Can COVID-19 be transmitted via urine and what precautions need to be taken for urine drug screening and office urinalysis? 

Posted on May 29, 2020 by Madalon Burnett

Summary

There are two case reports to suggest that COVID-19 can be found in urine specimens. Consider holding urine screening during the pandemic if possible, or finding alternatives to urine screening. If urine screening is necessary, make sure that staff remain 6 ft away from patients and use standard laboratory precautions for handling samples (gloves, gown, face shield or eye protection). 

I.   Empiric Evidence

  • A Chinese study tested 72 samples of urine in patients with confirmed COVID-19 illness and found no viral RNA (1)
  • One case report from China reports viable COVID-19 in urine (2)
  • One case report from China reports COVID-19 RNA found in urine (3)

II.   Guidelines and Recommendations

  • The CDC states that “ It is not yet known whether other non-respiratory body fluids from an infected person including vomit, urine, breast milk, or semen can contain viable, infectious SARS-CoV-2” (4)
  • The American Society for Microbiology says: “Clinical laboratories performing routine hematology, urinalysis and clinical chemistry studies—and microbiology laboratories performing diagnostic tests on serum, blood or urine specimens—should follow standard laboratory practices, including Standard Precautions when handling potential COVID-19 specimens.” (5)
  • Dr Jim Nichols in a Journal of Applied Laboratory Medicine podcast says: “As we deal with plasma, serum, standard urine samples in the laboratory, blood samples, these tend to be lower risk and our standard precautions of gloves, a gown, a face shield or an eye gear, that protective equipment seems sufficient to protect us.” (6)

III.   Considerations for Urine Sampling

  • The American Society of Addiction Medicine makes the following recommendations (7):
    • Consider pausing urine drug testing in clinical practice
    • Alternatives to drug testing:
      • If feasible for both the patient and provider, daily virtually observed self-administration of  addiction treatment medications via a video telehealth platform may be an alternative.
      • With patient consent, involve loved ones or other family members in helping support the patient and their medication adherence.
      • Increase the frequency of phone or other telehealth contacts with patients who may be struggling.
      • Reduce the amount of medication provided at a time and consider the use of alternate medication delivery options if increased in-person visits poses too high a risk in terms of COVID transmission.
      • Patient self-reported substance use.
      • Frequent query of the prescription drug monitoring program.
    • Precautions for necessary drug testing: 
      • Having sufficient PPE for staff collecting samples.
        • This may include face masks, face shields, gowns, and gloves, depending on resources, environmental context, and transmission risk.
      • Using low-cost testing metrics to identify sample alteration or dilution (e.g. urine creatinine and pH) to avoid need for observed sample collection.
      • Workflows that maintain 6 feet physical distance between staff and patients.
      • Ensuring space large enough to allow for 6 feet physical distance between patients who may be waiting to provide a sample.
      • Sanitizing collection areas between each patient.
    • Explore options for drug testing at a distance
      • Collecting specimens for drug testing outside the treatment facility
      • Drug testing from home

Questions? Comments? Does this need to be updated? Do you have valuable points to add ? Please email ask.reakt@ubc.ca.

References

  1. Wang W, Xu Y, Gao R, Lu R, Han K, Wu G, et al. Detection of SARS-CoV-2 in Different Types of Clinical Specimens. JAMA [Internet]. 2020 Mar 11 [cited 2020 May 29]; Available from: https://jamanetwork.com/journals/jama/fullarticle/2762997
  2. ‌Isolation of infectious SARS-CoV-2 from urine of a COVID-19 patient [Internet]. Emerging Microbes & Infections. 2020 [cited 2020 May 29]. Available from: https://www.tandfonline.com/doi/full/10.1080/22221751.2020.1760144
  3. Peng L, Liu J, Xu W, Luo Q, Deng K, Lin B, et al. 2019 Novel Coronavirus can be detected in urine, blood, anal swabs and oropharyngeal swabs samples. 2020 Feb 25 [cited 2020 May 29]; Available from: https://www.medrxiv.org/content/10.1101/2020.02.21.20026179v1
  4. CDC. Clinical Questions about COVID-19: Questions and Answers [Internet]. Centers for Disease Control and Prevention. 2020 [cited 2020 May 29]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html#Transmission
  5. Novel Coronavirus Lab Protocols and Responses: Next Steps | ASM.org [Internet]. ASM.org. 2020 [cited 2020 May 29]. Available from: https://asm.org/Articles/2020/February/Next-Steps-for-Novel-Coronavirus-Medical-Laborator
  6. A Laboratory Risk Assessment during the Coronavirus (COVID-19) Pandemic | AACC.org [Internet]. Aacc.org. 2020 [cited 2020 May 29]. Available from: https://www.aacc.org/publications/the-journal-of-applied-laboratory-medicine/jalm-talk/2020/laboratory-risk-assessment-during-the-coronavirus-covid19-pandemic
  7. ‌Adjusting Drug Testing Protocols [Internet]. Asam.org. 2020 [cited 2020 May 29]. Available from: https://www.asam.org/Quality-Science/covid-19-coronavirus/adjusting-drug-testing-protocols

Disclaimer

The above is intended to serve as a rapidly-created, accessible source of information curated by medical students and healthcare professionals. It is for educational purposes only and is not a complete reference resource. It is not professional medical advice, and is not a substitute for the discretion, judgment, and duties of healthcare professionals. You are solely responsible for evaluating the information above.