Transmission Routes of SARS-CoV-2: Based on the Epidemiological and Clinical Characteristics of 29 Cases in Jinan, China

Background: In late December 2019, the global outbreak of SARS-CoV-2 that began in Wuhan, China, spread rapidly throughout the world resulting in more than ten thousands cases and three thousands death till March 8 th , 2020. The numbers of confirmed cases are still rising, posing higher challenges for disease control and patient treatment. SARS-CoV-2 was transmitted in a more diverse way among human, asymptomatic infected person and possible fecal-oral transmission, created the conditions for a large-scale spread. These issues pose great challenges to disease diagnosis and epidemic control. Methods: We obtained data on 29 cases of COVID-19 patients in Jinan, Shandong province, China. All the cases were confirmed by RT-PCR and were analysed for epidemiological, clinical and radiological features and laboratory data. Blood and stool samples of 29 cases were detected by nucleic acid RT-PCR, amonge which environmental samples of 4 patients were also collected and tested. We systematically summarized and investigated the clinical and laboratory characteristics of cases in Jinan for the first time. Findings: Compared with Wuhan cases, the 29 cases of COVID-19 in Jinan exhibited mild or moderate symptoms, which are mainly imported cases from Wuhan contact history. Of the 29 cases SARS-CoV-2, influenza A and B viruses and respiratory syncytial virus are all negtive . 4(13.8%) cases of stool samples turn to positive after their release from hospital 5-7 days. We report the clinical data of asymptomatic patient confirmed by anal test positive for the first time. Some patients with gastrointestinal infections are secondary to pulmonary infections, and during the patients' recovery period, the virus may still exist in the patient's gastrointestinal tract over 7 days . We combined with epidemiological and clinical data to analyze the possible routes of virus transmission and infection, including eyes-nose, hands-eyes, fecal-oral and eyes-oral, et al. , and first presented the two-way transmission in eyes-oral , in order to provide the basis for suppressing the spread of the virus and antiviral treatment and advices for the protection of medical staff. The various infection sites of virus causing different clinical symptoms and directly affects the course of disease. Whether the excretion of feces in vitro during recovery period is infectious remains to be further studied. The criteria of patients discharged should be reassessing, and the nucleic acid testing of stool samples should be taken seriously.Funding Statement: Jinan Special Project on prevention and control of SARS-CoV-2; Shandong Medical and Health Science and Technology Development Project , 2017WS013; Academic promotion programme of Shandong First Medical University, 2019QL024.Declaration of Interests: The authors declare no competing interests.Ethics Approval Statement: This study was approved by the Ethics Commission of Jinan central hospital affiliated to Shandong university and Jinan infectious disease hospital affiliated to Shandong university.