Some coronavirus patients experience nausea, vomiting, or diarrhea before they get a fever. They could spread the virus through poop.

An exhibition center has been converted into a hospital in Wuhan, February 5, 2020.

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An exhibition center has been converted into a hospital in Wuhan, February 5, 2020.
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STR/AFP/Getty Images

The deadly new coronavirus that has spread from the city of Wuhan, China is giving some patients nausea, vomiting, and diarrhea.

The coronavirus is part of a family of respiratory illnesses that includes the common cold, severe acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS). Patients often show pneumonia-like symptoms, especially fever, cough, and difficulty breathing.

But gastrointestinal symptoms like nausea and diarrhea could be early clues of coronavirus infection, according to a growing body of preliminary research.

Missing those rarer symptoms could have deadly consequences, since they are sometimes the only early indicators that a person is infected. A peer-reviewed study published Friday in the Journal of the American Medical Association identified 14 coronavirus patients who had diarrhea and nausea before they showed any signs of fever or respiratory symptoms. That was 10% of the study’s 138-person sample size.

One of those patients was placed in a surgical ward because they only showed abdominal symptoms, so doctors didn’t suspect the new coronavirus. That patient then transmitted the virus to at least 10 healthcare workers and four other patients in the ward. (If you think you might have the coronavirus, call your doctor before leaving the house.)

Researchers found the virus in poop

The first US patient with the new coronavirus had diarrhea and reported abdominal discomfort the day after he arrived at the hospital, according to a report published in the New England Journal of Medicine. Researchers later detected the coronavirus’ RNA in his poop.

Another study, shared in the pre-publication repository biorXiv, detected an enzyme signature of the virus in cells from the small intestine and colon.

Patients in China and Vietnam have also had diarrhea, vomited, or reported nausea.

These symptoms could be relatively rare, though: A study published in the pre-print repository medRxiv (which has not been peer-reviewed) looked at data from 1,099 patients. Less than 4% of those people experienced diarrhea and about 5% experienced vomiting.

These uncommon symptoms aren’t emphasized in official guidelines from the US Centers for Disease Control and Prevention (CDC). But the agency’s guidance for healthcare professionals does make a brief mention of diarrhea as an uncommonly reported symptom, along with “a general feeling of being unwell.”

Watching for nausea, vomiting, and diarrhea could help contain the outbreak

Health workers wear full protective clothing during a clean up operation at Amoy Gardens in Hong Kong, where over 200 residents were infected with SARS, April 4, 2003.

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Health workers wear full protective clothing during a clean up operation at Amoy Gardens in Hong Kong, where over 200 residents were infected with SARS, April 4, 2003.
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Christian Keenan/Getty Images

This is not the first time scientists have found a coronavirus in patients’ poop. Research indicated that SARS traveled through a Hong Kong apartment’s sewage system to infect some residents after one sick person had diarrhea.

Dr. Susan Kline, a spokesperson for the Infectious Diseases Society of America, told MedPage Today that gastrointestinal symptoms were “not unusual” in SARS patients during the virus’s deadly 2003 outbreak.

The Wuhan coronavirus has killed more than 1,000 people – a higher death toll in six weeks than SARS had in eight months.

Kline said that many illnesses cause nausea, diarrhea, and vomiting, even if those aren’t the primary symptoms. Looking for them can be crucial in the early stages of a new outbreak, as it was with SARS and Ebola.

“It was not recognized early on that [Ebola] patients had prominent diarrhea. Later, as [there were] reports of large numbers of patients, it became more obvious that it could be a predominant part of the illness,” Kline said.

Kline added that it’s important not to assume that all patients will have gastrointestinal problems, though. Still, including those symptoms in official guidelines could help catch more coronavirus cases early on.

“That would be helpful for clinicians to have, so they could at least consider that a patient with novel coronavirus might have vomiting or diarrhea,” she said.

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