Does Fecal-Oral Transmission of SARS-CoV-2 Due to Low Sanitation Conditions Contribute to Low Mortality Rates From COVID-19

Abstract

Background: The novel coronavirus disease 2019 (COVID-19) is a global pandemic generated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The primary infection site is mucosal surfaces, mainly the lungs and the intestine, where epithelial cells can be infected. COVID-19 has spread throughout the world, causing millions of deaths and hundreds of millions of confirmed infections. Despite the global spread of SARS-CoV-2, there are extreme differences between countries in mortality rates and confirmed infections.Methods: Pearson correlations and a t-test were performed on data from 137 countries in order to test the correlation between number of deaths from diarrheal diseases (pre-COVID-19 pandemic data) as a marker for countries' sanitation level, and the number of confirmed COVID-19 cases and deaths per million.Results: It was found that countries' prevalence of confirmed COVID-19 cases and deaths per million are statistically correlated with their sanitation level.Conclusions: The hypothesis proposed in this article is that the low mortality rates from COVID-19 in countries where the level of sanitation is low are due to fecal-oral infection of the population by SARS-CoV-2, rather than infection of the respiratory system. This hypothesis is supported by the protective effect of the low sanitation level presented in this work and the fact that lung infection by SARS-CoV-2 can cause severe pathology, while infection in the intestine generally causes minor or no symptoms.

A narrative review of alternative transmission routes of COVID 19: what we know so far

“…Epidemiological studies suggested fecal-oro transmission in cases such as the Diamond Princess cruise ship, where at least 20% of passengers were confirmed to be infected with SARSCoV-2, plausibly as the result of a superspreading event not implying person-to-person transmission [ 165 ].…”