In the wake of the present the COVID-19 pandemic, there has been a much-needed increase in awareness among the general public of the importance of handwashing, social distancing and observing cough and sneeze etiquette. Observing a healthy ‘toilet hygiene’ must also be stressed, in view of the fact that COVID-19 affects the gastrointestinal tract too.

Most of us are aware that the COVID-19 presents with symptoms such as fever, cough and difficulty in breathing.

What is to be noted is that recent scientific data suggests that nearly 50% of the COVID-19 patients present with predominant digestive symptoms as their primary complaint.

The digestive symptoms include lack of appetite (83.8%), loose stools (29.3%), vomiting (0.8%) and abdominal pain (0.4%).

Although these patients usually do have coexisting respiratory complaints as well, a few of them (3%) can present with only digestive symptoms without any respiratory symptoms.

It appears that patients who report gastrointestinal symptoms usually have a more severe course of the disease and consequently a poorer outcome, compared to patients with COVID-19 infection without gastrointestinal symptoms.

As the disease progresses in severity, digestive symptoms also increases.

Shed in stools

Scientific studies have proven that apart from nasal and respiratory secretions, the COVID-19 virus is actively shed in the stools of infected patients. This shedding may continue to occur for as long as five weeks after the patient recovers from the respiratory symptoms.

In this regard, besides the already known measures such as avoidance of close contact, social distancing, observing cough/sneeze hygiene etiquette and wearing personal protective gear, the importance of a proper handwashing protocol, especially after bowel movements, must be stressed. Since there is a likelihood of bioaerosols being released in the air during flushing of the toilet (toilet plume), it is advisable to ensure that the commode lid is closed before flushing.

Avoiding the lavatory immediately after it has been used by another may also reduce exposure to the virus.

Since infected individuals may be asymptomatic and testing everyone would not be feasible, assuming everyone to be potentially infective and observing the mentioned personal hygiene measures universally may be the best way to break the chain of infection.

Fact File

50% of COVID-19 patients present with digestive symptoms

Infected patients actively shed the virus in the stools

Proper hand-washing protocol must be stressed after every bowel movement

Ensure closure of commode lid before flushing to avoid bio-aerosols

Avoid lavatory use immediately after usage by another