Table 2.

Key Considerations for Prevention of Gastrointestinal Tract Transmission of Human Coronaviruses in Hospitals

Recommendation	Key points
1. Elevate awareness about GI symptoms of COVID-19 and potential for fecal-oral transmission	•Around one-fifth of COVID-19 patients have GI symptoms •Index patient in a previous large SARS outbreak had diarrhea •Teach staff to recognize COVID-19 cases without respiratory symptoms •Post signs alerting patients and staff to all symptoms of COVID-19 (fever, respiratory, GI) •Ask screening questions about GI symptoms even if patients do not have fever or respiratory symptoms
2. Consider scaling up isolation precautions	•Isolate patients with n/v, diarrhea, and other GI tract symptoms under the appropriate airborne and contact protocols • Two possible modes of transmission: ○ Contaminated surfaces (fomites) ○ Bioaerosols from flushing uncovered toilets •Diarrhea possibly indicates higher viral RNA positivity and viral load in stool
3. Improve environmental controls	•Consider that toilet flushing could be an aerosol-generating procedure •Closing the toilet lid before flushing provides a 12-fold reduction in bioaerosol spread •Ensure adequate ventilation and plumbing systems

COVID-19 = novel coronavirus disease 2019; GI = gastrointestinal; n/v = nausea and vomiting.