Outpatient presentations of COVID-19 remain a tricky management challenge for all healthcare professionals. When it comes to quickly triaging a patient, you need your evaluation to be as accurate as possible, especially when that patient's symptoms may or may not traditionally fit testing criteria — or if your organization has testing kit shortages.
You also don't want to undertest patients who need diagnostic confirmation and may need hospitalization right away. Good news: fresh research from Harvard Medical School may be able to help you determine which presenting patients need further COVID-19 workups and which patients may have another condition.
The new study by researchers Pieter A. Cohen, Lara Hall, Janice N. Johns, and Alison B. Rapoport, "The Early Natural History of SARS-CoV-2 Infection: Clinical Observations From an Urban, Ambulatory COVID-19 Clinic," covers this gray area patient population in symptomatic depth.
Among the key new findings the researchers outline:
Body aches, especially very bad ones, can be a presenting COVID-19 symptom that shouldn't be overlooked diagnostically.
Fever, contrary to popular belief, might not be present with COVID-19. If fever is present, it may be lower than your physicians are specifically looking for as part of a standard COVID-19 evaluation.
If a patient complains of serious exhaustion, that should be taken into consideration as a COVID-19 symptom.
Fever, cough and shortness of breath are considered to be hallmarks of COVID-19, but they don't always appear in a constellation. Your doctors might not think to check for these kinds of less expected signs. However, it's key to be on the lookout for cough without fever, sore throat, diarrhea, stomach pain, headache, body aches, back pain, dizziness, falling, and fatigue.
Nearly zero COVID-19 patients experience shortness of breath in the initial one to two days of becoming symptomatic. If shortness of breath occurs, it most likely will happen of day four or later in the progression time of the illness.
Once shortness of breath does begin, however, your team needs to swiftly step up patient monitoring. If outpatients are deemed not sick enough to be in the hospital and are quarantined at home, they need to be checked on frequently by telemedicine visits or in-person exams. Ongoing oxygen saturation level testing is crucial, as changes in condition can happen suddenly, and that testing can also be a valuable clue to a rapidly worsening condition.
Anxiety can mimic COVID-19 breathing issues as well. The researchers point out that shortness of breath due to COVID-19 shortness of breath will get worse if a patient is engaging in physical activity, unlike with anxiety. Also, patients dealing with anxiety won't show a drop in their blood oxygen levels, but COVID-19 will indeed cause those levels to lower.
Your doctors should consult the study further, and then they can potentially use this information as part of a quick list of key clinical pearls. It's also much better to err on the side of caution and hospitalize patients at high risk of serious COVID-19 outcomes as quickly as possible. This will focus your team squarely on the primary objective of setting your patients up on the care plan they need — or in the better-case scenario, searching quickly for other clues to illnesses that are not COVID-19.
