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COVID-19 in gastroenterology: a clinical perspective
  1. John Ong1,2,
  2. Barnaby Edward Young3,4,
  3. Sharon Ong5,6
  1. 1 Department of Engineering, University of Cambridge, Cambridge, UK
  2. 2 Department of Medicine, National University of Singapore, Singapore
  3. 3 National Centre for Infectious Diseases, Singapore
  4. 4 Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
  5. 5 Department of Anaesthesia & Intensive Care, Singapore General Hospital, Singapore
  6. 6 Duke-NUS Medical School, Singapore
  1. Correspondence to Dr John Ong, University of Cambridge Department of Engineering, Cambridge CB2 1PZ, UK; jo401{at}

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We read with interest the article ‘Diarrhoea may be underestimated: a missing link in 2019 novel coronavirus’ by Liang et al.1 Indeed, we agree with the authors that diarrhoea may be an underestimated and under-reported symptom of coronavirus disease 2019 (COVID-19). Similar to data from China, fever and cough are the two most commonly reported symptoms of COVID-19 in Singapore; around 30% of cases were afebrile, which may have been due to intensive efforts at contact tracing.2 3 In contrast, while gastrointestinal symptoms appear to be infrequent in China (nausea and vomiting: 5.0% and diarrhoea: 3.7%), 17% of patients with COVID-19 in Singapore reported diarrhoea.3 Interestingly, SARS-CoV2 RNA was detected in 50% of patients’ stool samples but was not clearly associated with abdominal symptoms. In those with detectable faecal virus RNA, approximately half had diarrhoea and half had normal stool consistency.

Besides the gut, studies suggest SARS-CoV2 also affects the liver.4–6 In a study of 148 infected …

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