Alert for SARS-CoV-2 infection caused by fecal aerosols in rural areas in China

Recent studies found that SARS-CoV-2 can be detected in fecal and urine of COVID-19 cases, especially the asymptomatic cases . SARS-CoV can persist in feces from infected people for as long as four days, and SARS-CoV-2 may persist in feces for a longer time. Based on these characteristics, COVID-19 is prone to cause outbreaks in the community, particularly in rural areas. Excreta treatment in scattered rural areas is generally decentralized and self-processing. In concentrated areas, residents mainly use flush toilets, which can generate huge quantities of aerosols; the ventilation and plumbing systems in these places are not effective for maximal hygiene. The feces may form high concentrations of viral aerosols, and travel through the air to cause infection. In order to prevent the spread of fecal aerosols, we recommend the following points. First, to avoid wide spread viral aerosols in concentrated areas, state-of-the-art ventilation and plumbing systems should be constructed and maintained.