Changing Symptoms of Coronavirus

Introduction:

Coronavirus disease (COVID-19) is a highly contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which had a catastrophic effect on the world's demography, resulting in more than six million deaths across the globe. This disease was declared a global pandemic, ravaged many countries worldwide, and overwhelmed healthcare systems. The symptoms may also vary depending on the temperature, community or herd immunity, age, sex, and underlying medical conditions.

What Are the Common Symptoms of Coronavirus?

The coronavirus infection can be asymptomatic. The common symptoms of coronavirus include

• Cough.

• Fever or chills.

• Shortness of breath or difficulty breathing.

• Muscle or body aches.

• Fatigue.

• Headache.

• Sore throat.

• New loss of taste or smell.

• Nausea or vomiting.

• Diarrhea.

• Congestion or runny nose.

The symptoms change with emerging variants and depend on vaccination status.

What Are the Changing Symptoms of Coronavirus?

The National Institutes of Health system has classified coronavirus disease as asymptomatic, mild, moderate, severe, and critical COVID-19.

• Asymptomatic Infection: This infection involves positive individuals for the SARS-CoV-2 test without symptoms. 50 percent of individuals who test positive for the COVID-19 test are asymptomatic, commonly higher in persons with pre-existing immunity. It is common among young and middle-aged patients, women, and individuals without underlying comorbid conditions. The patients may be asymptomatic initially and can eventually develop symptoms of infection.

• Mild Disease: Mild cases include individuals with symptoms of fever, sore throat, myalgia, and malaise but without shortness of breath, dyspnea, or abnormal chest imaging indicating the presence of lower respiratory tract disease. Most symptoms result in mild infection, such as gastrointestinal symptoms like diarrhea, nausea, and emesis. The loss of taste and smell significantly varies in mild disease and proceeds as a hallmark or pathogenic feature.

• Moderate, Severe, and Critical Disease: Moderate disease patients have lower respiratory tract infections on physical examination or chest imaging with an oxygen saturation level equal to or greater than 94 % on room air at sea level. Individuals with a severe infection will have oxygen saturation levels less than 94 % at sea level, a ratio of arterial pressure of oxygen to fraction of inspired oxygen of less than 300 mm Hg, or a respiratory rate greater than 30 breaths/min or lung infiltrates greater than 50 %. The critical disease is respiratory failure, septic shock, or multiorgan failure. The initial phase of the pandemic accounted for up to 14 % of cases and critical infections about five percent of cases, according to the Centers for Disease Control and Prevention China.

The rate of severe infection varies based on factors such as the history of prior illness, vaccination status, variant causing the disease, and available healthcare resources. For example, the omicron variant is associated with milder disease than the delta variant. In addition, the risk of disease progression from severe to critical is decreased in persons with prior immunity, especially after vaccination.

What Are the Effects Associated With Coronavirus?

The associated symptoms or effects of coronavirus are:

• Acute Respiratory Distress Syndrome (ARDS): ARDS is a disease that presents with bilateral pulmonary infiltrates and severe hypoxemia, resulting from extensive damage and edema of the alveolar system due to infiltration by the inflammatory cells and mediators.

ARDS develops in about 30 % to 50 % of cases presenting with COVID-19 pneumonia and hypoxemia and varies with the implementation of steroid therapy, vaccination, and outpatient therapeutics. The mortality rate of ARDS in COVID-19 patients is higher than other causes of ARDS, including damage from the virus to lung parenchyma and thrombotic microangiopathy and thrombosis that develops in severe COVID-19.

• COVID-19 Associated Pulmonary Aspergillosis (CAPA): COVID-19 increases the risk of pulmonary aspergillosis due to pulmonary epithelial damage. Risk factors for death due to CAPA include age, sex, and pre-existing lung disease. It is not seen in all cases but can be one cause of death due to COVID-19.

Extrapulmonary Manifestations Of COVID-19:

• Cutaneous Manifestations: These are rare and reported in less than two percent of cases. However, certain features associated with cutaneous infections have been reported. They are urticarial rash, maculopapular rash as a sign of systemic infection, and papulovesicular exanthems that occur before the onset of symptoms. Livedo racemosa-like pattern lesions are often associated with severe coagulopathy. Acral ischemia with cyanosis of toes, dry gangrene, and skin blisters are reported in patients with severe COVID infection.

• Neurological Manifestations: The most common neurological symptoms include dizziness and headache. Few cases with severe covid disease present with acute encephalopathy, change in vision, seizures, cerebrovascular accidents, and radiculopathy. A nonspecific and subjective inability to concentrate or perform tasks, known as brain fogging, has also been associated with COVID-19 sequela. Ischemic stroke is the most common cause of death rate ranging from 30 % to 40 % in younger and healthy individuals. Other risk factors include hypertension, diabetes, chronic kidney disease, cerebrovascular events, and chronic liver diseases.

• Cardiac Injury: The underlying cardiovascular conditions and cardiac injury due to COVID-19 have been reported to carry a poor prognosis. It can range from asymptomatic to severe myocarditis and heart failure. The pathogenic mechanisms include direct viral infection, pulmonary emboli, cytokine storm, coronary thrombosis, hypercoagulability, and an imbalance between supply and demand. Association of myocarditis with COVID-19 has also been reported with a higher risk of COVID-19 infection people and found in children younger than 16 years and elderly patients above 75 years.

• Thrombotic Episodes: A significant event of thrombotic episodes are described in symptomatic and asymptomatic cases with SARS-CoV-2 infection, resulting in an increased risk of deep vein thrombosis, and pulmonary embolism to stroke, thrombotic microangiopathy and disseminated intravascular coagulation that further increases morbidity and mortality of the disease. During thrombosis, the adhesion of damaged epithelial cells and stimulation of cytokines to produce platelets results in clot formation.

What Are the Symptoms Associated With Multiple Systems?

The symptoms associated with multiple organ involvement with COVID-19 infection are:

• Cognitive dysfunction (brain fog).

• Mental disorders (depression, anxiety).

• Headache.

• Musculoskeletal complaints ( myalgia, joint pain, chest wall pain).

• Taste and smell disorders.

• Chronic cough.

• Alopecia.

• Insomnia.

Conclusion:

COVID-19 infection is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and is a highly contagious disease. The disease is classified as asymptomatic, mild, moderate, severe, and critical by the national institutes of health. The common symptoms result from upper respiratory tract infection. The extrapulmonary symptoms of the COVID disease are brain fog, depression, anxiety, myalgia, etc.