Woman suffering from abdominal pain. (Photo by: BSIP/Universal Images Group via Getty Images)
While we are focused on cough and fever as the initial signs of COVID-19, its also important to be aware that abdominal pain, vomiting and diarrhea could precede respiratory symptoms in some people.
Results of a new study published in the American Journal of Gastroenterology indicate that a subset of persons could develop symptoms such as vomiting and diarrhea along with abdominal pain during early stages of infection with SARS -CoV-2, the virus that causes COVID-19.
That said, its still important to realize that respiratory symptoms are the more common presentationfever and dry coughas COVID-19 mainly affects the lungs. The potential for also having minimal early symptoms (nasal congestion, aches pains, and sore throat)or none at all has also been described, and is believed to be associated with ongoing asymptomatic transmission.
In the small study of 204 patients diagnosed with COVID-19 in the Hubei province of China, researchers noted that nearly 49% of these patients presented to the emergency department with gastrointestinal (GI) symptoms such as vomiting, diarrhea or abdominal pain. This subset of patients with abdominal pain as their chief presenting symptom also had a more severe course of their illness, while also taking longer to seek medical care.
The authors provide detailed clinical information from 204 patients suggesting that a small minority (7/204) had only GI symptoms without any respiratory symptoms, through 45% had both respiratory and GI symptoms, said Arun Swaminath MD, FACG, Associate Professor of Medicine, Zucker School of Medicine at Hofstra/Northwell, Director Inflammatory Bowel Disease Program, Lenox Hill Hospital, Northwell Health.
The public and patients should understand that some GI symptoms (such as loose stools up to 3 times per day) may accompany respiratory complaints in almost half of patients.Physicians evaluating new GI complaints should consider COVID-19 and take appropriate precautions, explained Swaminath.
Swaminath also qualified that no patients with underlying bowel diseases were included, so we don't know how COVID-19 affects patients with underlying bowel diseases, such as Crohn's disease and ulcerative colitis.
Given that COVID-19 is found in stool, it's probably best to use meticulous hand hygiene and bleach/antiseptic wipes in shared bathrooms (if self- quarantined).If the luxury of a second bathroom exists, then one should be for exclusive use of the quarantined patient, added Swaminath.
The take-away from this study is that COVID-19 patients diagnosed with GI symptoms had an adverse outcome and increased risk of death compared to those without GI symptoms. This underscores the need to evaluate GI symptoms nausea, vomiting or diarrhea as a potential presentation of COVID-19, prior to development of respiratory symptoms.
At the same time, its also possible to realize that such symptoms could also be due to influenza or the common cold, emphasizing the importance of testing for COVID-19 , as well as influenza and other common respiratory pathogens.
Based on data from The WHO, nearly 1 in 6 persons who is diagnosed with COVID-19 will develop severe illness and respiratory compromise that may lead to the need for mechanical ventilation.
A recent study of 21 elderly patients in Seattle early in the outbreak noted that 71% of patients ended up requiring mechanical ventilation, with 100% of these patients developing acute respiratory distress syndrome (ARDS). The researchers in this study further noted that those with congestive heart failure, diabetes, and chronic kidney disease were at highest risk for adverse outcomes including death.
SARS-CoV-2 is primarily transmitted by droplets, via coughing or sneezing, as opposed to transfer from surfaces, according to the CDC. (The virus can be active on hard surfaces such as plastic or stainless steel for 2-3 days and cardboard for 1 day) While the virus may potentially be aerosolized via droplets for several hours (< 3 hours), this is not believed to be the primary mode of transmission.
Data thus far indicates that people who typically require hospitalization arrive at the hospital within 7-9 days of onset of symptoms, with a peak in mortality seen at 3 weeks after initial symptoms.
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Stomach Ache And Diarrhea May Be Among The First Signs Of COVID-19 Coronavirus - Forbes
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