• Min Kang, Jianjian Wei, Jun Yuan, Juxuan Guo, Yingtao Zhang, Jian Hang, Yabin Qu, Hua Qian, Yali Zhuang, Xuguang Chen, Xin Peng, Tongxing Shi, Jun Wang, Jie Wu, Tie Song, Jianfeng He, Yuguo Li, and Nanshan Zhong.
• Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China (M.K., Y.Z., Y.Q., Y.Z., X.C., J.W., J.H.).
• Ann. Intern. Med. 2020 Dec 15; 173 (12): 974980974-980.

BackgroundThe role of fecal aerosols in the transmission of severe acute respiratory syndrome coronavirus 2 has been suspected.ObjectiveTo investigate the temporal and spatial distributions of 3 infected families in a high-rise apartment building and examine the associated environmental variables to verify the role of fecal aerosols.DesignEpidemiologic survey and quantitative reverse transcriptase polymerase chain reaction analyses on throat swabs from the participants; 237 surface and air samples from 11 of the 83 flats in the building, public areas, and building drainage systems; and tracer gas released into bathrooms as a surrogate for virus-laden aerosols in the drainage system.SettingA high-rise apartment building in Guangzhou, China.Participants9 infected patients, 193 other residents of the building, and 24 members of the building's management staff.MeasurementsLocations of infected flats and positive environmental samples, and spread of virus-laden aerosols.Results9 infected patients in 3 families were identified. The first family had a history of travel to the coronavirus disease 2019 (COVID-19) epicenter Wuhan, whereas the other 2 families had no travel history and a later onset of symptoms. No evidence was found for transmission via the elevator or elsewhere. The families lived in 3 vertically aligned flats connected by drainage pipes in the master bathrooms. Both the observed infections and the locations of positive environmental samples are consistent with the vertical spread of virus-laden aerosols via these stacks and vents.LimitationInability to determine whether the water seals were dried out in the flats of the infected families.ConclusionOn the basis of circumstantial evidence, fecal aerosol transmission may have caused the community outbreak of COVID-19 in this high-rise building.Primary Funding SourceKey-Area Research and Development Program of Guangdong Province and the Research Grants Council of Hong Kong.

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