Generic placeholder image

Infectious Disorders - Drug Targets


ISSN (Print): 1871-5265
ISSN (Online): 2212-3989


Shared Food, Meals and Drinks: 10 Arguments Suggesting an Oral Transmission Route of SARS-CoV-2

Author(s): Jean-Michel Wendling*, Aure Saulnier and Jean-Marc Sabatier

Volume 22, Issue 2, 2022

Published on: 16 July, 2021

Article ID: e160721194830 Pages: 5

DOI: 10.2174/1871526521666210716110603


Numerous observational, epidemiologic data have suggested that the risk of COVID19 is related to shared meals or drinks. The presence of ACE2 receptors in the gastrointestinal tract supports this hypothesis. Furthermore, several patients experience gastrointestinal symptoms without any respiratory disease. The SARS-CoV-2 found on food and packaging in China and the epidemic resurgence attributed to foods are also strong indications of an oral transmission route. Unprecedented biopersistence on skin, food, and beverages supports this theory. Finally, animal models reproducing the disease by oral inoculation are additional arguments in favor of an oro-digestive route of infection.

Keywords: SARS-CoV-2, COVID-19, contamination, digestive route, epidemiology, restaurants, food.

Waltenburg MA, Rose CE, Victoroff T, Butterfield M, Dillaha JA, Heinzerling A, et al, et al. Coronavirus Disease among Workers in Food Processing, Food Manufacturing, and Agriculture Workplaces. Emerg Infect Dis 2021 Jan; 27(1): 243-9.
Miller JS, Holshue M, Dostal TKH, Newman LP, Lindquist S. COVID-19 Outbreak Among Farmworkers — Okanogan County, Washington, May–August 2020. MMWR Morb Mortal Wkly Rep 2021 Apr 30; 70(17): 617-21.
Dyal JW, Grant MP, Broadwater K, Bjork A, Waltenburg MA, Gibbins JD, et al, et al. COVID-19 Among Workers in Meat and Poultry Processing Facilities ― 19 States, April 2020 MMWR Morb Mortal Wkly Rep [Internet] 2020 May 8 [cited 2021 Jun 4] 69(18) Available from:
Ming Z, Han S, Deng K, Reyes E, Ha Y, Kim S, et al , et al. Prevalence of SARS-CoV-2 Contamination on Food Plant Surfaces as Determined by Environmental Monitoring. J Food Prot 2021 Mar 1; 84(3): 352-8.
Ortiz-Prado E, Henriquez-Trujillo AR, Rivera-Olivero IA, Lozada T, Garcia-Bereguiain MA. High prevalence of SARS-CoV-2 infection among food delivery riders. A case study from Quito, Ecuador. Sci Total Environ 2021 May; 770: 145225.
Duy C, Nong VM, Van Ngo A, Doan TT, Nguyen TQ, Truong PT, et al, et al. Nosocomial Coronavirus Disease Outbreak Containment, Hanoi, Vietnam, March–April 2020. Emerg Infect Dis 2021 Jan; 27(1): 10-7.
COVID-19 virus found in imported frozen chicken wings_Notices-Shenzhen Government Online [Internet] [cited 2021 May 29] Available from:
Liu P, Yang M, Zhao X, Guo Y, Wang L, Zhang J, et al, et al. Cold-chain transportation in the frozen food industry may have caused a recurrence of COVID-19 cases in destination: Successful isolation of SARS-CoV-2 virus from the imported frozen cod package surface. Biosaf Health 2020 Dec; 2(4): 199-201.
Hamner L, Dubbel P, Capron I, Ross A, Jordan A, Lee J, et al, et al. High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice — Skagit County, Washington, March 2020. MMWR Morb Mortal Wkly Rep 2020 May 15; 69(19): 606-10.
Shen Y, Li C, Dong H, Wang Z, Martinez L, Sun Z , et al, et al. Community Outbreak Investigation of SARS-CoV-2 Transmission Among Bus Riders in Eastern China. JAMA Intern Med 2020 Dec 1; 180(12): 1665.
Kakimoto K, Kamiya H, Yamagishi T, Matsui T, Suzuki M, Wakita T. Initial Investigation of Transmission of COVID-19 Among Crew Members During Quarantine of a Cruise Ship — Yokohama, Japan, February 2020. MMWR Morb Mortal Wkly Rep 2020 Mar 20; 69(11): 312-3.
Hatzianastasiou S, Mouchtouri VA, Pavli A, Tseroni M, Sapounas S, Vasileiou C, et al, et al. COVID-19 Outbreak on a Passenger Ship and Assessment of Response Measures, Greece, 2020. Emerg Infect Dis 2021 May 12; 27(7)
Mahale P, Rothfuss C, Bly S, Kelley M, Bennett S, Huston SL, et al, et al. Multiple COVID-19 Outbreaks Linked to a Wedding Reception in Rural Maine — August 7–September 14, 2020. MMWR Morb Mortal Wkly Rep 2020 Nov 13; 69(45): 1686-90.
