There is a lot the medical community is learning about the new coronavirus, including symptoms that manifest in patients and what those symptoms may mean in terms of severity of its disease, COVID-19. While this is considered a respiratory disease, an April 17 article in Science Magazine by the American Association for the Advancement of Science points out the new coronavirus can cause destruction through multiple organs and symptoms. “[The disease] can attack almost anything in the body with devastating consequences,” said cardiologist Harlan Krumholz of Yale University and Yale-New Haven Hospital, who is quoted in the article, and is leading multiple efforts to gather clinical data on COVID-19. “Its ferocity is breathtaking and humbling.”
By April 21, there have been more than three quarters of a million cases of COVID-19 in the U.S., and over 2.5 million worldwide, killing 172,000 globally.
Dr. Hari Nallapaneni, chief medical officer at CareSTL Health, said symptoms they screen for include fever, shortness of breath and cough, and the screening questions are crucial to determining a person’s risk of COVID-19 exposure and possible illness.
“One of the main things I really wanted to make sure in the questionnaire that they ask is to make sure we identify somebody who is not very critically ill,” Nallapaneni said. “We want to make sure that we don’t have anyone who is clinically unstable, coming through the drive through.”
Nallapaneni, a cardiologist, said there are other big killer diseases out there, like influenza, heart attack, pulmonary embolism, aortic dissection. The most common COVID-19 symptoms – fever, cough, shortness of breath, are the three things that most of the driving centers use as a questionnaire. He said it’s also important is how this disease is impacting the heart.
“I am seeing some reports where it is causing elevation of cardiac enzymes, elevation of CHO peptide and there is an association where it can cause a cardiomyopathy type of symptoms. A heart failure type of symptoms,” Nallapaneni said.
There are also some early descriptions of COVID-19 causing uncommon neurological effects.
“Sometimes patients can have confusion or a disturbed state of consciousness from the systemic involvement, especially if the oxygen level is low,” Dr. Raymond Roos, professor of Neurology at the University of Chicago in Illinois, said in the April 17 article in Medscape Neurology.
In The Hospitalist on April 6, neurologist Dr. Robert Stevens at Johns Hopkins School of Medicine in Baltimore said most COVID-19 patients have had a normal neurological presentation, however, “Abnormal neurological findings we have seen include loss of smell and taste sensation, and states of altered mental status including confusion, lethargy, and coma.”
“I think we are still learning a lot about it and when the whole pandemic comes to a cycle and all the reports are put together, we will have a complete idea of what all these symptoms are and what it means for us,” Nallapaneni said.
He said it is well documented from ophthalmologists in China that COVID-19 can affect the eyes, with early patients going to doctors with eye inflammation or conjunctivitis.
“At this time, yes, all these reports are accurate, but when we go back and do introspective analysis, then we’ll have a much better idea what these symptoms are and also what it means in terms of clinical significance,” Nallapaneni said.
Symptoms to look out for have changed a bit since the beginning of the pandemic. COVID-19 Coronavirus symptoms that appear two to 14 days after exposure from posted at CDC.gov now include fever, cough, shortness of breath or difficulty breathing; chills, shaking with chills; muscle pain, headache, sore throat, and new loss of taste (hypogeusia) or smell (anosmia).
“Even if we take a step back, flu and most wider symptoms, typically have all those things, like upper respiratory tract infection, which also includes having a slight inflammation of the eyes – you have irritation, watering of the eyes, definitely part of the syndrome which is not uncommon to see in respiratory symptoms,” Nallapaneni said.
Eye irritation is also common among allergy sufferers. Fever or having a high body temperature is the symptom Nallapaneni said almost all COVID-19 patients experience.
“Ninety nine percent, according to the literature, do report temperature,” he said. He said that is why the protocol for visitors and staff at CareSTL Health gets a temperature check before they go inside the building.
“One reasons I think that fever is a good way to screen is that fever is objective,” he said. “You check it and it gives you a number and you know where the number is.”
Last week, one of the CareSTL Health COVID-19 testing sites temporarily halted testing after one employee at that location tested positive for COVID-19. Nallapaneni said while they don’t know how this person may have contracted the new coronavirus, all 42 employees at the site were tested.
Nallapaneni said, “I am very happy to report that all the employees we tested came back negative.”
