Understanding COVID-19: Episode 5 – Disease Presentation

By Bob Arnot, M.D., sponsored by DeVry University

March 31, 2020
3 min read

Coronavirus disease presentation – signs and symptoms – explained. Using China as an example, Dr. Arnot looks at the severity of COVID-19 from mild to severe. He also lists out the most prevalent symptoms and compares radiology methods for detecting the virus.

Video Transcription

Let's now have a look at the illness itself from data reported largely in The New England Journal of Medicine. Again, the most prestigious of medical journals. We'll have a look at signs and symptoms of Corona a doctor would observe, X-rays, cat scans, and lab tests.

SEVERITY
First, corona is not a severe illness for most of the population. Although these numbers may be smaller with the technologically advanced US medical system, these were the observations in China:

Critical, 4.7% requiring ICU care.
Severe, 13.8% with some requiring ventilator care.
Mild, 80.9%.

SYMPTOMS
These symptoms may begin on average five days after infection. Here's how the symptoms rank. First cough, fatigue, produce sputum, shortness of breath, muscle or joint aches, headache, chills, nausea and vomiting, nasal congestion.

COMPLICATIONS
The most frequent complication was pneumonia and seen in 91.1% of patients. Of those, 3.4% developed acute respiratory syndrome and may have required ventilator support. Kidney, muscle and coagulation complications all rank less than 1%.

AGE
Here's how severe illness broke down in terms of percentages found in each age group:

Up to 14, 0.6%
15 to 49, 41.1%
50 to 65, 31.5%
Over 65, 27%

The common myth has been that young people don't get sick, but this just isn't true. At St. Thomas's in London, the young people who are at highest risk for the acute respiratory distress syndrome and required a ventilator were pregnant women, postpartum women, and those who were obese and with metabolic syndrome.

In stealing yourself against the coronavirus, getting yourself into the best possible shape, lowering your weight and normalizing blood sugar would be paramount.

RADIOLOGY
86.2% of CT scans of the lung were abnormal. 46.4% of these scans showed the typical ground glass look. X-rays were less reliable and were positive in 59.1% of cases and showed patchy infiltrates in 51.8%. So, if you have a choice, the CT scan is the best indicator of disease.

CT

Here's a closeup of the CT, which gives a far more detailed look than an X-ray. The hazy veil you see in parts of the lung is typical of viral infections that hit the lungs. These scatter in thicken as the disease becomes more severe.
Lab

Lab results are not specific for the disease. C reactive protein reflects the inflammation, and this is elevated in 60.7% of patients. D Dimer is also elevated at 46.4%, LDL 41%, and aspartate 22.2%.
Pneumonia

How quickly does pneumonia develop? Three days after symptoms and zero days after diagnosis in the Chinese data.

RISK
What is your risk of becoming sick? As you can see in the graph, the risk increases with age, at first slowly, decade by decade. Then abruptly after age 60.

Disclaimer: The opinions expressed are those of the author. The content is intended to provide general information on the nature of the pandemic, potential exposures, and is not intended to provide medical advice or address medical concerns or specific risk circumstances. Always seek the advice of your doctor or other qualified health provider regarding a medical condition. Neither DeVry University nor its employees or business partners, nor any contributor to this content, makes any representations, express or implied, with respect to the information provided herein or to its use.

View the next episodes, Understanding COVID-19: Episodes 6 & 7 – Treatment & Vaccine >

View the previous episode, Understanding COVID-19: Episode 4 – Fatality >