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New Delhi: A person who no longer displays symptoms of coronavirus (COVID-19) may still be shedding it, including through stool, a German study conducted on nine patients has revealed.

However, it is unclear whether “shedding” is infectious or not and the study advises further investigations.

The study has been conducted by researchers from multiple German institutes in Munich and Berlin. It is funded by grants from the German government and military as well as the European Union, but they had no role in the research itself.

The research has been termed one of the first outside coronavirus epicentre China to look at clinical data of infected patients. However, it hasn’t been peer-reviewed. It was published Sunday on MedRxiv, a portal for preprints or preliminary reports that have not been peer-reviewed.

MedRxiv, read as med-archive, was founded by Cold Spring Harbor Laboratory (CSHL), a not-for-profit research institution, along with Yale University, and BMJ, a peer-reviewed journal.

Also Read: How China’s authoritarianism ‘aided’ its fight against coronavirus

Some positive findings

The study also offers good news. It suggests a good chance that COVID-19 can be detected through throat swabs when symptoms are still mild, which means a patient can start treatment early.

Another positive finding seeks to address the imminent pressure on a country’s healthcare framework that outbreaks are known to usher in. According to the researchers, patients can be discharged from hospitals and prescribed home isolation after day 10 of symptoms if they have less than 1 lakh viral RNA copies per ml of sputum.

“Based on the present findings, early discharge with ensuing home isolation could be chosen for patients who are beyond day 10 of symptoms with less than 100,000 viral RNA copies per ml of sputum,” the report states.

These conditions, according to the researchers, suggest the patient would have a low risk of spreading the infection.

The study calls for further research to address “whether SARS-CoV-2 (the name for the virus that causes COVID-19, severe acute respiratory syndrome coronavirus 2) shed in the stool is rendered non-infectious though contact with the gut environment”.

“Our initial results suggest that measures to contain viral spread should aim at droplet, rather than fomite-based transmission,” the study states.

Also Read: Is Indian economy equipped to deal with the global disruption caused by coronavirus?

Patients ‘highly infectious in early stage’

The team of researchers tried to isolate the virus from sputum, throat swabs and stool samples to determine how a coronavirus-infected patient passes it on and how long they can do so.

However, the researchers found they could not isolate viruses from throat swabs or sputum specimens after day eight of illness, especially from people who had mild infections.

Patients who contract COVID-19 are likely to infect others during the very early stage of their infection, the researchers state.

“In general, viral RNA concentrations were very high in the initial samples. Whereas symptoms mostly waned until the end of the first week, the virus remained detectable in throat swabs well into the second week. Stool and sputum samples remained positive over even longer periods, in spite of full resolution of symptoms,” they add.

Awaiting clarity on the period of shedding

Public health officials are still awaiting clarity on patients who have recovered from the virus attack but test positive through throat swabs and sputum samples.

According to Maria Van Kerkhove, who heads the World Health Organization’s emerging diseases and zoonoses unit, “early studies on COVID-19 suggest people who have contracted the coronavirus are emitting, or ‘shedding’, infectious viruses very early on — in fact sometimes even before they develop symptoms”.

“We do know from shedding studies that people can shed in the pre-symptomatic phase… it seems that people shed more in the early phases rather than the late phases of the disease.”

Also Read: Forget coronavirus, homoeopathy can’t cure anything. It’s a placebo, at best

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