Fecal viral shedding in COVID-19 patients: Clinical significance, viral load dynamics and survival analysis

•Fecal SARS-CoV-2 was relevant to milder condition and better radiological recovery.•The first attempt of using a survival analysis for SARS-CoV-2 RNA duration.•SARS-CoV-2 RNA survival in feces was significantly longer than in oropharyngeal swabs.•In spite of the negative oropharyngeal swabs, Fecal viral load easily rebounded. To investigate the clinical significance, viral shedding duration and viral load dynamics of positive fecal SARS-CoV-2 signals in COVID-19. COVID-19 patients were included. SARS-CoV-2 RNA was tested in stool and respiratory specimens until two sequential negative results were obtained. Clinical, laboratory and imaging data were recorded. Of the 69 COVID-19 patients, 20 (28.99 %) had positive fecal viral tests who were younger, had lower C-reactive protein (CRP) and fibrinogen (FIB) levels on admission (all P < 0.05), and showed more improvement and less progression on chest CT during recovery. The median duration of positive viral signals was significantly longer in stool samples than in respiratory samples (P < 0.05). In spite of the negative oropharyngeal swabs, eleven patients were tested positive for viral RNA in stool specimens, with their fecal SARS-CoV-2 RNA Ct (cycle threshold) values reaching 25–27. 6 of these 11 patients' Ct values rebounded. SARS-CoV-2 RNA in stool specimens was associated with a milder condition and better recovery of chest CT results while the median duration of SARS-CoV-2 RNA persistence was significantly longer in fecal samples than in oropharyngeal swabs. The fecal viral load easily reached a high level and rebounded even though respiratory signals became negative.