International Journal of Celiac Disease
ISSN (Print): 2334-3427 ISSN (Online): 2334-3486 Website: Editor-in-chief: Samasca Gabriel
Open Access
Journal Browser
International Journal of Celiac Disease. 2020, 8(2), 64-67
DOI: 10.12691/ijcd-8-2-7
Open AccessArticle

Covid-19 and the Human Gut: A New Runner on the Tract

Lerner Aaron1,

1Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel

Pub. Date: June 25, 2020

Cite this paper:
Lerner Aaron. Covid-19 and the Human Gut: A New Runner on the Tract. International Journal of Celiac Disease. 2020; 8(2):64-67. doi: 10.12691/ijcd-8-2-7


The severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) dwells in the respiratory airways, however, its digestive tract presence, infectivity, mucosal attachment and penetrating mechanisms, enteric proliferation, stool shading, flashed bio-aerosol spreading and fecal-oral transmission is far from being understood. The present review opens some skylights to lighten the long, tortuous, dark and challenging tunnel of the gastrointestinal tract and his uninvited covid-19 viral new inhabitant.

covid-19 SARS-CoV-2 corona virus gut intestine gastrointestinal tract endoscopy stool infectivity transmission

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  da Costa VG, Moreli ML, Saivish MV. The emergence of SARS, MERS and novel SARS-2 coronaviruses in the 21st century. Arch Virol. 2020 Apr 22.
[2] remarks-at-the-media-briefing-on-covid-19---17-april-2020.
[3]  Lerner A. Are my patients with celiac disease at higher risk of COVID-19 virus? Internat J of Celiac Dis. 2020; 8: x-y.
[4]  Rao K, Verma P, Kumar K, Verma MK, Siddiqui AH, et al. Review on Newly Identified Coronavirus and its Genomic Organization. SSR Inst. Int. J. Life Sci. 2020; 6(2): 2509-2519.
[5]  Harari, Y.N. Sapiens: A Brief History of Humankind; Vintage Books: London, UK, 2011; pp. 1-466.
[6]  Vaninov N. In the eye of the COVID-19 cytokine storm. Nat Rev Immunol. 2020 Apr 6.
[7]  Kwok KO, Lai F, Wei WI, Wong SYS, Tang JWT. Herd immunity - estimating the level required to halt the COVID-19 epidemics in affected countries. J Infect. 2020 Mar 21. pii: S0163-4453(20)30154-7.
[8]  Wu, Yi-Chi, Chen, Ching-Sung, Chan, Yu-Jiun. The outbreak of COVID-19, J of the Chinese Med Assoc: March 2020; 83: 217-220.
[9]  Valencia DN. Brief Review on COVID-19: The 2020 Pandemic Caused by SARS-CoV-2. Cureus 2020; 12: e7386.
[10]  Mills, S.; Shanahan, F.; Stanton, C.; Hill, C.; Coffey, A.; Ross, R.P. Movers and shakers: Influence of bacteriophages in shaping the mammalian gut microbiota. Gut Microbes 2013; 4: 4-16.
[11]  Manrique P, Dills, M, Young, MJ. The Human Gut Phage Community and Its Implications for Health and Disease. Viruses 2017; 9: 141.
[12]  Navarro F, Muniesa M. Phages in the Human Body. Front. Microbiol. 2017; 8: 566.
[13]  Lerner A, Ramesh A, Matthias T. David and Goliath war revival in the enteric viruses and microbiota struggle. Potential implication for celiac disease. Microorganisms, 2019; 7: 173.
[14]  Rothan HA, Byrareddy SN .The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak. J Autoimmun. 2020; 109: 102433.
[15]  Jin X, Lian JS, Hu JH, Gao J, Zheng L, Zhang YM, et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut. 2020 Mar 24. pii: gutjnl-2020-320926.
[16]  Xu XW, Wu XX, Jiang XG, Xu KJ, Ying LJ, Ma CL, et al. Clinical findings in a group of patients infected with the 2019 novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case series. BMJ. 2020; 368:m606.
[17]  Fang D, Ma J, Guan J. et al. Manifestations of digestive system in hospitalized patients with novel coronavirus pneumonia in Wuhan, China: a single-center, descriptive study. Chin J Dig. 2020, 40: [Epub ahead of print].
[18]  Tian Y, Rong L, Nian W, He Y. Review article: gastrointestinal features in COVID-19 and the possibility of faecal transmission. Aliment Pharmacol Ther. 2020; 51: 843–851.
[19]  Wei XS, Wang X, Niu YR, Ye LL, Peng WB, Wang ZH, et al. Diarrhea is associated with prolonged symptoms and viral carriage in COVID-19. Clin Gastroenterol Hepatol. 2020 Apr 17. pii: S1542-3565(20)30526-7. [Epub ahead of print].
