Incident SARS-CoV-2 Infection and a Shared Latrine

Del Brutto et al discuss their cohort study in Atahualpa, Ecuador which evaluated most adult villagers for factors associated with chronic diseases along the past 9 years. The SARS-Cov-2 pandemic struck Atahualpa in March 2020, as shown by an almost 3-fold excess mortality during April and May, and by a significant number of symptomatic cases. In a recent serosurvey, we found that the use of open latrines (instead of flushing toilet systems) was significantly associated with seropositivity to SARS-CoV-2 on lateral flow-based antibody testing suggesting a contributory role for fecal--oral transmission of the disease, as previously proposed by others.