Abstract
Background: The novel coronavirus disease 2019 (COVID-19) is a global pandemic generated by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The primary infection site is mucosal surfaces, mainly the lungs and the intestine, where epithelial cells can be infected. COVID-19 has spread throughout the world, causing millions of deaths and hundreds of millions of confirmed infections. Despite the global spread of SARS-CoV-2, there are extreme differences between countries in mortality rates and confirmed infections.Methods: Pearson correlations and a t-test were performed on data from 137 countries in order to test the correlation between number of deaths from diarrheal diseases (pre-COVID-19 pandemic data) as a marker for countries’ sanitation level, and the number of confirmed COVID-19 cases and deaths per million.Results: It was found that countries’ prevalence of confirmed COVID-19 cases and deaths per million are statistically correlated with their sanitation level.Conclusions: The hypothesis proposed in this article is that the low mortality rates from COVID-19 in countries where the level of sanitation is low are due to fecal-oral infection of the population by SARS-CoV-2, rather than infection of the respiratory system. This hypothesis is supported by the protective effect of the low sanitation level presented in this work and the fact that lung infection by SARS-CoV-2 can cause severe pathology, while infection in the intestine generally causes minor or no symptoms.
Highlights
Coronaviruses constitute a large family of enveloped, positive-sense, single-stranded RNA viruses that cause diseases in mammals and birds [1]
Data for 14 countries with fewer than 600 confirmed COVID-19 cases per million were not included, in order to avoid countries in which COVID-19 did not spread in the population due to radical government intervention and avoid countries in which COVID-19 cases may not be monitored satisfactorily due to lack of test kits for SARS-CoV-2
It is suggested that fecal-oral infection with SARS-CoV-2 is more common under low sanitation conditions than respiratory infection, and that a high proportion of those who are infected with the virus via the fecal-oral route are asymptomatic
Summary
Coronaviruses constitute a large family of enveloped, positive-sense, single-stranded RNA viruses that cause diseases in mammals and birds [1]. Four strains are endemic globally and cause only mild upper respiratory tract diseases, and three result in severe infections. These strains include the Middle East respiratory syndrome coronavirus (MERS-CoV), the severe acute respiratory syndrome coronavirus (SARS-CoV), and the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [2]. SARS-CoV-2 is a novel coronavirus that emerged in late 2019 in China and quickly spread throughout the world, causing the novel coronavirus disease 2019 (COVID-19). This virus has to date resulted in the confirmed infection of hundreds of millions and in the death of millions worldwide [3]. Despite the global spread of SARS-CoV-2, there are extreme differences between countries in mortality rates and confirmed infections
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
