Title: Shedding of SARS-CoV-2 in serum, stool and urine samples of Ethiopian Covid-19 patients

Authors: Dawit Hailu Alemayehu et al. (1)

(1)  Armauer Hansen Research Institute (AHRI), dawit.hailu@ahri.gov.et

Background: Covid-19 disease is a respiratory disease caused by the Serious Acute Respiratory Syndrome Corona Virus-2 (SARS-CoV-2). We routinely use oropharyngeal or nasopharyngeal swab samples for the detection of SARS-CoV-2, but investigation for the presence of SARS-CoV-2 in other body fluids like serum, urine and stool is important to explain potential routes of transmission besides respiratory droplets.

Methods: Whole blood, urine and stool samples were simultaneously collected from 136, 75 and 43 Covid-19 patients, respectively immediately after the patients were admitted to St. Paul Millennium Hospital. Serum was separated from whole blood urine was centrifuged, and the pellet resuspended in normal saline. Stool samples were resuspended in normal saline, centrifuged and the resulting supernatant saved for testing. Nucleic acid was then extracted from all the processed samples and assayed for SARS-CoV-2 using RT-qPCR method.

Results: Out of 136 serum samples tested, 6 samples (4.4%) were positive for SARS-CoV-2. The virus was detected in 8 out of 75 (10.7%) urine samples. RT-qPCR for the stool samples showed 30.2 %( 13 of 34) positivity. All the serum and urine samples had late cycle threshold (ct) values compared to ct values of stool specimens.

Conclusion: This study showed that SARS-CoV-2 virus is detectable in serum, urine and stool samples of Ethiopian covid-19 patients In comparison, stool samples showed a higher rate of positivity and higher viral load than serum and urine samples. Further experiment is needed to investigate if the virus detected in these samples is viable and able to replicate in human waste, which shows transmission route other than respiratory droplets.