A New Transmission Route for the Propagation of the SARS-CoV-2 Coronavirus

SIMPLE SUMMARY: In animals, two dominant organs are infected by coronaviruses, the respiratory tract and the gut. In past epidemics, a shift from the lung to the gut or vice versa has been observed. Analysis of the SARS episode in 2003 had suggested the possibility of a “double epidemic” explaining the absence of severe cases in Shanghai at the time. Here, using data from Wuhan and Hong Kong, Singapore, and Shenzhen, we discuss whether the present respiratory contagion route for SARS-CoV-2 might have also resulted from faecal contamination. We noticed that the propagation of the disease in the city of Wuhan underwent an original course. Besides the expected respiratory route, the disease appeared to have been greatly facilitated by a secondary propagation route, thus substantiating the beneficial effect of an effective quarantine. By contrast, a similar situation based on early data did not prevail in Hong Kong or Singapore. Our work shows how health authorities could decide to orient their prevention measures, depending on the analysis of ongoing epidemics, as a function of the identification of a secondary route in parallel with the prevailing one. Our model could also help highlight voluntarily or accidentally biased data collection. ABSTRACT: Background: Starting late 2019, a novel coronavirus spread from the capital of the Hubei province in China to the rest of the country, then to most of the world. To anticipate future trends in the development of the pandemic, we explore here, based on public records of infected persons, how variation in the virus tropism could end up in different patterns, warranting a specific strategy to handle the epidemic. Methods: We use a compartmental model to describe the evolution of an individual through several possible states: susceptible, infected, alternative infection, detected, and removed. We fit the parameters of the model to the existing data, taking into account significant quarantine changes where necessary. Results: The model indicates that Wuhan quarantine measures were effective, but that alternative virus forms and a second propagation route are compatible with available data. For the Hong Kong, Singapore, and Shenzhen regions, the secondary route does not seem to be active. Conclusions: Hypotheses of an alternative infection tropism (the gut tropism) and a secondary propagation route are discussed using a model fitted by the available data. Corresponding prevention measures that take into account both routes should be implemented to the benefit of epidemic control.