Gastrointestinal and Hepatobiliary Manifestations of Coronavirus Disease-19: Potential Implications for Healthcare Resource-Deficient Countries

Abstract

It is believed that the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has evolved and developed with broad tissue tropism as hospitalized coronavirus disease (COVID)-19 patients have been showing non-respiratory manifestations. As evidenced in recent clinical studies, even if the results of oral or nasal swab test were negative, the tests on rectal swab, feces, and blood samples in recovered patients could still be positive. The viral shedding in these specimens provides a cautionary warning that fecal-oral route may represent a hidden trigger of rampant spread of COVID-19 in developing countries with poor sanitization. In addition, the presence of SARS-CoV-2 in rectal, fecal, and blood samples endorses gastrointestinal and hepatic origins for the pathogenesis of COVID-19. These observations highlight the importance for the infected patients to obtain accurate and timely diagnosis as well as the treatment of COVID-19 and its associated non-respiratory symptoms to reduce the risk of spreading the infection through unexpected routes. This review also discusses the potential implications of fecal-oral transmission of COVID-19 for healthcare resource-deficient countries.