In the next three videos, I will be describing the clinical characteristics of COVID-19. In Video 1, we will cover the symptoms associated with this infection. In the second, what tests are used to diagnose COVID-19, and the third, I will cover other laboratory studies that are helpful for following the course of the illness in hospitalized patients and describe helpful imaging studies. Finally, I will review the course of illness. How does disease usually progresses and factors that affect prognosis? Let me begin with a case that I help to manage. Some of the details have been changed to maintain confidentiality. This woman did not work at UF Health, but in another medical facility in Florida. This 50-year-old woman was a respiratory therapist. Six days before her admission to the hospital she had to change several tracheostomy tubes and clean a tracheostomy site. Psychically, she learned that three of these cases proved to be positive for SARS-CoV-2. She knew that for these manipulations she should be wearing an N95 mask. However, upon requesting one, the hospital administration reported their supply was depleted and she was given a disposable surgical mask. Three days later, She was turned away from her diabetes clinic during screening because she was found to have a fever. Two days before her admission to the hospital, she began experiencing fatigue, fever, chills, and a dry cough. One day before admission, she was walking in the kitchen and noticed marked shortness of breath. Over the next 24 hours, her shortness of breath became progressively worse. Being a respiratory therapist, she checked her oxygen saturation. It was 83 percent far below the normal of 94-100 percent. She was rushed to the emergency room. On admission, her temperature was notably 102.6 degrees Fahrenheit and oxygen saturation was 88 percent on room air. Her chest x-ray showed pneumonia and her SARS-CoV-2 RT-PCR from the nasal pharynx was positive. She is placed on four liters of nasal oxygen and her O_2 saturation increased to 93 percent. On the second day, her respiratory rate suddenly increased to 38, and O_2 saturation was 88 percent on 100 percent oxygen rebreather mask. She required intubation and ventilator support. Despite administering 70 percent oxygen, her arterial blood oxygen levels were markedly reduced, and she was placed on her stomach, are placed in a prone position to improve her oxygenation. She next developed shock and her kidneys stop producing urine. Over the next 12 days she remained on a respirator. On hospital Day 6, she received convalescent plasma, 48 hours later, her blood pressure returned to normal, her renal function normalized, and her oxygenation improved. On the 17th day of hospitalization, she was extubated and is now receiving physical therapy. This case illustrates the potentially devastating consequences of this infection. What are the usual clinical manifestations of this disease? This graph summarizes the symptoms and signs experienced by 1,251 patients who had COVID-19 and were monitored at home throughout the United States from February through December of 2020. All patients measured their oral temperature using the smartphone linked electronic thermometer from cancer. Seventy four percent of those who moderate their temperature for 72 hours or longer had a fever, defined as a temperature of 37.6 degrees centigrade or 99.7 degrees Fahrenheit or higher, or a change in body temperature one degree centigrade or 1.85 degrees Fahrenheit. These patients were compared to a match control group, the lighter bar graphs. In addition to fever, other complaints recorded more common in COVID-19 patients included chills, stuffy nose, earache, loss of taste and smell, headache, cough, difficulty breathing, fatigue, body aches, and diarrhea. The odds ratio of having COVID-19 was estimated using a logistics regression analysis. If you had fever alone, the odds of having COVID-19 was 1.6. In other words, you were 1.6 times more likely to have COVID-19. If fever was accompanied by loss of smell and taste, the odds ratio is 10.4. When fever was accompanied by troubled breathing, the odds ratio was 4.2, 4.1 with fatigue, 3.6 when accompanied by cough. The most worrisome symptom is trouble breathing or shortness of breath. Because this symptom suggests that inflammatory fluid is filling the lungs and earring interfering with oxygen exchange. If possible, patients should check their oxygen saturation using a finger oximeter and O_2 saturation of below 94 percent is worrisome and warrants a visit to a medical facility. To encourage pattern recognition. We train all of our medical students to create an illness script, which consists of four elements. First, epidemiology. In this case of COVID-19, as discussed earlier, we want to ask about travel to an endemic areas with high levels of infection, being exposed to a large crowd like a mega church or going on a cruise. Finally, as in our case, exposure to someone with COVID-19 or exposed to some with symptoms suggestive of this disease. Next, what is the pace of illness? Acute development where 12-48 hours subacute over 3-10 days, or chronic developing our weeks to months. In the case of COVID-19, the onset is acute to subacute. Next, what are the classic symptoms and signs in this disease? It is fever, dry cough, and the most worrisome sign, shortness of breath. Finally, we should include past medical history because patients with this infection do worse if they have diabetes, hypertension, cardiovascular disease, chronic lung disease, or cancer. The original descriptions of the clinical presentation of COVID-19 were based on infections with wild-type virus. The Alpha and Delta variance, as first suggested by animal studies, Omicron primarily grows in the nose and throat areas causing sore throat. This variant is less likely to spread to the lower respiratory tract. Consequently, these patients are less likely to present with pneumonia, to have reduced arterial oxygen levels at room air, or to require supplemental oxygen, dexamethasone, and are less likely to require mechanical ventilation or placement in the MICU. Omicron is associated with a higher mortality in those over 65 years of age, those with underlying disease or receiving immunosuppressive agents. Because omicron infects higher percentage of patients with these conditions, this variant has resulted in surgeries and hospitalizations and in countries with higher percentage of elderly individuals has a vitality rate comparable to the Delta variant. To summarize the symptoms and other key patient information required for evaluating COVID-19 patients, first review epidemiology, travel to an endemic area, exposure to a large crowd, or exposure to someone who's infected. Second, assess the onset of illness. In this disease, it should be acute or subacute. Third, identify the key symptoms. The literature is emphasized fever, dry cough, and less commonly shortness of breath or trouble breathing. Our recent analysis that over 1,200 COVID-19 patients emphasize that loss of taste and smell strongly suggests that diagnosis of COVID-19, increasing the odds by over tenfold. When fever is accompanied by shortness of breath, fatigue, stuffy nose, or cough, the odds of having COVID-19 are also much higher. Patients infected with the omicron variant are more likely to complain of a sore throat and less likely to have lower respiratory tract symptoms or signs. Finally, remember to view the past medical history with regards to hypertension, diabetes, cardiovascular disease, chronic lung disease, and cancer.
