COVID-19: Symptoms, Complaints, Signs

The following symptoms and complaints may indicate SARS-CoV-2 (novel coronavirus: 2019-nCoV) or COVID-19 (corona virus disease 2019):

• Prodromal symptoms (precursor symptoms).
  • Fever > 38 °C, chills (98.6%) (on admission to hospital: 43.8%; during hospitalization: 88.7%)Note: some patients experience nausea (nausea) and diarrhea (diarrhea) before the onset of fever
  • General feeling of illness
  • Myalgia (muscle pain)
  • Arthralgia (pain in the limbs)
  • Sore throat
  • Anorexia (loss of appetite)
  • Fatigue (tiredness) (69.6%)
• Median time from first symptom to dyspnea was approximately 5 days
  • Dry cough (59.4%) (67.8%).
  • Dyspnea* (shortness of breath; shortness of breath), possibly also tachypnea (increased breathing; more than 20 breaths/min) (19%)

* In a meta-analysis, dyspnea was the only symptom significantly associated with both severe illness (pOR 3.70, 95% CI 1.83 – 7.46) and ICU admission (pOR 6.55, 95% CI 4.28 – 10.0) and was more strongly associated with the latter. Note: Infection is asymptomatic in most cases or with mild symptoms in 80.9% of cases. Note: Pulse oximeter (measurement of oxygen saturation (SpO₂) of arterial blood as well as pulse rate) may sometimes show early decreased oxygen saturation unnoticed by patients. Other possible symptoms

• Conjunctivitis (inflammation of the conjunctiva) (0.8%).
• Hemoptysis (coughing up blood)
• Stuffy nose (rare)
• Neurologic symptoms (36.4% of patients; with severe symptoms, 45.5%)
  • Cephalgia (headache)
  • Dysosmia (olfactory dysfunction): hypo- to anosmia (decreased to absent sense of smell) (postviral olfactory dysfunction) – In South Korea, 30 percent of patients who tested positive for the virus with mild symptoms reported anosmia as one of their main symptoms.
    • In a survey of patients at the University Hospital of Milan, 34% of this group of patients reported a disorder of the sense of smell or taste; 19% reported both.
  • Olfactory and gustatory impairments (olfactory and gustatory impairments):
    • 41% of patients have olfactory impairments and.
    • 38.2% gustatory impairments.
  • Meningitis (meningitis)/encephalitis (brain inflammation) (case report).
• Gastrointestinal symptoms (gastrointestinal distress) (estimated: approximately 10% of COVID-19 patients; more common in children).
  • Abdominal pain (abdominal discomfort)
  • Diarrhea (diarrhea) (rare) (3.8%)
  • Nausea/vomiting
• Cardiovascular symptoms (cardiovascular symptoms) are prominent in patients with cardiac damage, rather than the usual symptoms such as fever or cough:
  • Angina pectoris (“chest tightness”; sudden pain in the heart area).
  • Palpitations (heart palpitations)
  • Syncope (brief loss of consciousness) – patients with syncope or even falling without external cause were SARS-CoV-2 positive in about 24% of cases.
• Dermatologic symptoms (approximately 20% of patients).
  • Maculopapular lesions (patchy and with papules, i.e., vesicles; 47% of patients): lesions perifollicular with varying degrees of scaling, sometimes resembling pityriasis rosea (rose lichen)
  • Acral (“belonging to the extremities ends”) erythematous swellings (“accompanied by skin redness”) with some vesicles (fluid-filled vesicles) and pustules (pustules; 19% of patients): asymmetrically on the hands and feet frostbump-like changes (pseudo-chilblain; pseudo-frostbump); formation in the later course of the disease (on average after 12.7 days)
  • Urticular lesions (wheals; 19% of patients): localizations: Trunk and in some cases palmar
  • Livedo (livid discoloration of the skin) or necrosis (tissue damage due to death of cells; 6% of patients): localization trunk and acra due to ischemia (reduced blood flow); clinical picture like occlusive vascular disease (occlusive disease); mortality (mortality rate): 10%.

Note: The upper respiratory tract seems to be affected less frequently than in banal coronavirus infections.This is an important clue for differentiation from seasonal influenza. Other clues

• According to a large cohort study of 16,749 individuals with COVID-19, the most common comorbidities (concomitant diseases) were:
  • Chronic heart disease (29%)
  • Uncomplicated diabetes mellitus (19%)
  • Non-asthmatic chronic lung disease (19%.
  • Bronchial asthma (14 %)

  Forty-seven percent of patients had none of the documented comorbidities. Three clusters were found in the symptoms for COVID-19:

  • Respiratory (“respiratory-related”): cough, sputum, sore throat, runny nose, earache, wheezing, and chest pain.
  • Enteric (“intestinal concerning”): diarrhea (diarrhea), abdominal pain (abdominal pain), and vomiting
  • Systemic (“affecting the whole body”): myalgia (muscle pain), arthralgia (pain in the limbs) and fatigue (tiredness).

The main differences in the symptoms of infection with SARS-CoV-2 (coronavirus) compared to the flu (cold) or influenza (flu):

Legend

• Frequent: ++++
• Little: +++
• Sometimes: ++
• Rarely +
• No: 0