Atypical signs in Covid-19

A study published in the April 13, 2020 issue of the International Forum of Allergy and Rhinology, a monthly, peer-reviewed medical journal, states that people with influenza-like symptoms and a dysfunction of smell and taste are strongly associated with Covid-19 infection.

We spoke to experts to find out what this strand of coronavirus is and what can be done now to stop the spread of the disease.

Signs & symptoms

Coronavirus is an RNA virus that was first detected in China in December 2019. Four months since, it has spread to many countries, infecting thirty lakh people in the world. The coronavirus 2019 (COVID-19) belongs to the coronavirus family which caused other contagions such as SARS in 2003 and MERS in 2012.

As per Dr D. P. Bansal, consultant pulmonary and critical care medicine, Olive Hospital, the important symptoms of Covid-19 are fever, dry cough, headache, body pain, sore throat.

“Also, sometimes the disease can present itself in a body with shortness of breath, which could indicate the more severe form of the Covid-19 infection,” he adds.

However, as per the doctor, about 80% of patients will have mild symptoms and need to be isolated in hospitals or at home to avoid transmitting the infections to others. About 15% of infected patients will suffer severe diseases such as pneumonia, requiring oxygen therapy and admission to hospitals.

Only 5% of the patients infected by the disease will be critically ill and require admission to critical care units or ICU. Additionally, Dr Bansal points out that people suffering from heart disease, chronic lung disease, diabetes, cancer and kidney disease are more vulnerable to the severe form of the infection, with high mortality.

The doctor then lists out the clinical signs in mild COVID-19 infections such as fever, congestion of the throat, increase in a patient’s heart rate, etc. “In case of severe infections, patients can suffer from pneumonia or respiratory failure owing to which the patient will be breathless, with reduced oxygen levels,” he explains.

“Critically ill patients will experience respiratory failure and will require ICU care including invasive and non-invasive ventilation, some of whom may even develop multiple organ dysfunction such as acute respiratory distress syndrome (ARDS), renal failure and shock. The multiple organ failure increases the mortality rate up to 60–70%.”

Diagnosing and treating

The gold standard test to confirm COVID-19 is real-time reverse transcription-polymerase chain reaction (RT-PCR) on the throat and nasal swabs of a patient suspected to have the infection.

“This test comes positive in about 70% of patients suffering COVID-19 infections. But it can still miss about 30% of those with the infection,” says Dr Bansal.
As per Dr Bansal, antibody testing may be a useful method for doing surveillance in the population to know the number of people infected. However, antibody testing is not yet available.

The doctor then points out that people with severe disease require getting admitted in hospitals for monitoring and oxygen therapy. However, according to the doctor, if these patients’ oxygen levels don’t improve with ventilatory support, the prone positioning and extracorporeal membrane oxygenation may be conducted on them.

“Unfortunately, while there is no definitive therapy for a Covid-19 patient, some drugs used in treatment include hydroxychloroquine with azithromycin, a lopinavir/ritonavir combination, ivermactin and remdesivir,” states Dr Bansal.

Incidentally, a very recent study from the USA has shown patients to recover faster with remdesivir. Even so, Dr Bansal is cautious. “There still need to be more studies using remdesivir to know its efficacy and mortality benefits,” he says.

The medical fraternity is also taking a cue from a few studies about the role of convalescent plasma therapy in severe Covid-19 patients.

The therapy uses antibodies found in the blood of convalesced patients, or patients who’ve recovered from an infection, to treat infected patients.

As per Dr Bansal, many centres in India have been using plasma therapy in critically ill Covid-19 patients, although the results are yet awaited.