The Covid-19 pandemic has obviously changed so much of our normal lives. From dining out, to hybrid schooling, and even sporting events, our lives have been completely changed by this virus. The other interesting aspect of this pandemic is the constant concern that we are going to succumb to the disease. The scratchy throat that would have been written off as allergies last year is now a reason for people to be concerned that they have been exposed to the pandemic.
As an Emergency Physician, the symptoms that people are concerned about are wide ranging. This is an ever evolving virus, with constantly changing knowledge about the diagnosis and treatment of Covid-19. There are some symptoms that are more likely to be associated with a worse outcome than others. Read on, and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had Coronavirus.
Altered Mental Status
As in any viral syndrome, a patient that is altered or confused needs prompt medical treatment. The confusion or mental status changes can be due to hydration or even due to other organs not working. This will often need intravenous hydration and blood work to determine the reason for the patient’s condition.
Persistently Low Oxygenation
There have been many discussions within medicine about what oxygen saturation is most concerning with Covid-19. Normal oxygen saturation is usually greater than 95%. Some experts believe patients with Covid can tolerate numbers greater than 92%, while others think it is much lower. No matter which school of thought, there is agreement that an oxygen level that does not improve with treatment is most concerning.
Although Covid-19 is a virus, it can present on chest X-ray with the appearance of pneumonia. This is one of the difficult treatment aspects of Covid-19 as antibiotics that can be helpful for pneumonia, are useless with viruses. The one fact we do know is the appearance of pneumonia in both lungs is associated with a more serious case of coronavirus.
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There is currently data that suggests Covid-19 damages the lining of blood vessels. Any damage within a blood vessel can cause blood to slow down and clot. This is currently the understanding of the increased risk for blood clots with Covid-19. Therefore symptoms such as swelling to one leg or arm, or even acute increase in shortness of breath could be a sign of a blood clot and should be immediately evaluated by a physician.
Hemoptysis is the act of coughing up blood. This is not a symptom that patients tend to overlook. It is concerning in Covid-19 however for a number of reasons. Firstly, it can be a symptom of pneumonia. It can also present in patients who have blood clots in their lungs, call pulmonary embolii.
Although it is difficult to know if you have an enlarged heart, you can know some of the warning signs. It can present with swelling to both legs, or worsening shortness of breath with exertion, and even sometimes a feeling that you need to sleep sitting up right on a few pillows. These are similar symptoms to congestive heart failure, but in the post viral period of Covid-19 they may be a sign of an enlarged heart.
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Low White Count
Since these are cells that fight infection, it may seem logical that your white blood cell counts would be elevated with Covid-19. The white blood cell counts of many patients with Covid-19 are actually normal, with some of the worst cases have much lower levels. Although it is difficult to determine without lab tests, it can be a sign of a weakened immune system.
Infections can cause any organ to shut down, with kidneys being one of the most common. It can be caused from direct damage to the kidney cells by the virus or from dehydration as it is difficult to eat and drink when you don’t feel well. Kidney failure is a very concerning symptom for patients with Covid-19, which can lead to dialysis for some patients.
Stroke Like Findings
There is some data at present that Covid-19 can damage the lining of the blood vessels of the body. This damage can cause blood clots which can present in the legs, or even in the lungs. It can also cause stroke like findings from clots going to the brain. Strokes are a concerning finding independently, but in combination with Covid-19 it is a very concerning and serious finding.
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Increased Respiratory Rate
This is a finding that can be very normal even for a patient without Covid-19. If you run a mile, you may have an increased rate of breathing while you are running, and for a few minutes thereafter. The concern for patients with Covid-19 is that they have an elevated resting respiratory rate. It can also be linked to other concerning findings of Covid-19 such as an enlarged heart or blood clots even after your initial symptoms have subsided.
No Improvement With Proning
Proning a patient, which means having them lay face down in the bed, has been used for patients in the ICU for a number of years. Enough research has been done that it has now been used for Covid-19 patients as well. This can keep patients from being intubated, which means having a tube placed into their throat to help them breath. It has been extremely helpful with Covid-19 patients and has helped minimize the number of patients on ventilators. If a patient does not improve with proning, either before or after intubation, this is a serious finding.
How to Avoid COVID-19
As for yourself, do everything you can to prevent getting—and spreading—COVID-19 in the first place: Wear a face mask, get tested if you think you have coronavirus, avoid crowds (and bars, and house parties), practice social distancing, only run essential errands, wash your hands regularly, disinfect frequently touched surfaces, and to get through this pandemic at your healthiest, don’t miss these 35 Places You’re Most Likely to Catch COVID.