More than two months since The World Health Organization officially declared the coronavirus outbreak to be a pandemic, researchers now know that carriers exhibit vastly different symptoms depending on age, comorbidities, region, and clinical care access.
With a sufficient data set composed of mild and critical cases, experts can develop concessive methods to treat the former and anticipate the latter.
The elderly and immune-deficient individuals suffering from underlying conditions tend to succumb to COVID-19 by way of acute respiratory distress syndrome or advanced pneumonia. Thus, early indicators of nasty bouts of coronavirus more often than not denote disturbances to lung function.
A new study published in the journal Frontiers in Pediatrics however, has revealed that young patients who develop serious manifestations of SARS-CoV-2 infection often exhibit prodromes that are not associated with breathing difficulties at all.
Teenagers and young adults who contract the illness experience neuropathies like loss of smell, trembling and stroke with some frequency, while children consistently develop gastric impairments.
Additionally, either of the demographics listed above might endure fevers that exceed 102.2 F, extremely red eyes, dry, cracked lips, and red, swollen tongue alongside the aforementioned symptoms.
The lion’s share of young carriers will begin to show symptoms two to 14 days after exposure to the virus. This population also develops purple or blue lesions on their feet and toes (COVID toes) much more often than older patients.
“Most children are only mildly affected by COVID-19 and the few severe cases often have underlying health issues,” Dr. Wenbin Li from the Department of Pediatrics at Tongji Hospital said in a statement. “It is easy to miss its diagnosis in the early stage when a child has non-respiratory symptoms or suffers from another illness.”
Clinical Characteristics of 5 COVID-19 Cases With Non-respiratory Symptoms as the First Manifestation
“An outbreak of the novel coronavirus disease 2019 (COVID-19) occurred in Wuhan, China, in December 2019, which then rapidly spread to more than 80 countries. However, detailed information on the characteristics of COVID-19 in children is still scarce,” the authors wrote in the report. “This case series is the first report to describe the clinical features of COVID-19 with non-respiratory symptoms as the first manifestation in children.”
Perhaps the most influential addition motioned by the new paper explores a dual nature with respect to coronavirus symptomology.
For the majority of serious SARS-CoV-2 cases, labored breathing occurs as a result of inflammation in the lungs after the virus has reprogramed host cells against their protective duties.
However, there are pockets of people who develop symptoms as a result of an overactive immune response to the virus but not the virus itself.
Cytokine release syndrome” alternatively referred to as a “cytokine storm,” describes a massive release of virus-fighting immune proteins that lead to persistent high fevers, extreme fatigue, difficulty breathing, and a sharp drop in blood pressure.
Similarly, preceding literature surveying the diagnostic significance of the novel coronavirus’ genetic material has been vindicated in the latest report.
The virus requires the ACE2 gene to successfully replicate its RNA and that the very same gene is produced in the digestive system. This concurrently explains the increasing number of gastrological correlations linked to COVID-19 and alerts epidemiologists to other potential avenues of infection alongside the confirmed respiratory droplets expelled from a sneeze, cough, and speech.
Even still, the symptoms reviewed in the new paper were not limited to stomach pains. The five cases studied were only meaningfully linked by a lack of respiratory symptoms at presentation.
When being consulted with, COVID-19 was not initially a concern for health care workers which deprived them of the foresight to take necessary precautions during the treatment phase.
Three of the cases required emergency operations though only cases four and five primarily showcased gastrointestinal symptoms. Case 4 was transferred directly from the emergency department to the pediatric intensive care unit in critical condition.
Case five, in particular, proved to be a unique challenge in respect to diagnosis. It involved a two-month-old infant without a fever or a cough, whose parents reported that their child seemed abnormally fatigued and was not eating properly. Among these five cases, only case two evidenced an apparent history of exposure to the novel coronavirus, and case 5 had an unclear suspected contact history.
“Four of the five cases had digestive tract symptoms as the first manifestation of this disease,” the authors continued. “One had a kidney stone, another a head trauma. All had pneumonia confirmed by chest CT scan before or soon after admission and then confirmed to have COVID-19. “This suggests that COVID-19 might infect patients not only through the respiratory tract in the form of air droplets but also through the digestive tract by contact or fecal-oral transmission.”
More research needs to be conducted to add to the list of non-respiratory predictors and exposure risks linked to COVID-19 infection.
CW Headley is a reporter for the Ladders and can be reached at email@example.com