Title of Manuscript: Prevalence of SARS- CoV-2 virus in saliva, stool, and urine samples of COVID-19 patients in Bihar, India

Introduction The coronavirus illness caused by SARS- CoV-2 can cause multiple organ involvement, with varying degrees of severity. Besides, inhalation as a route for transmission, feco-oral has also been proposed. Its transmission to sewage systems is a growing public health issue. Objective To detect SARS-CoV-2 RNA in non-respiratory samples (saliva, urine, and stool) collected from COVID-19 cases, in Bihar. Materials and methods This Cross-Sectional observational study was conducted from January 2021 to March 2022 on human non-respiratory samples. A total of 345 samples including saliva (116), stool (97), and urine (132) were collected from 143 covid-19 cases. Samples were analyzed for SARS-CoV-2 by multiplex RT-PCR targeted against E, ORF 1ab, and RdRp gene. Results In this study, out of 143 cases, a total of 107(74.8%) were positive for SARS-CoV-2 RNA in at least one of the non-respiratory samples. Conclusion There is a high prevalence of SARS-CoV-2 virus in non-respiratory samples.