbial Pathogenesis at the London School of Hygiene and Tropical Medicine, Brendan Wren said.

“There are many potential sources of gastrointestinal symptoms that may not be associated with COVID-19. Indeed, the fact is that COVID-19 patients may exhibit poor hygiene and co-infection with other gastrointestinal pathogens,” said Wren.

The most interesting thing in this study was the demonstration of the direct release of the SARS-Cov-2 virus from patient feces. This method is considered to cause transmission of COVID-19 apart from respiratory transfer.

Professor of Virus Genomics at the University of Edinburgh in Scotland, Dr. Jurgen Haas said that he and his colleagues had reviewed the scientific research and made conclusions.

“The implications are quite surprising, we think this is an important study. It is known that a certain percentage of COVID-19 patients experience diarrhea and gastrointestinal symptoms, in addition to respiratory symptoms. We also know this from several other common cold coronaviruses and for example from influenza,” he said .

What is new is that a subgroup of COVID-19 patients with no respiratory symptoms or severe symptoms is highly likely to experience positive SARS-CoV2 virus in the stool. People who are infected with HIV can spread it through fecal-oral transmission.

These subgroups have an initial disease, but they contain and spread the virus for a longer period of time. Gastrointestinal infections and fecal-oral spread are far more important in COVID-19 than previously thought.

Haas said he and his epidemiologist who also reviewed the study said there were minor weaknesses such as imbalances in variables. For example in the sex, age, and symptoms that might be biased in some findings.

Haas recommends washing hands frequently, using hand sanitizers and not touching the face with dirty hands. There are several other viruses (such as Noro, Rota- and Adenoviruses) that can cause diarrhea.

While SARS-CoV-2 is just one of many viruses and it’s most likely not to appear as often as others.

“However, this study shows that people with diarrhea or without the respiratory system who have been in contact with COVID-19 patients, definitely need to be tested,” Haas concluded.

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