Routes of Transmission

The fact that the majority of new infections occurred in close contacts of patients, such as household members, healthcare workers, or other patients who were not protected with contact or respiratory precautions, indicates that the virus is predominantly spread by droplets or by direct and indirect contact (CDC, Seto).

The presence of virus in the stool suggests the possibility of oral-fecal transmission (Drosten, Peiris 2003b). This is reminiscent of characteristics of other coronaviruses (Cho), and feces are therefore potentially an additional route of transmission. In the Amoy Gardens outbreak (see Chapter 4: Epidemiology, Hong Kong), the SARS virus may have been spread through the sewage systems of the buildings (for details, see Government of Hong Kong Special Administrative Region).