Far from the Flu: COVID-19's Mysterious Presenting Symptoms

Dr. Matt Birnholz:
Coming to you from the ReachMD Studios, this is COVID-19: On the Frontlines. I’m Dr. Matt Birnholz.

Early reports of COVID-19 identified dry cough and fever as the key presenting symptoms of the disease. But in the following weeks, emerging data from several hot spot regions have begun to paint a more complex picture of the virus’s manifestations.

Some reports out of China found more than half of affected patients were afebrile at time of admission. In one study of 204 patients hospitalized in Wuhan, almost half presented with digestive symptoms as their major initial complaint. And the finding of anosmia, or loss of smell, also appears to be increasingly common, even in otherwise asymptomatic patients. This finding prompted the British Rhinological Society among others to advise against prescribing oral steroids to otherwise healthy patients suffering from anosmia, given recent research suggesting that corticosteroids may worsen the course of disease in coronavirus-positive patients.

Researchers have also discovered that the nasal cavity in particular harbors an especially high viral load. This may account for the disproportionate number of ENTs hospitalized in China, Italy, and Iran.

American healthcare systems, in turn, are responding to emerging data with new guidelines for ENT clinics. The American Academy of Otolaryngology has recently issued a statement advising postponement of all non-essential procedures, and recommends ENTs proceed only after patients have been tested for coronavirus. For those testing positive, a Positive Air Purifying Respirator, or PAPR, should be utilized in any procedure involving trans-nasal and trans-oral routes.

For ReachMD, this is COVID-19: On the Frontlines. For continuing access to this and other episodes, and to add your perspectives toward the fight against this global pandemic, visit us at ReachMD.com and become Part of the Knowledge. Thank you for listening.