Study In China Reveals Persistent Fecal Virus Shedding In Children Deemed ‘Recovered’ From COVID-19 After Testing Negative Via Nasal Swab Tests!

While the Western world especially countries like the United States and the United Kingdom  are trying to downplay issues about viral persistence in those that are deemed as ‘recovered’ from the COVID-19 disease , in other countries medical experts are focusing more studies on this issue. In the United States and also the United Kingdom, individuals are stupidly deemed as ‘recovered’ as long as they test negative via a nasal swab or saliva test! The ‘experts’ in countries like the United States and also the United Kingdom are also similarly trying to evade the issues of various long term medical conditions - some even dangerous and possibly fatal arising as a result of having being infected with the SARS-CoV-2 coronavirus or what is known as Long COVID due to pressure from certain politicians, pharma giants and also billionaires with vested interests.

In a new study by Chinese researchers from Guangzhou Women and Children’s Medical Center, Guangzhou Medical University-China, it was found that children infected by the SARS-CoV-2 coronavirus who were later deemed as recovered from such nasopharyngeal testing that showed negative results were found to exhibit persistent fecal viral shedding.
 
The study team reported the epidemiological and clinical investigations on ten pediatric SARS-CoV-2 infection cases confirmed by real-time reverse transcription PCR assay of SARS-CoV-2 RNA. Symptoms in these cases were nonspecific and no children required respiratory support or intensive care.
 
Chest X-rays lacked definite signs of pneumonia, a defining feature of the infection in adult cases. Notably, eight children persistently tested positive on rectal swabs even after nasopharyngeal testing was negative, raising the possibility of fecal–oral transmission and the issues of viral persistence.
 
The study results were published in the peer reviewed journal: Nature Medicine. https://www.nature.com/articles/s41591-020-0817-4?fbclid=IwAR2l7kUrielm_fc1Sfga346tceiY6NEmsqoowZj_jEqojDjgmog6UguPfnM
 
On 20 February 2020, a total of 745 children and 3,174 adults, most of whom had either close contact with diagnosed patients or had members of the family reporting familial outbreaks in the previous 2 weeks, were screened by nasopharyngeal swab real-time PCR with reverse transcription (RT–PCR) for SARS-CoV-2 infection. Overall, 10 children (1.3%) and 111 adults (3.5%) tested positive. The 2.7-fold difference between children and adults is statistically significant (P = 0.002). All ten pediatric patients were admitted to our hospital, a treatment center for SARS-CoV-2 infection designated by the local municipal government.
 
It was found that upon admission, seven had fever but none had a temperature above 39 °C. Other symptom presentations included coughing (five children), sore throat (four children), nasal congestion and rhinorrhea (two children) and diarrhea (three children). One child was completely asymptomatic (patient 4). None of the patients had other symptoms commonly seen in adult patients such as lethargy, dyspnea, muscle ache, headache, nausea and vomiting and disorientation. In fact, none of them sought medical care; they we re all identified and diagnosed because of their exposure history.
 
Interestingly chest X-rays of these patients were either normal or showed only coarse lung markings without unilateral or bilateral pneumonia. Chest computed tomography (CT) scans showed isolated or multiple patchy ground-glass opacities in five patients but were within normal ranges in the other five. These changes were mainly seen in the outer lung fields and few patients had subpleural bands or strips. There was no pleural effusion, enlarged lymph nodes or other changes that are typically seen in the critically ill adult patients^.
 
Detailed blood count, urine and stool analyses, coagulation function, blood biochemistry and infection biomarkers were tested upon admission. Almost all test results were normal in the patients except for patient 9. Few cases had leukopenia, leukocytosis, lymphopenia or elevated transaminase, which in contrast are frequently seen in adult patients. Viral testing for influenza-A virus (H1N1, H3N2, H7N9), influenza B virus, respiratory syncytial virus, parainfluenza virus, adenovirus, SARS-CoV and MERS-CoV were negative in all patients.
 
Importantly out of nine patients (the tenth patient was transferred from another hospital that did not conduct cytokine tests upon admission), seven showed elevated interleukin (IL)-17F and five of these patients had concurrent elevation of IL-22. Five patients had elevated IL-6.
 
It must be noted that all patients received antiviral therapy with α-interferon oral spray initiated from admission (8,000 U, two sprays, three times a day). Patient 1 was the very first pediatric case of SARS-CoV-2 infection diagnosed in Guangzhou and also treated with azithromycin 10 mg kg⁻¹ per day for 5 d and IVIG 300 mg kg⁻¹ per day for 3 d. No patient required respiratory support or intensive care unit care.
 
The study team followed the pattern of viral excretion from respiratory and gastrointestinal tracts in all ten patients by a chronological series of nasopharyngeal and rectal swab samples using real-time RT–PCR . Patient 4 was asymptomatic but tested positive on multiple occasions. Patient 6 was asymptomatic on the day his nasopharyngeal swab tested positive and then developed nasal congestion and rhinorrhea the following day. The remaining eight patients had positive tests soon after the onset of symptoms. In addition, eight of ten patients also had real-time RT–PCR-positive rectal swabs, suggesting potential fecal viral excretion. Moreover, eight of ten patients (patients 1–6, 8 and 10) demonstrated persistently positive real-time RT–PCR tests of rectal swabs after their nasopharyngeal testing had become negative.
 
Many clinical features of SARS-CoV-2 infection in adults have been reported elsewhere^. However, few pediatric cases are published and their clinical features have yet to be documented.
 
Compared to adult patients, the ten pediatric patients reported here had clinically milder symptoms and showed fewer alterations in radiological and laboratory testing parameters. For example, none of the ten patients showed clear clinical signs or chest X-ray findings consistent with pneumonia, a typical feature seen in the initial adult patients^. Mild and atypical presentations of the infection in children may make it difficult to detect. Indeed, all the patients reported here were found through screening of suspected cases.
 
The study team also observed positive real-time RT–PCR results in rectal swabs in eight out of ten pediatric patients, which remained detectable well after nasopharyngeal swabs turned negative, suggesting that the gastrointestinal tract may shed virus and fecal–oral transmission may be possible. Indeed, fecal–oral transmission does exist with other respiratory viruses. https://pubmed.ncbi.nlm.nih.gov/26209373/
 
These study findings also suggest that rectal swab-testing may be more useful than nasopharyngeal swab-testing in judging the effectiveness of treatment and determining the timing of termination of quarantine.
 
For the latest coronavirus news, keep on logging to Thailand Medical News