Ravindran B, Hogarth F, Williamson K, Wright R, Kirk M, Dalton C. High COVID-19 attack rate among attendees of wedding events in Bali, Indonesia, March 2020 Commun Dis Intell [Internet] 2020 Sep 16; [cited 2021 May 29](44) Available from:$File/high_covid_19_attack_rate_among_attendees_of_wedding_events_in_bali_indonesia_march_2020.pdf
Chau NVV, Hong NTT, Ngoc NM, Thanh TT, Khanh PNQ, Nguyet LA, et al, et al. Superspreading Event of SARS-CoV-2 Infection at a Bar, Ho Chi Minh City, Vietnam. Emerg Infect Dis 2021 Jan; 27(1): 310-4.
Kreidl P, Schmid D, Maritschnik S, Richter L, Borena W, Genger J-W, et al, et al. Emergence of coronavirus disease 2019 (COVID-19) in Austria. Wien Klin Wochenschr 2020 Nov; 132(21–22): 645-52.
Muller N, Kunze M, Steitz F, Saad NJ, Mühlemann B, Beheim-Schwarzbach JI, et al, et al. Severe Acute Respiratory Syndrome Coronavirus 2 Outbreak Related to a Nightclub, Germany, 2020. Emerg Infect Dis 2020 Feb; 27(2): 645-8.
Kang CR, Lee JY, Park Y, Huh IS, Ham HJ, Han JK, et al, et al. Coronavirus Disease Exposure and Spread from Nightclubs, South Korea. Emerg Infect Dis 2020 Oct; 26(10): 2499-501.
Sami S, Turbyfill CR, Daniel-Wayman S, Shonkwiler S, Fisher KA, Kuhring M, et al. Community Transmission of SARS-CoV-2 Associated with a Local Bar Opening Event — Illinois, February 2021. MMWR Morb Mortal Wkly Rep 2021 Apr 9; 70(14): 528-32.
Lentz RJ, Colt H, Chen H, Cordovilla R, Popevic S, Tahura S, et al, et al. Assessing coronavirus disease 2019 (COVID-19) transmission to healthcare personnel: The global ACT-HCP case-control study. Infect Control Hosp Epidemiol 2021 Apr; 42(4): 381-7.
Galmiche S, Charmet T, Schaeffer L, Grant R, Fontanet A, Paireau J, et al, et al. Etude des facteurs sociodémographiques, comportements et pratiques 42 associés à l’infection par le SARS-CoV-2 ComCor(49)
Fisher KA, Tenforde MW, Feldstein LR, Lindsell CJ, Shapiro NI, Files DC, et al. Community and Close Contact Exposures Associated with COVID-19 Among Symptomatic Adults 318 Years in 11 Outpatient Health Care Facilities — United States, July 2020. MMWR Morb Mortal Wkly Rep 2020 Sep 11; 69(36): 1258-64.
Schnake-Mahl AS, O’Leary G, Mullachery PH, Vaidya V, Connor G, Rollins H, et al, et al. Evaluating the impact of keeping indoor dining closed on COVID-19 rates among large US cities: a quasi-experimental design [Internet] Epidemiology; 2021 Apr [cited 2021 May 25] Available from:
van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med 2020 Apr 16; 382(16): 1564-7.
Chin AWH, Chu JTS, Perera MRA, Hui KPY, Yen H-L, Chan MCW, et al, et al. Stability of SARS-CoV-2 in different environmental conditions. Lancet Microbe 2020 May; 1(1): e10.
Kwon T, Gaudreault NN, Richt JA. Seasonal Stability of SARS-CoV-2 in Biological Fluids. Pathogens 2021 Apr 30; 10(5): 540.
Castrica M, Balzaretti C, Miraglia D, Lorusso P, Pandiscia A, Tantillo G, et al, et al. Evaluation of the persistence of SARS-CoV-2 (ATCC® VR-1986HKTM) on two different food contact materials: flow pack polyethylene and polystyrene food trays. LWT 2021 Jul; 146: 111606.
Abrahão JS, Sacchetto L, Rezende IM, Rodrigues RAL, Crispim APC, Moura C, et al. Detection of SARS-CoV-2 RNA on public surfaces in a densely populated urban area of Brazil: A potential tool for monitoring the circulation of infected patients. Sci Total Environ 2021 Apr; 766: 142645.
Montagna MT, De Giglio O, Calia C, Pousis C, Apollonio F, Campanale C, et al, et al. First Detection of Severe Acute Respiratory Syndrome Coronavirus 2 on the Surfaces of Tourist-Recreational Facilities in Italy. Int J Environ Res Public Health 2021 Mar 21; 18(6): 3252.
Mouchtouri VA, Koureas M, Kyritsi M, Vontas A, Kourentis L, Sapounas S, et al, et al. Environmental contamination of SARS-CoV-2 on surfaces, air-conditioner and ventilation systems. Int J Hyg Environ Health 2020 Sep; 230: 113599.
