Dear Doctor: Every time I turn on the news and hear about the coronavirus, the symptoms keep changing. Why is that? How do we even know when we should go see a doctor?
Dear Reader: It feels like it’s been forever, but news of the virus that causes the disease we now know as COVID-19 first emerged in the U.S. at the start of 2020. (The name is shorthand for “coronavirus disease 2019.”) It’s caused by a novel — never seen before — coronavirus, which is the same type of virus that causes upper respiratory infections, including the common cold. This particular virus is brand-new to humans, which means that not only do we lack immunity, but also that we’re learning about its symptoms and effects in real time.
Our first glimmers of understanding came from patients infected in the initial outbreaks. At that time — and it still is true today — common symptoms included a new cough, fever and shortness of breath. The severity of the resulting illness ranges from something akin to a mild cold to the devastating pneumonia that has taken so many lives throughout the world. As the number of infections continues to grow, so does the data set used by the medical and scientific communities to understand the virus’s effects and behavior. We learned that older adults and those with underlying health conditions are at greatest risk of becoming gravely ill. Children appear to be somewhat safe from the virus. And as screening got underway, it has emerged that some people who never exhibited any symptoms at all have tested positive.
Now, close to five months into what has become a global pandemic, additional symptoms and effects of COVID-19 continue to emerge. One, noted anecdotally by people who shared their stories after becoming ill, is a sudden loss of the sense of smell. Known as anosmia, it’s believed to occur in anywhere from one-fifth to one-half of all cases. A study in Europe pegged the prevalence of anosmia in COVID-19 patients at more that 85%.
Additional reported symptoms include chills, muscle pain, aching joints, sore throat and persistent headache. The disease is known to cause gastrointestinal symptoms that include nausea, vomiting or diarrhea. In addition to anosmia, neurological symptoms can include tingling or numbness in the extremities, muscle weakness, dizziness, confusion and delirium. Although seizures, stroke and abnormalities in blood clotting have been reported, these symptoms appear to be rare. An effect of the virus, which is widely reported but is not yet part of the Centers for Disease Control and Prevention’s list of symptoms, is extreme fatigue. Some children and a few adults have experienced something dubbed “COVID toes,” which is a red or purple rash similar to frostbite or chilblains.
All of this has prompted the CDC to continually update information pertaining to COVID-19 on its website. The amended guidelines about when to seek emergency medical care now include trouble breathing, persistent pain or pressure in the chest, bluish lips or around the face and the onset of confusion. For more information, visit the CDC website at cdc.gov. Links to a variety of information are on the front page.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.
