- The University of Southern California study found that COVID-19 symptoms often start in a certain order.
- According to the study, while impact typically begins with a cough, the first symptom of COVID-19 is fever.
- However, doctors working with patients with COVID-19 said in their experience that the symptoms are not as predictable.
The symptoms of COVID-19, including fever and cough, are frustratingly similar to a host of other common diseases, including seasonal flu.
How can you tell if a fever is the flu like COVID-19 with flu season around the corner? A new study has shed light on how COVID-19 symptoms are present, which can help people to find out if their cough is just a cough or something worse.
The University of Southern California (USC) study found that COVID-19 symptoms often start in a certain order.
This finding could self-isolate people with COVID-19 and provide earlier treatment, which could significantly improve patient outcomes.
“This sequence is especially important to know if we have overlapping cycles of diseases such as the flu that coincide with COVID-19 infections,” said Peter Kuhn, PhD, one of the study’s authors and professor of medicine, biomedical engineering, and aerospace and mechanical engineering at USC. “Physicians can determine what steps to take to care for the patient, and they can prevent the patient’s condition from deteriorating.”
To predict the order of symptoms, researchers examined rates of symptom incidence collected by the World Health Organization (WHO) for more than 55,000 confirmed COVID-19 cases in China. They also looked at a dataset of nearly 1,100 cases collected between December and January by the China Medical Treatment Expert Group for COVID-19 and delivered by the National Health Commission of China.
To compare the sequence of symptoms of COVID-19 with influenza, the researchers analyzed data from more than 2,000 COVID-19 cases in North America, Europe, and the Southern Hemisphere reported to health authorities between 1994 and 1998.
“The order of the symptoms is businesslike,” said Joseph Larsen, author of lead study and doctoral candidate USC Dornsife. “Knowing that each disease progresses differently means that doctors can identify sooner if someone is likely to have COVID-19, or another disease, which can help them make better treatment decisions.”
According to research results, this is the sequence of symptoms that patients may experience:
- fever
- cough and muscle aches
- nausea or vomiting
- diarrhea
“The study found that patients with seasonal flu were more likely to develop a cough before the onset of fever,” said Drs. Robert Glatter, emergency physician, Lenox Hill Hospital, New York, at Healthline. “In fact, this can be difficult to distinguish, because the flu often starts abruptly with a three-way symptom, including back pain, chills, along with a dry cough.”
Glatter said the study’s findings are potentially useful “in evaluating multiple patients in a busy clinical setting.”
According to the study, while impact typically begins with a cough, the first symptom of COVID-19 is fever.
“Our results support the idea that fever should be used to screen for entry into facilities as regions begin to open after the onset of Spring 2020,” the study’s authors wrote.
Glatter shared his experience treating COVID-19 patients in New York City.
“In general, although fever is usually the most commonly described initial symptom of COVID-19 infection, the reality of what I see on the front lines is more variable,” he said. “In fact, some patients may present only with loss of taste or smell and otherwise feel good. I have also seen patients present with ‘COVID toes’, like chilblains; in livedo-type [reddish-blue discoloration] of skin reaction in response to acute inflammation, in the absence of fever, cough or other respiratory symptoms. ”
Glatter said other patients had also “presented with malaise, headaches, and dizziness,” which somehow resembled the symptoms of stroke, but without fever, cough, or any evidence of upper respiratory symptoms.
“I have also seen patients present only with chest pain, without values of respiratory symptoms,” he said. “The onset of nausea, vomiting, and diarrhea after the onset of respiratory symptoms such as fever and cough may also suggest that a person may have COVID-19.”
According to Glatter, the bottom line is that health care professionals need to stay awake and keep an open mind when evaluating patients who have symptoms associated with the disease. “They do not present ‘according to the book’, so you have to throw a wide net when you think about who might have COVID-19 or not,” he said.
“It is critically important to understand the progression of symptoms of COVID-19 infected individuals so that you can stop the spread of the disease – in isolation, isolate and then initiate effective contact trace,” Glatter said. “This is very relevant for a virus that is two to three times more contagious than flu, leading to outbreaks in clusters.”
He also said that understanding the first symptoms not only helps patients to look for tests faster, but also to start physically as well as social distance after the first symptoms begin. “It also underscores the importance of wearing masks and hand hygiene when learning symptoms,” Glatter said.
He also finds that sudden loss of odor and taste and inflammatory skin reactions such as shortness of breath “may be important clinical indications that may distinguish COVID-19 from seasonal effects.”
It is possible that humans may have both COVID-19 and seasonal flu, said Glatter, who “skyrocketed morbidity and mortality this fall.” This fact makes rapid testing “more important than ever” and increases the value of knowing how each disease progresses.
He also warned that there is a possibility of a ‘twindemy’, a combination of flu and COVID-19, which could be devastating.
“Medical providers up front expect the flu season to be exponentially worse, as these two viruses collide this fall,” Glatter said. “We must continue to wear masks and practice social distance and hand hygiene as we approach autumn. It is a matter of life and death. ”
Researchers analyzed data from more than 50,000 patients with COVID-19 and compared their symptoms with previous records of people who had the flu to find that COVID-19 symptoms occur in a certain order.
This information can help people with COVID-19 differentiate themselves from those who just have the flu, and help those with COVID-19 care sooner and self-isolate.
Experts with frontline experience emphasize that this progression is not always how the disease progresses, but it is still a useful guide for health care providers. They also hold caution that the coming flu season could bring a ‘twindemy’ of flu and COVID-19, with potentially devastating consequences.
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