If someone going outdoors during the lockdown needs to use a public toilet, or if someone shares a toilet at home with someone who might have contracted COVID-19, is there a risk of being infected through the faeces of the infected person? The short answer: it is possible in theory, but very unlikely to happen.
Emerging information on the novel coronavirus SARS-CoV2, which causes COVID-19 disease, suggests that the virus can be present in some cases. But as the Health Ministry notes in its FAQs, spread of the novel coronavirus through the faecal route is not the main feature of the outbreak. The primary route remains droplets from an infected person coughing or sneezing. Spread through this route is far more common than spread through touching infected objects and then touching one’s face, mouth or nose.
The US Centers for Disease Control and Prevention (CDC) notes that the virus has been detected in the faeces of some COVID-19 patients, but what is unknown is the amount of virus in the stool, or whether the virus in stool is infectious at all. As such, the risk of transmission is also unknown. “However, the risk is expected to be low based on data from previous outbreaks of related coronaviruses (SARS and MERS)… There has been no confirmed fecal-oral transmission of COVID-19 to date.”
It may seem that flushing a toilet will have got rid of the virus, even if it was present in the faeces. But flushing creates “toilet plumes”, which are a subject of ongoing research. Toilet plumes refer to the dispersal of microscopic particles as a result of flushing. Over the last several years, researchers have been studying the risk of toilet plume aerosols sent into the air, then settling on the toilet seat and infecting someone. In a study published in the American Journal of Infection Control in 2013, which itself was based on an analysis of several peer-reviewed studies, researchers found that potentially infectious aerosols may be produced in substantial quantities during flushing, which can expose subsequent toilet users. Yet, they added, no studies have yet clearly demonstrated or refuted toilet plume-related disease transmission. The paper stressed the need for additional research.
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It is considered good hygiene if you flush the toilet with the lid down. A widespread view is that doing so prevents some of the toilet plume from escaping into the air. It also makes sense to wait a few minutes before using a toilet that has just been used by someone else.
While noting that the risk of catching COVID-19 from faeces appears to be low, the Health Ministry adds: “Because this is a risk, however, it is another reason to clean hands regularly, after using the bathroom and before eating.”
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