COVID-19: Clinical Aspects

by Sean Elliott, MD

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    00:08 COVID-19 Clinical Aspects.

    00:11 COVID-19 or the infection caused by SARS-Coronavirus II, typically has an incubation period of 2 to 14 days, on average 4 to 5 days most infections.

    00:21 In fact, 80% of infections are mild or even asymptomatic, however, 15% of infections are severe requiring hospitalization and some form of oxygen delivery.

    00:33 5% percent of these infections however, are critical, so, after initial hospitalization these patients rapidly are transferred to the intensive care unit and require some form of ventilation, whether it's invasive or non-invasive.

    00:46 The clinical presentation and symptom profile can vary with each virus variant and the general immune status of the population in general.

    00:53 Subsequent strains have generally been increasingly mild as the immunity of the general population has increased.

    01:01 Typical common symptoms, are fevers, anywhere from 100 degrees Fahrenheit or 37.7 Celsius and higher, accompanied by a dry non-productive cough and typical flu-like symptoms, so, malaise, myalgias, anorexia, et cetera.

    01:18 Those cases that go on to be more severe, however, rapidly progress to develop dyspnea, so, difficulty breathing, along with shortness of breath, chest pain, hemoptysis, on exam they may have fine crackles and they certainly will have evidence of respiratory insufficiency.

    01:35 Complications after one has even mild but many times severe COVID-19, can include a whole list as you see here.

    01:43 Anywhere from pneumonia and acute respiratory distress syndrome, to cardiac injury with deconditioning especially in athletes and dysrhythmias, septic shock, liver dysfunction, multi-organ failure, including acute kidney injury specifically and then a higher risk than normal of venous and arterial thrombosis.

    02:07 Asymptomatic cases are fortunate I guess, because they don't develop any noticeable symptoms, although they may still yet go on to develop anosmia, hyposmia and dysgeusia, so, abnormalities in their ability to taste and smell.

    02:23 Unfortunately, even while asymptomatic, they can just as easily transmit the virus as anybody else.

    02:30 Asymptomatic cases are anywhere from 17% to 50% of all cases, the challenge of course is that one doesn't know what one doesn't know.

    02:38 So, there may be far more asymptomatic cases out there, that have not presented to medical attention and therefore, have not been identified through, antibody or molecular diagnostic modalities.

    02:50 What is known, for those asymptomatic cases that have been confirmed, is that their transmission rate is at least 42%, so, these represent a significant challenge to epidemic and pandemic control, because they don't know that they're sick potentially and therefore, can be contagious.

    03:08 However, if they do happen to come to medical attention, many times for some other reason, they may yet still show radiologic and laboratory findings, typically seen with COVID-19, patients who have typical symptoms.

    03:22 The mild cases, so again these are 80% of all the symptomatic cases, will have that same dry not productive cough, moderate fever and the abnormalities and taste and smell, along with flu-like symptoms, sometimes, they also will have gastrointestinal disturbances, especially, loose stools or non-bloody diarrhea, nausea and vomiting, abdominal pain which is non-specific and crampy, they may go on to develop a productive cough, along with headache the significant myalgias and arthralgias so muscle joint pain and then non-specific rashes.

    03:58 Severe disease, the 15% of symptomatic cases, in addition to the initial presentation as seen with mild illness, will go on to develop dyspnea, hypoxia and potentially significant abnormalities on chest radiography, where over half of their lung fields, are whited out are involved with inflammatory disease.

    04:18 These patients, also will likely have higher fevers, along with chest pain hemoptysis, significant anorexia, even including weight loss.

    04:27 Then the 5% of symptomatic cases that go on to have critical disease, these are the ones who will develop some degree of respiratory failure, which may start as hypoxia, requiring oxygen delivery and then difficulty maintaining ventilation and perfusion and requiring some form of ventilation.

    04:44 They also may show evidence of sepsis, including pneumonia, cardiomyopathy, acute respiratory distress syndrome, acute kidney injury, certainly thrombosis.

    04:55 Recovery time for the mild cases, is anywhere from a couple days to two weeks, depending on how many symptoms they initially present with.

    05:03 However, recovery time for severe and critical disease, is three to six weeks and in fact those who are in an intensive care unit, with critical disease may well be, in hospital for six weeks or longer.

    05:16 Symptoms and signs even with mild COVID-19, can last anywhere from the several weeks of recovery, from the acute process to three months or even months to years, with what is now known as long COVID syndrome or post COVID syndrome.

    05:33 A post-COVID-19 condition is defined by the World Health Organization as one that occurs three months from the onset of COVID 19 with symptoms that lasts for at least two months and cannot be explained by an alternative diagnosis.

    05:46 In general, these post-COVID symptoms are less commonly experience in vaccinated individuals.

    05:53 Some of these symptoms may be specific to COVID-19, but many others are very typical as you might see with other viruses, especially and including fatigue, myalgias et cetera.

    06:05 If you look at a chart as this one, for post COVID-19 symptoms, you can see that a majority of these last from weeks to months and in many cases, months to even longer.

    06:19 So, reduction in quality of life, sort of a non-specific marker of, “I don't feel well, but I feel less well than I did before I got sick.” Well over half of COVID-19 survivors report this this perception, for at least three months or longer.

    06:36 Fatigue up to 87% comment on fatigue for over three months, dyspnea, the challenge with shortness of breathing, especially noted with exercise or even just walking, much less walking upstairs up to 71% will report this finding, for two to three months.

    06:54 Chest discomfort, so that sort of non-specific, chest tightness or shortness of breath up to 44% will report this for again, two to three months.

    07:05 Some form of cough, anywhere from weeks to months, anxiety, depression, impaired memory, the cognition effects, especially the concentration effects, poor concentration, with post COVID-19 survivors can be quite dramatic and of a huge concern.

    07:22 Fortunately, fewer percentages of people report these, but again, they last for weeks to months.

    07:28 The anosmia, dysgeusia complaints, so alterations of sense of smell and taste, will last anywhere from month, to some people up to six months or so.

    07:40 And then a combination of findings, sort of, the long COVID syndrome, which you see listed there, so joint pain headaches, sicca syndrome, rhinitis, dysgeusia, poor appetite, all these things.

    07:52 These can be seen in 16% of individuals, as a specific long COVID syndrome, lasting at least months and in some individuals, anecdotally a year or more.

    08:04 And because those individuals, who were very sick with COVID-19, or even mildly sick and yet had alterations in their job, perhaps, they lost their job they lost their home et cetera, they're likely to have post-traumatic stress disorder, 10% to even higher will have PTSD, lasting for at least a month.

    About the Lecture

    The lecture COVID-19: Clinical Aspects by Sean Elliott, MD is from the course Coronavirus.

    Included Quiz Questions

    1. 80%
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    4. 65%
    5. 95%
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    1. 16% to 22%
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    4. 25% to 30%
    5. 1% to 5%
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    2. 5 days
    3. 3 weeks
    4. 1 month
    5. 6 weeks

    Author of lecture COVID-19: Clinical Aspects

     Sean Elliott, MD

    Sean Elliott, MD

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