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COVID-19: It’s Not Just A Cough Anymore
New symptoms & when to get help
June 29, 2020

M
ac Ernest is a retired physician. Before moving to Oriental in 2014,
mac ernest
Mac Ernest
Mac was the Chair of the Dept of Obstetrics and Gynecology at Carolinas Healthcare in Charlotte. Prior to that he was Professor of Obstetrics-Gynecology at Wake Forest medical school in Winston-Salem.

In addition to patient care and teaching, his research has included studying infectious diseases.

Mac has agreed to provide a series of columns about COVID-19. This column was prepared with the assistance of Sharon Stephenson MD and Ros Cheetham MSc.


For months, we have heard about the novel coronavirus (officially called severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2) and the symptoms that can occur when one develops coronavirus disease (or COVID-19).

We initially learned that the infection may cause fever, dry cough, and shortness of breath.

Not just a cough The CDC has now reported additional symptoms of COVID-19. These include chills, fatigue, muscle or body aches, headache, difficulty breathing (one of the most concerning symptoms), sore throat, congestion or runny nose, and new loss of taste or smell. Hospitals treating COVID-19 patients have reported digestive symptoms including diarrhea, nausea, or vomiting.

We have also learned that symptoms of COVID-19 can range from mild to severe illness and appear 2-14 days after we are exposed to the virus.

We can even catch it from someone showing no symptoms at the time of our exposure.

Because they are both viral infections that have many symptoms in common, comparisons between COVID-19 and influenza are frequent and natural. We are familiar with seasonal flu, have experienced (and survived) it, and know what to expect when it occurs to us or to our loved ones.

However, COVID-19 is unlike the flu in a number of important ways:

Differences from the Flu
COVID-19 infections spread faster than the flu. A single person infected with influenza will infect an average of 1.3 other people, while a single infected person with COVID-19 will infect 2-3 others.
We have less experience treating serious cases of COVID-19 than the flu. The flu has several treatments approved by the FDA including antiviral drugs and drugs that inhibit the virus, while there are currently no FDA approved COVID-19 treatments.
COVID-19 is deadlier than the flu. Best estimates are that COVID-19 case fatality rates are at least 5 times greater than those of influenza.
COVID-19 has a number of potentially serious complications that are very different than those associated with the flu.

When to seek immediate medical attention
What are these other serious complications which require immediate medical attention?

Wheezing or chest pain: signals serious pulmonary effects
Bluish skin or lips: signals a lack of oxygen in the blood
Dizziness, confusion, impaired balance, or delirium: signals virus penetration into the nervous system
Blood clots or stroke: seen in patients in the ICU and may indicate damaged blood vessels; also seen in patients under the age of 50
Kidney injury: seen in hospitalized patients, particularly those on ventilators
“COVID toes”: Dermatologists are reporting patients (frequently younger, healthy individuals) with purple, swollen toes that resemble frostbite which may signal blood vessel inflammation and damage
Skin rashes: Dermatologists have seen red, itching, chicken pox like rashes on some patients that have positive virus tests
Multi-system disease: Although young children rarely develop symptoms from COVID-19, a few will develop lengthy fevers, low blood pressure and inflammation of the heart and arteries as part of a new syndrome called MIS-C, or multisystem inflammatory syndrome in children

Two possible symptoms with the virus: Blue lips and COVID toes.
Mental health challenges
The outbreak of COVID-19 presents challenging medical issues to many, and also may produce overwhelming fear and anxiety in adults and children. The CDC reminds us that stress during an infectious disease outbreak can include the following:

• Fear and worry about our own health and the health of loved ones
• Changes in sleep and eating patterns
• Difficulty sleeping or concentrating
• Worsening of chronic health problems (particularly when routine health check-ups are postponed or skipped)
• Worsening of mental health problems
• Increased use of alcohol, tobacco, or other drugs

Mental health experts are concerned about predictions that deaths from suicide, drugs, or alcohol abuse because of the COVID-19 pandemic could equal or exceed deaths from the infection itself. During these difficult times it is critical to seek help promptly if you observe symptoms or signs that may lead to these issues in loved ones.

Adolescents may show symptoms of depression differently than adults, so we should be on the lookout for withdrawal, anger, or other behavioral changes (such as changes in eating habits, sleeping or acting out) in our children during this stressful time.

COVID-19 will continue to be an infectious challenge for some time, and fortunately as we learn more, we realize that many patients have asymptomatic or mild cases. Continuing growth of our knowledge about this disease will help us find ways to treat and prevent it.

However, we must maintain our vigilance (the 3 W’s) to reduce the chance of infection and the development of serious complications, be compulsive in continuing our routine and emergency medical visits for non-COVID health issues, and continue to care for our families and loved ones as we monitor their – and our – physical, emotional, mental, and spiritual well-being.

References:
Center for Disease Control and Prevention: Symptoms of Coronavirus
Journal of the American Medical Association: Assessment of Deaths From COVID-19 and From Seasonal Influenza
Center for Disease Control and Prevention: Coping with Stress
• North Carolina Department of Health & Human Services: Crisis Services

Contributors:
Diana Silimperi, MD/Sharon Stephenson, MD/Ros Cheetham MSc as part of the COVID-19 Community Task Force.