[20]  Kam KQ, Yung CF, Cui L, Lin Tzer Pin R, Mak TM, Maiwald M, et al. A Well Infant with Coronavirus Disease 2019 (COVID-19) with High Viral Load. Clin Infect Dis. 2020 Feb 28. pii: ciaa201. [Epub ahead of print].
[21]  Wong SH, Lui RN, Sung JJ. Covid-19 and the digestive system. J Gastroenterol Hepatol. 2020 Mar 25. [Epub ahead of print].
[22]  Indwiani Astuti, Ysrafil. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2): An overview of viral structure and host response. Diabetes Metab Syndr. 2020 Apr 18. [Epub ahead of print].
[23]  Zhang H, Kang Z, Gong H. et al. The digestive system is a potential route of 2019-nCov infection: a bioinformatics analysis based on single-cell transcriptomes. BioRxiv 927806. Post online Jan 31.
[24]  Liu Q, Wang R., Qu G et al. Macroscopic autopsy findings in a patient with COVID-19. J Forensic Med. 2020;36:1-3.
[25]  Yang Z, Li G, Dai X, Liu G, Li G, Jie Y. Three cases of novel coronavirus pneumonia with viral nucleic acids still positive in stool after throat swab detection turned negative. Chin J Dig. 2020;40:E002–E002.
[26]  Zhang J, Wang S, Xue Y. Fecal specimen diagnosis 2019 novel coronavirus-infected pneumonia. J Med Virol. 2020. Published online Mar 3.
[27]  Jiang X, Luo M, Zou Z, Wang X, Chen C, Qiu J. Asymptomatic SARS-CoV-2 infected case with viral detection positive in stool but negative in nasopharyngeal samples lasts for 42 days. J Med Virol. 2020 Apr 24.
[28]  Ozma MA, Maroufi P, Ehsaneh Khodadadi E, Köse SU, Esposito I, Ganbarov K, et al. Clinical manifestation, diagnosis, prevention and control of SARS-CoV-2 (COVID-19) during the outbreak period. Le Infezioni in Medicina, 2020;2:153-165.
[29]  Gu J, Han B, Wang J. COVID-19: Gastrointestinal Manifestations and Potential Fecal-Oral Transmission. Gastroenterology. 2020 Mar 3. pii: S0016-5085(20)30281-X. [Epub ahead of print]
[30]  Hindson J. COVID-19: faecal-oral transmission? Nat Rev Gastroenterol Hepatol. 2020 Mar 25. [Epub ahead of print]
[31]  McDermott CV, Alicic RZ, Harden N, Cox EJ, Scanlan JM. Put a lid on it: Are faecal bio-aerosols a route of transmission for SARS-CoV-2? J Hosp Infect. 2020 Apr 18. pii: S0195-6701(20)30199-7. [Epub ahead of print].
[32]  Yu I T., Li Y., Wong TW, Tam W, Chan AT, Lee JH. Evidence of airborne transmission of the severe acute respiratory syndrome virus. N Engl J Med. 2004; 350: 1731-1739.
[33]  Knowlton SD, Boles CL, Perencevich EN, Diekema DJ, Nonnenmann MW, CDC Epicenters Program Bioaerosol concentrations generated from toilet flushing in a hospital-based patient care setting. Antimicrob Resist Infect Control. 2018;7:16.
[34]  Johnson D, Lynch R, Marshall C, Mead K, Hirst D. Aerosol Generation by Modern Flush Toilets. Aerosol Sci Technol. 2013; 47: 1047-1057.
[35]  Santana SV, Queiroz GR, Eduardo CL, Ricardo M-FP. Prolonged fecal shedding of SARS-CoV-2 in pediatric patients. A quantitative evidence synthesis. J of Pediatr Gastroenterol and Nutr.: May 22, 2020, [Epub ahead of Print].
[36]  Sociedad Española de Patología Digestiva; Asociación Española de Gastroenterología. Recommendations by the SEPD and AEG, both in general and on the operation of gastrointestinal endoscopy and gastroenterology units, concerning the current SARS-CoV-2 pandemic (March, 18). Rev Esp Enferm Dig. 2020 Mar 23.
[37]  Repici A, Maselli R, Colombo M, Roberto Gabbiadini R, Spadaccini M, Anderloni A, et al. Coronavirus (COVID-19) outbreak: what the department of endoscopy should know. Gastrointest Endosc 202 Mar 13.
[38] Clinical Insights for Our Community of Gastroenterologists and Gastroenterology Care Providers. Posted on March 15, 2020 by the American College of Gastroenterology News Team.
[39]  Walsh CM, Fishman DS, Lerner DG, NASPGHAN Endoscopy and Procedures Committee. Pediatric Endoscopy in the Era of COVID-19: A NASPGHAN Position Paper. J of Pediatr Gastroenterol and Nutr, 2020.
[40]  Murray KF, Gold BD, Shamir R, Agostoni C, Pierre-Alvarez R, Kolacek S, et al. COVID-19 and the Pediatric Gastroenterologist. J of Pediatr Gastroenterol and Nutr.
[41]  Sinonquel P, Roelandt P, Demedts I, van Gerven L, Vandenbriele C, Wilmer A, et al. COVID-19 and gastrointestinal endoscopy: what should be taken into account? Dig Endosc. 2020 Apr 26.