Wuhan Novel Coronavirus/COVID-19
Coronaviruses (CoVs) primarily cause enzootic infections in birds and mammals but, in the last few decades, have shown to be capable of infecting humans as well
- the outbreak of severe acute respiratory syndrome (SARS) in 2003 and, more recently, Middle-East respiratory syndrome (MERS) demonstrated the lethality of CoVs when they cross the species barrier and infect humans
- the outbreak of the coronavirus infection in Wuhan is another example of coronavirus infecting humans (1)
Severe acute respiratory illness with fever and respiratory symptoms, such as cough and shortness of breath, comprise the working case definition used to select people for viral testing (2)
Fever, cough or chest tightness, myalgia, fatigue and dyspnoea are the main symptoms reported (1).
A variety of abnormalities may be expected on chest radiographs, but bilateral lung infiltrates appear to be common (similar to what is seen with other types of viral pneumonia) (1).
- the general clinical case definition for COVID-19 was updated to include loss of or change in smell or taste. It is (2):
- New continuous cough OR fever OR loss of/ change in smell or taste
- everyone, including health and social care workers, should self-isolate if they develop a new continuous cough or fever or loss of/ change in smell or taste.
The individual’s household should also self-isolate for 14 days as per the current guidelines and the individual should stay at home for 7 days, or longer if they still have symptoms other than cough or loss of sense of smell or taste (2)
* For further guidance:https://www.gov.uk/government/collections/wuhan-novel-coronavirus
A meta-analysis reports that main clinical symptoms of 1994 COVID-19 patients were fever (88.5%), cough (68.6%), myalgia or fatigue (35.8%), expectoration (28.2%), and dyspnoea (21.9%) (3)
Non-respiratory symptoms
- gastrointestinal symptoms
- occur in 2-40% of patients (4)
- diarrhoea can be the initial manifestation of infection
- taste or olfactory disorders e.g. new anosmia, have been noted in up to 53% of the cases (4)
- neurological symptoms among patients with covid-19 that have been reported include:
- ischaemic or haemorrhagic stroke, dizziness, headache, musculoskeletal disturbance, altered mental state, Guillain-Barré syndrome, and acute necrotising encephalopathy
- large vessel stroke in young patients - a rapid communication to be published in the NEJM (29/4/2020) reports five cases of large vessel stroke over a 2-week period in COVID-19 patients under age 50 years. These occurred in patients with mild or asymptomatic from COVID 19
- cardiovascular events that have been associated with covid-19 include myocardial injury
- especially in patients with severe infections, myocarditis and myopericarditis with reduced systolic function, cardiac arrhythmias, heart failure, and misdiagnosis as acute coronary syndrome- also Covid-19 has been associated with a hypercoagulable probably increasing the risk for venous thromboembolic events including pulmonary embolus (4)
- in case series of patients with COVID-19 who had ST-segment elevation, there was a huge variability in presentation, a high prevalence of nonobstructive disease, and poor prognosis (5)
- all these patients had elevated D-dimer levels
- this suggests that myocardial injury in patients with COVID-19 is frequent and could be due to plaque rupture, cytokine storm, hypoxic injury, coronary spasm, microthrombi, or direct endothelial or vascular injury
- venous and arterial thromboembolic disease
- COVID-19 may predispose to both venous and arterial thromboembolic disease due to excessive inflammation, hypoxia, immobilisation and diffuse intravascular coagulation (DIC)
- a study has detailed 31% incidence of thrombotic complications in ICU patients with COVID-19 pneumonia (6) - these thrombotic complications occurred despite systematic thrombosis prophylaxis
- ocular manifestations - such as conjunctival hyperaemia, chemosis, and increased secretions, have been reported in up to 32% of infected patients (4)
- it has been noted that COVID-19 is capable of causing ocular complications such as viral conjunctivitis in the middle phase of illness (7) - a case report detailed bilateral acute conjunctivitis which occurred 13 days after illness onset (7)
- infectious diseases in the eldery
- might be more difficult identify - could be masked
- a mild pneumonia might cause only fever, a fall, or confusion, leading to misdiagnosis
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