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Overemphasis On Fever As A Predominant Symptom Of Coronavirus May Lead To Missing Several Cases: AIIMS Study

The study titled ‘Clinico-demographic profile and hospital outcomes of COVID-19 patients admitted at a tertiary care centre in north India’ evaluated symptoms of 144 patients of Novel Coronavirus

Overemphasis On Fever As A Predominant Symptom Of Coronavirus May Lead To Missing Several Cases: AIIMS Study
Highlights
  • 29 doctors from AIIMS have conducted the study on COVID-19 patients
  • 44.4 per cent of the patients surveyed were asymptomatic: Study
  • Among the symptomatic, cough (34.7%) was the most common symptom: Study

New Delhi: Since the start of the Coronavirus pandemic, fever has been seen as a predominant symptom of SARS-CoV-2 causing COVID-19 disease. This is the reason, at the start of the pandemic, temperature checks at entry points at airports, railway stations, offices and other public places was mandated. However, after seven months into dealing with the pandemic, various other symptoms like loss of taste or smell, diarrhoea, chills, have been reported. A study titled ‘Clinico-demographic profile & hospital outcomes of COVID-19 patients admitted at a tertiary care centre in north India’ conducted by 29 doctors including Dr Randeep Guleria from All India Institute of Medical Sciences (AIIMS) has found that fever was not a prime symptom of Novel Coronavirus.

The study published in the Indian Journal of Medical Research (IJMR) focused at single-centre collection of data regarding epidemiological, demographic, clinical and laboratory parameters, management and outcome of COVID-19 patients admitted in a tertiary care facility in north India. Data of 144 patients with COVID-19 admitted at AIIMS, Delhi, from March 23 till April 15, 2020, were recorded and analysed.

Also Read: Is Skin Rash A New COVID-19 Symptom? Experts Explain

Analysis Of Coronavirus Symptoms And The Treatment

According to the findings, a significant proportion of patients (44.4 per cent) was asymptomatic at admission, and remained so throughout the hospital course. As per the report, this may be a cause of concern as these asymptomatic patients are potential carriers or transmitters of infection in the community.

Among the symptomatic, cough (34.7 per cent) was the most common symptom followed by nasal symptoms (21.5 per cent), throat irritation (21.5 per cent) and fever (17.4 per cent).

Explaining what does this mean, the study states,

Fever was present in only 17 per cent of our patients, which was far less compared to other reports across the globe, including the Chinese cohort in whom 44 per cent had fever at the time of presentation and 88 per cent developed fever during the hospital stay. Thus, overemphasis on fever as a predominant symptom may lead to several cases being missed.

The majority of the patients were treated with supportive care and required only symptomatic treatment that is antihistamines (a drug used to treat allergies), vitamin C and paracetamol.

Also Read: Coronavirus Outbreak Explained: What Are The Long-Term Impacts Of COVID-19 On Human Body And The Recovery Process?

Only five (3.5 per cent) patients required oxygen supplementation, four (2.8 per cent) patients had severe disease requiring intensive care, one required mechanical ventilation and mortality occurred in two (1.4 per cent) patients. The two deaths were among the severe group, amounting to the mortality to 50 per cent in that group. Elaborating on the two deaths, the study states,

One of these was a 35-year-old male with diabetic ketoacidosis, multilobar consolidation and septic shock, who required cardiopulmonary resuscitation immediately on arrival to the hospital and died within the next three hours. The second was an emaciated, malnourished patient with bicytopenia (reduction of any of the two cell lines of blood), bilateral lung infiltrates and right upper zone cavitation, who died on the fifth day of admission due to refractory acute respiratory distress syndrome.

Patients’ Demography

Out of 144 patients studied, 134 (93.1 per cent) were males. The research document states that this may be related to the fact that the majority of the patients were part of a public congregation mainly attended by males, which was identified as a COVID-19 hotspot, and patients were identified on active screening.

While 134 patients were Indian nationals, 10 (6.9 per cent) were foreign nationals – Fiji, Kyrgyzstan, Malaysia and Thailand.

Also Read: Coronavirus Explainer: 20 COVID-19 Related Terms And What These Mean

In the case of 119 (82.6 per cent) patients, close contact with COVID-19 patients in public congregations was documented as the reason for exposure to the virus. Another prominent exposure characteristic is domestic travel to and from affected states (77.1 per cent).

Two patients (1.4 per cent) were reported to be smokers whereas seven (4.9 per cent) were reformed smokers. All nine patients recovered with treatment.

None of them had severe disease, or worsening during the hospital course. Due to the low number of smokers and the low frequency of adverse events, we could not evaluate the correlation of smoking with the severity of disease or adverse outcome, states the report.

Comorbidities were present in 23 (15.9 per cent) patients, of which diabetes mellitus was the most common; found in 16 (11.1 per cent) patients.

Also Read: Top US Doctor Raises Alarm Over India Heading Towards Becoming A Global Coronavirus Hotspot

Coronavirus Symptoms Identified So Far

According to the government, there are a total of 10 symptoms of COVID-19 – fever; cough; fatigue; shortness of breath; expectoration; myalgia (muscle pain); rhinorrhea (runny nose); sore throat; diarrhoea; loss of smell (anosmia) or loss of taste (ageusia) preceding the onset of respiratory symptoms.

On June 13, the Ministry of Health and Family Welfare added a new symptom of COVID-19 – loss of smell (anosmia) or loss of taste (ageusia) – in its existing list of symptoms. However, on April 27, the Centers for Disease Control and Prevention (CDC), a leading national public health institute of the United States had added six new symptoms of COVID-19 including ‘new loss of taste or smell’.

According to the doctors, since it’s a Novel Coronavirus, medical experts across the globe are learning about it every day and the symptoms are evolving.

Right from the lung to the gastrointestinal tract to the vascular system to the central nervous system to the eyes to the skin, Coronavirus is showing its manifestation in every area, said Dr Ravindra Mehta, Chief of Pulmonary and Critical Care Medicine at Apollo Hospitals in Bengaluru.

Also Read: Airborne Transmission Of Novel Coronavirus Can Occur In Healthcare Settings: World Health Organisation

NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (WaterSanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollutionwaste managementplastic banmanual scavenging and sanitation workers and menstrual hygiene

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