SARS-CoV-2, faecal shedding and our duty to schools 

Christopher J Butcher from Eastern Michigan University in the US, says that most of the arguments for reopening schools in the autumn have validity. However, one aspect is currently being overlooked – the toilet situation.

_{There is good evidence that faecal shedding is a major source of SARS-CoV-2 spread. The deciding factor on whether schools can and should be safely opened depends on how this situation is handled. Images: balabolka/123rf}

Faecal shedding is present in infected people who have symptoms, as well as those who are asymptomatic. According to research, six to ten days after nose-swab tests are found to be negative, infected patients are still shedding SARS-CoV-2 RNA in their faeces (Chen, 2020).

This can be further exacerbated by the understanding that asymptomatic infected individuals, who have no obvious reason to be tested, are shedding the virus in their faeces for the better part of a month. Research shows that since the virus can remain viable and infectious in aerosols for hours and on surfaces for days, transmission via these routes is plausible (Asadi, 2020). 

In addition to every surface, top and bottom, even the toilet paper, soap and hand towels, sinks, mirrors, floors, ceilings – in short, everything – is required to be discrete between uses, even the air in the bathroom. It is a matter of utmost efficacy that every square inch of every surface of every lavatory is completely sanitised of viral load after every use. Since the virus can remain viable and infectious for days, this means it can survive in cubicles over a weekend.

Among the many standard operating procedures (SOP) that should be developed in schools are: flow dynamics – the physical route of the child from classroom to toilet and back to classroom, the number of children allowed to go at a given time, sanitisation concerns and the source of the funds for sanitising products and cleaning works.

There must be a strict one-at-a-time discrete excretion rule, with a thorough sanitisation after each deposit. The average child visiting the toilet will not have the correct professional experience to perform a proper wipe-down, so there should be an attendant for each toilet in each school. On a national scale, this adds up to a large number of new employees with specific job descriptions needed to be taken on and trained in a short period of time.

The one-at-a-time concept alone can cause the full reopening of schools in a second wave to be easily considered a wrong and dangerous direction of action to exposing the youth of our nations. How do administrators develop and implement the proper SOP needed to ensure no cross-contamination? There needs to be an entire committee immediately convened and dedicated to figuring out the safest lavatory usage schedule, for students and staff alike.

For argument’s sake let us assume that the average toilet ‘visit’ takes ten minutes, and a thorough scrub down of every surface and sanitisation of the air takes, at the very least, another ten minutes. Let us assume we have 1,000 children who all visit the toilet once in a day. At 20 minutes per child, this means that 20,000 minutes are dedicated to usage and cleaning per day. If there are four toilets in the school, that gives us about 83 hours a day spent on using and sanitising each toilet.

We also need to consider how we can safely arrange the children waiting to use the toilets. We cannot simply have the children form a queue in front of them, owing to social distancing guidelines. And standing in the hallway for that extended period of time defeats the purpose of opening schools up in the first place, by increasing spread potential.

Then there are the decisions about the logistics of who can go and when – should there be a rota system based on age or gender? What if the child does not need to go, even if it is their turn?

As a result, the process of faecal shedding could overpower and undo every other preventative countermeasure implemented.

Everyone wants to return to business as usual, or something similar. We still believe that educating our children is a worthwhile investment and we all agree that schools should begin operations, as soon as it is possible to do so safely. However, the fatal flaw in the US pandemic response in particular, is a failure to acknowledge that fighting SARS-CoV-2 has to be a collective effort. One of the most important factors for re-opening schools in an intelligent manner therefore, should be how we decide to approach the faecal shedding issue.

Sources

Asadi, S. (2020). The coronavirus pandemic and aersols: Does COVID-19 transmit via expiratory particles? Aersol Science and Technology, 635-638.

Chen, Y. (2020, 07 17). The present of SARS-COV-2 RNA in the feces of COVID-19 patients. Retrieved from Pubmed