Signs and symptoms of COVID-19 are categorized as constitutional, respiratory, gastrointestinal, neurological, laboratory, imaging, and other.
Constitutional signs and symptoms include fever (Median=80% prevalence on cross-sectional retrospective chart reviews; range 30-98%), fatigue (M=41%; range 8-81%), myalgia or arthralgia (M=31%; range 5-63%), headache (M=9%; range 6-70%), sore throat (M=19%; range 11-53%), weight loss (M=31%; 23-50%), and hypotension (31%; Aggarwal et al., 2020).
Respiratory symptoms include cough (M=63%; range 33-88%), nasal congestion (M=41%; range 14-68%), rhinorrhea (M=7%; range 5-60%), dyspnea (M=53%; range 5-88%), phlegm (M=28%; range 18-40%), hemoptysis (5%; Xu et al., 2020) and chest tightness (M=40%; range 23-64%).
Gastrointestinal (GI) signs and symptoms include nausea and vomiting (M=14%; range 2-22%), diarrhea (M=18%; range 3-35%), and low appetite (M=21%; range 12-63%).
Approximately 36% of COVID-19+ patients present with neurological signs and symptoms which may include delirium, confusion, hallucinations, dizziness, seizure, or loss of senses of smell or taste. Presence of neurological findings is indicative of a worse outcome (Chen et al. 2020).
Abnormal laboratory findings are more common in older patients (Chen et al., 2020) and may include elevated C-reactive protein and erythrocyte sedimentation rate, lymphopenia, elevated D-dimer, leukopenia, elevated lactate dehydrogenase, lower white blood cell count, lower oxygen saturation (=94% or supplemental oxygen required), and hyponatremia (Duan et al., 2020; Ihle-Hansen, et al.2020; Xu et al., 2020; Fu et al., 2020).
The majority of COVID-19 + patients have abnormal imaging findings including multiple mottling and ground glass opacities (GGO) on chest CT scan. Bilateral pneumonia is present in between 73-98% of adults in critical care (Fu et al., 2020; Du et al., 2020).
Other signs and symptoms observed in LTC home residents with dementia include increased falls, change in behavior from the previous shift, more unsettled, and increased wandering (Ihle-Hansen et al., 2020).
The majority of patients (63%) of all ages present with symptoms that have lasted between 4 and 7 days (Buckner et al. 2020; Ihle-Hansen et al., 2020; Lin et al., 2020).
See Table 2 for a summary of infrequent (<10%), frequent (20-50%), and very frequent (>60%)clinical manifestations, laboratory test abnormalities and radiographic findings from a paper by Bonanad et al. 2020.
Screening and Testing Considerations:
Although 90.5% of COVID-19 + patients of all ages present with cough, fever, and/or breathlessness (Baker et al., 2020), screening for typical symptoms alone will fail to identify approximately half of those with COVID-19 who are elderly, particularly those with frailty and other co-morbidities (Kimball et al., 2020).
The majority of recommendations favour a more sensitive threshold for fever detection in older adults, i.e. 37.5°C or an increase of >1.5°C from usual temperature (Holroyd-Leduc et al., 2020).
Screening of older adults or those with comorbidities should include supplemental questions to determine if atypical symptoms are present such as fatigue, myalgias, headache, conjunctivitis, tachycardia, hypotension, and hypoxia. Presence of atypical symptoms should trigger COVID testing.
Tools developed by the Ontario Ministry of Health (2020) and Alberta Health Services (2020) may be useful guides for healthcare provider screening of individuals at higher risk of COVID-19 infections (i.e. frail older adults with comorbidities).
Prioritization of mass testing should be for those with atypical presentations. Specifically, testing should be commenced first for older adults with changes in delirium, unexplained or increased numbers of falls, weight loss, change in appetite, acute functional decline, or worsening chronic conditions (ON Ministry of Health COVID Screening Guide, 2020).
Tupper, S; Ward, H; Dalidowicz, M; Ellsworth, C. What is the case definition for COVID-19 in elderly people? 2020 Jun 12; Document no.: LTC060201 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 39 p. (CEST rapid review report)