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Is diarrhea a symptom of COVID-19?

By LAI S. REYES, The Philippine STAR Published Apr 13, 2021 5:00 am

Red or purple lesions on patients’ hands and feet, rashes and hair fall. These symptoms, strange as they seem, reinforce what medical experts around the world have come to realize: The coronavirus is “capable of causing more than a respiratory illness; it can launch a full-body attack.”

And yes, the dreaded virus could hit your gastrointestinal (GI) tract in no time. When it does, expect some mild to moderate tummy trouble as common as diarrhea.

How does it happen?

According to Dr. Tony Galang, the immediate past president of the Philippine Society of Gastroenterology (PSG), the SARS-CoV 2 virus that causes COVID-19 typically enters the body through our nose and into the lungs, “particularly by binding ACE2 receptors found lining the digestive respiratory system.”

The other GI symptoms of COVID-19 include anorexia or loss of appetite, vomiting, nausea, abdominal pain and even bleeding.

“However, these receptors are also found elsewhere,” the amiable doctor explains. “In our digestive system, these receptors are represented in the esophagus, bile ducts and small intestinal cells. This explains why gastrointestinal symptoms like diarrhea have been reported to be present in COVID-19 patients (about three to 79 percent).”

The other GI symptoms of COVID-19 include anorexia or loss of appetite, vomiting, nausea, abdominal pain and even bleeding.

Keep your gut healthy

As common as it may seem, diarrhea remains a worldwide problem. And, despite the availability of a simple treatment solution, it accounts for eight percent of childhood deaths worldwide.

“In COVID, diarrhea is the most common GI symptom in both children and adults, with a mean duration of four days,” explains Dr. Galang. “Just like any other viral causes of diarrhea, it should be self-limiting (which means it stops by itself), not bloody, and is typically not explosive or so voluminous as to cause dehydration, as is seen in some infectious causes of diarrhea from bacterial infection.”

If you have a healthy digestive system, you won’t be knocked down easily by the coronavirus.

“A healthy digestive system ensures that the rest of the body organs are performing well,” adds Dr. Galang.

  Dr. Augusto Galang

The main function of our digestive system is to metabolize and break down complex food compounds into readily available forms of energy that the rest of the body needs to function adequately.

“However, the digestive system performs many other tasks aside from mere digestion of food,” he notes.

These include detoxification of potentially harmful ingested substances, entrapment and subsequent neutralization of disease-causing microorganisms through its inherent immune system capability, reabsorption of body fluids, electrolytes and other nutrients to help maintain overall balance and adequate body hydration, etc.

“An unhealthy digestive system makes the whole body weak without sufficient energy to function. It may cause an increased risk for systemic infection and makes us prone to develop significant illnesses like heart, kidney and endocrine disease like diabetes, etc.,” he warns.

The first line of defense

According to Dr. Galang, our digestive system offers several layers of protection from getting infection.

“However, it is still good practice to follow the minimum health standards of protection to stay away from getting infected. Regular, effective hand-washing practices, particularly before eating and preparing food, and of course, after coming from the toilet,” he advises.

During this pandemic, we cannot overemphasize the importance of physical distancing, especially during mealtime (when we take off our face masks).

“Avoid talking during meals to prevent aerosol generation,” he adds.

It is advisable that patients who are confirmed infected — even those suspected to have COVID — should stay isolated with toilet provisions for his/her exclusive use.

When asked if the virus can be transmitted fecal-orally, Dr. Galang replies: “It has been reported that viral RNA has been detected in feces in up to 30 percent of patients from day five after onset of COVID-19 symptoms and up to four to five weeks in moderate cases. However, the significance of fecal viral shedding for disease transmission has not been clearly established. But we still advise the public with precautions against this possibility.”

And so it is advisable that patients who are confirmed infected — even those suspected to have COVID — should stay isolated with toilet provisions for his/her exclusive use.

“Sharing the toilet and toiletries is not recommended to prevent possible disease transmission,” says Dr. Galang, who was one of the key speakers during the recent Philippine Digestive Health Week media briefing via Zoom.

Malusong na tiyan, masiglang katawan’

A board-certified gastroenterologist and digestive endoscopist practicing in Angeles City, Dr. Galang has been serving as the head physician of the NGAC (South) Task Force Save Haven COVID Temporary Treatment and Monitoring Facility in New Clark City in Capas, Tarlac, since the pandemic struck last year.

As an advocate of promoting digestive health, Dr. Galang is personally continuing the gains that the PSG has recently accomplished during the observance of the 2021 Philippine Digestive Health Week last March 7-13, as officially declared by President Rodrigo Duterte via Proclamation No. 930.

With the Department of Health (DOH) taking the lead, the theme “Empowering the Filipino to care for their digestive health” and proactive slogan “Malusong na Tiyan, Masiglang Katawan,” the event was held in collaboration with the Philippine Society of Digestive Endoscopy and the Hepatology Society of the Philippines, along with several other medical societies caring for patients with digestive disease.

During the observance of the PDHW, Dr. Galang, together with Dr. Marilou Tan, president of the Philippine Society for Pediatric Gastroenterology, Hepatology & Nutrition; Dr. Roberto De Guzman, president of the Hepatology Society of the Philippines; and Dr. Clarito Cairo Jr., medical officer IV, Disease Prevention and Control Bureau, DOH, urge Filipinos to take a proactive role in caring for their digestive health as colorectal cancer, liver cancer, peptic ulcer disease, stomach cancer and diarrhea are among the leading causes of sickness and death in the country.

Dr. Galang shares tips on how to keep our digestive system healthy:

Have a balanced diet. A balanced diet is the most effective way to keep our digestive system healthy. Cut down on red meat and processed food.

Wash raw food items. Cook food well. Store food properly.

Talk to your doctor about probiotics.

Exercise daily. Engaging in physical activities helps ensure good blood circulation and frequent stimulation of the gut.

Drink moderately.

Don’t self medicate. Self-medicaton may have deleterious effects on the liver and alimentary tract.

Try to maintain a stress-free life. It keeps our digestive functions at bay.

Manage non-modifiable risk factors associated with some digestive diseases. Early detection saves lives.

Hand hygiene should be observed to reduce transmission of microbes that cause diarrhea.