By now everyone is familiar with the basic symptoms of COVID-19: cough, fever, shortness of breath and sometimes loss of smell. But not every patient is the same.
Some coronavirus patients develop uncommon or unusual symptoms, some of which – like neurological symptoms or muscle pain – can be extremely serious.
In an Aug. 12 presentation to the Knox County Board of Health, board member Dr. James Shamiyeh described symptoms from a selection of UT Medical Center COVID-19 patients who had died of the disease.
“From an educational perspective I wanted to highlight a few things,” Shamiyeh said, “A significant number of people presented with fever, but not all of them presented with fever.”
“Cough was a consistent symptom but not as reliable (as fever) for these severe cases,” he continued.
Most of the patients in Dr. Shamiyeh’s presentation had at least one common symptom of COVID-19, such as coughing, fever or shortness of breath. But a substantial portion had less common symptoms.
Many of the symptoms coincide with what we commonly associate with COVID-19: loss of respiratory function. A quarter of patients in Dr. Shamiyeh’s data set had low blood oxygen levels, which indicates impaired lung function.
But other symptoms were not common. For example, 22% of patients in the set had neurological symptoms like confusion or anxiety. Twenty-three percent of had muscle weakness or muscle pain. Another 8.5% had nausea, diarrhea or gastrointestinal symptoms.
While Shamiyeh did not respond to requests for comment, a spokesperson for the University of Tennessee Medical Center, where Dr. Shamiyeh is employed, confirmed that Knox News’ figures were accurate but cautioned that the original presentation was preliminary.
“It was not intended to be published medical research,” said UTMC spokesperson Jim Ragonese.
Even though Shamiyeh’s data was preliminary, it casts light on a growing body of research that COVID-19 is complex.
“Based on the data that are presented, they had symptoms compatible with COVID-19,” said Dr. David Aronoff, director of the infectious disease division of Vanderbilt Medical Center in Nashville. “We’ve learned a lot since January about the symptoms people develop with COVID.”
Emerging COVID-19 research
COVID-19 has the potential to cause symptoms outside of the lung. A team of researchers in Bangladesh found that 20-30% of COVID-19 patients had headaches, body aches and diarrhea.
A pair of studies from Germany demonstrated that COVID-19 can injure heart tissue, even in mild cases. A study of patients in Italy found that many patients experienced gastrointestinal symptoms or fatigue.
A survey of COVID-19 case data from a research team in the United Kingdom found that many COVID-19 patients had inflammation in the brain, spine and peripheral nerves and that this caused delirium, cognitive dysfunction and muscle weakness. Similar neurological results were reported from Wuhan and other parts of China.
Other studies have shown similar trends for digestive symptoms and systemic, multiorgan failures. Still more studies have demonstrated links to strokes.
“When we look at our hospitalized patients here at Vanderbilt we see a spectrum of illness,” said Aronoff from Vanderbilt. “Often it’s shortness of breath or new neurological problems or a stroke bringing people into the hospital.”
“But when we talk about their symptoms early in the disease… things like diarrhea or nausea or inability to focus are quite common,” he continued.
The COVID Symptom Study, an app-based, real-time survey of 4 million patients in the US, UK and Sweden, reported that there were six different ways COVID-19 might present itself in patients. The study team is based out of Harvard, Massachusetts General Hospital, Kings College London and Stanford University. The study authors report that some common symptom clusters closely resembled mild flu while more severe symptoms included confusion, abdominal pain or fatigue.
“People should have a pretty low threshold to go and get tested (for COVID-19) if they have symptoms of a new illness they cannot easily explain,” said Aronoff, “and I think it’s important for people to know that fever, cough and shortness of breath are not the only important symptoms.”
The Centers for Disease Control and Prevention now recognizes diarrhea, muscle or body aches, fatigue, nausea, vomiting or diarrhea as possible symptoms of COVID-19. The CDC is conducting research to investigate systemic inflammation from COVID-19 in children.
Not all COVID-19 patients report that their symptoms ceased after a standard 14-day incubation cycle. According to a July 24 Centers for Disease Control survey, 50% of patients reported at least one persistent symptom of COVID-19. A report by a COVID-19 patient advocacy and research group, Patient Led Research, said that almost a quarter of COVID-19 patients with unusual or long-lasting symptoms felt dismissed or misdiagnosed by doctors.
COVID-19 is a rapidly-evolving global public health emergency. Knox County Health Department asks that patients and health care providers be open to new information as it develops.
“This is a new infection and we are learning more every day.” said Charity Menefee director of emergency preparedness for the Knox County Health Department. She emphasized that people to talk to their health care providers for testing if they were worried about symptoms.
“We encourage providers to keep an eye our for what’s emerging in the science,” she continued.