Luo L, Liu D, Zhang H, Li Z, Zhen R, Zhang X, et al, et al. Air and surface contamination in non-health care settings among 641 environmental specimens of 39 COVID-19 casesAbd-Alla AMM, editor. PLoS Negl Trop Dis. 2020 Oct 9;14(10):e0008570.
Lui G, Lai CKC, Chen Z, Tong SLY, Ho WCS, Yeung ACM, et al. SARS-CoV-2 RNA Detection on Disposable Wooden Chopsticks, Hong Kong. Emerg Infect Dis 2020 Sep; 26(9): 2274-6.
Blondin-Brosseau M, Harlow J, Doctor T, Nasheri N. Examining the persistence of human Coronavirus 229E on fresh produce. Food Microbiol 2021 Sep; 98: 103780.
Dai M, Li H, Yan N, Huang J, Zhao L, Xu S, et al, et al. Long-term Survival of SARS-CoV-2 on Salmon as a Source for International Transmission. J Infect Dis 2021 Feb 13; 223(3): 537-9.
Harbourt DE, Haddow AD, Piper AE, Bloomfield H, Kearney BJ, Fetterer D, et al, et al. Modeling the stability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on skin, currency, and clothing. Murray KO, editor PLoS Negl Trop Dis. 2020; p. (11): e0008831.
Walker GJ,, Clifford V, Bansal N, Stella AO, Turville S, Stelzer-Braid S, et al. SARS-CoV-2 in human milk is inactivated by Holder pasteurisation but not cold storage J Paediatr Child Health 2020 Dec; 56(12): 1872-4.
Fukuta M, Mao ZQ, Morita K, Moi ML. Stability and Infectivity of SARS-CoV-2 and Viral RNA in Water, Commercial Beverages, and Bodily Fluids. Front Microbiol 2021 May 5; 12: 667956.
Lin L, Jiang X, Zhang Z, Huang S, Zhang Z, Fang Z, et al. Gastrointestinal symptoms of 95 cases with SARS-CoV-2 infection. Gut 2020 Jun; 69(6): 997-1001.
Xiao F, Tang M, Zheng X, Liu Y, Li X, Shan H. Evidence for Gastrointestinal Infection of SARS-CoV-2. Gastroenterology 2020 May; 158(6): 1831-1833.e3.
Lamers MM, Beumer J, van der Vaart J, Knoops K, Puschhof J, Breugem TI, et al, et al. SARS-CoV-2 productively infects human gut enterocytes. Science 2020 Jul 3; 369(6499): 50-4.
Petrillo M, Brogna C, Cristoni S, Querci M, Piazza O, Van den Eede G. Increase of SARS-CoV-2 RNA load in faecal samples prompts for rethinking of SARS-CoV-2 biology and COVID-19 epidemiology. F1000Research 2021 May 11; 10: 370.
Song Y, Liu P, Shi XL, Chu YL, Zhang J, Xia J, et al, et al. SARS-CoV-2 induced diarrhoea as onset symptom in patient with COVID-19. Gut 2020 Jun; 69(6): 1143-4.
Ghimire S, Sharma S, Patel A, Budhathoki R, Chakinala R, Khan H, et al, et al. Diarrhea Is Associated with Increased Severity of Disease in COVID-19: Systemic Review and Metaanalysis. SN Compr Clin Med 2021 Jan; 3(1): 28-35.
Almario CV, Chey WD, Spiegel BMR. Increased Risk of COVID-19 Among Users of Proton Pump Inhibitors. Am J Gastroenterol 2020 Oct; 115(10): 1707-15.
Sun S-H, Chen Q, Gu H-J, Yang G, Wang Y-X, Huang X-Y, et al, et al. A Mouse Model of SARS-CoV-2 Infection and Pathogenesis. Cell Host Microbe 2020 Jul; 28(1): 124-133.e4.
Lee AC-Y, Zhang AJ, Chan JF-W, Li C, Fan Z, Liu F, et al, et al. Oral SARS-CoV-2 Inoculation Establishes Subclinical Respiratory Infection with Virus Shedding in Golden Syrian Hamsters. Cell Rep Med 2020 Oct; 1(7): 100121.
Hartman AL, Nambulli S, McMillen CM, White AG, Tilston-Lunel NL, Albe JR, et al. SARS-CoV-2 infection of African green monkeys results in mild respiratory disease discernible by PET/CT imaging and shedding of infectious virus from both respiratory and gastrointestinal tracts. Pekosz A, editor PLOS Pathog. 2020.(9): :e1008903.
Zhang C, Guo Z, Zhao Z, Wang T, Li L, Miao F, et al, et al. SARS-CoV-2 Aerosol Exhaled by Experimentally Infected Cynomolgus Monkeys. Emerg Infect Dis 2021 Jul; 27(7): 1979-81.
Lio CF, Cheong HH, Lei CI, Lo IL, Yao L, Lam C, et al, et al. Effectiveness of personal protective health behaviour against COVID-19. BMC Public Health 2021 Apr 29; 21(1): 827.
Rodríguez-Barranco M, Rivas-García L, Quiles JL, Redondo-Sánchez D, Aranda-Ramírez P, Llopis-González J, et al, et al. The spread of SARS-CoV-2 in Spain: Hygiene habits, sociodemographic profile, mobility patterns and comorbidities. Environ Res 2021 Jan; 192: 110223.

© 2023 Bentham Science Publishers | Privacy Policy