Trending Clinical Topic: COVID-19 Symptoms

Ryan Syrek


May 29, 2020

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Several COVID-19 symptoms have recently been added to official lists, while other potential manifestations of the disease are being watched closely, leading to this week's top trending clinical topic.

The Centers for Disease Control and Prevention (CDC) recently added several new COVID-19 symptoms to its official list (see infographic below). These join the previously recognized symptoms of fever, cough, and shortness of breath or difficulty breathing. The CDC website still indicates that symptoms appear within 2-14 days of exposure to the novel coronavirus. Also listed are "emergency warning signs" for serious COVID-19, including trouble breathing, persistent pain or pressure in the chest, bluish lips or face, confusion, or an inability to wake up or to stay awake.

Elsewhere, the United Kingdom has added anosmia, the partial or complete loss of smell, to its official COVID-19 symptom list. Scotland's interim chief medical officer (CMO), Dr Gregor Ian Smith, explained in a news briefing that the addition of loss of taste or smell to that list is likely to at least somewhat increase the number  of cases of suspected COVID-19 that are later proven not to be the disease. He added, "However, it's my view, and that of my CMO colleagues, that on balance, this is outweighed by the benefits of identifying more cases at an early stage."

Various dermatologic manifestations are also being watched for potential association with COVID-19. "COVID toes" are described as lesions on the feet that resemble pernio/chilblains, which are usually a reaction to cold temperatures. Additional skin findings that may be associated include a measles-like exanthem, urticaria, vesicular eruptions, a dengue-like petechial rash and ovate scaling macules, and plaques that mimic pityriasis rosea.

More alarming is that children have presented with a multisystem inflammatory condition that resembles toxic shock syndrome and Kawasaki disease. Although children and young adults of any age can develop severe COVID-19, a new study has found that the oldest and youngest in this group are most likely to be hospitalized and critically ill. The single-center study of 177 pediatric patients found that children younger than 1 year and teenagers/young adults older than 15 years each represented 32% of the 44 hospitalized patients. More than three quarters of the patients in the study presented with respiratory symptoms, 66% had fevers, and 48% had both.

Older adults also have unique symptoms possibly associated with COVID-19. Elderly individuals infected with the novel coronavirus may not show the typical symptoms of fever, cough, and shortness of breath. Instead, they may act unusual or "off," sleep more often, stop eating, seem unusually apathetic or confused, stop speaking, become dizzy and fall, or simply collapse. Experts have stressed the need to have a high suspicion of COVID-19 in the older population, given how deadly the infection can be in that group.

The general public and healthcare professionals are both acutely focused on recognizing any potential new symptoms associated with COVID-19, which explains why it was this week's top trending clinical topic.

Read more about the presentation of COVID-19.


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