Category Archives: Medical Research

Clinical Course of COVID-19: presenting symptoms, how the illness progresses clinically, and why patients deteriorate

According to the Department of Health, the recognised symptoms of COVID-19 (coronavirus) currently include fever, shortness of breath, and flu-like symptoms such as coughing, sore throat and fatigue.

Others may include reduced sense of smell or taste, altered taste, gastrointestinal symptoms and cardiac presentations, including new onset myocarditis, pericarditis or atrial fibrillation.
Gastrointestinal symptoms comprised the chief complaint in 48.5% of patients, a paper published in The American Journal of Gastroenterology on 20 March found.

Patients with COVID-19 may appear to improve but can then experience a rapid deterioration later in the illness. Some patients spontaneously improve, and other patients deteriorate. The deterioration can be a few days, even a week later, rather than a stepwise deterioration from the time of presentation. That can make it tricky, just as patients appear to be improving clinically, they can deteriorate rapidly.

The below progression of symptoms, written by an Emergency Physician in New Orleans is likely to be an accurate representation of the clinical course of COVID-19 (it is consistent with data from Wuhan China):

  • Day 2–11 post-exposure (on average, day 5) – the patient develops onset of flu-like symptoms. These commonly include fever, headache, dry cough and muscle aches (mainly back pain), nausea without vomiting, abdominal discomfort with some diarrhoea, anorexia, reduction in smell and fatigue.
  • Day 5 – The patient is likely to develop increasing shortness of breath due to bilateral viral pneumonia.
  • Day 10 – A cytokine storm may occur in those with severe manifestations of SARS-CoV-2, leading to acute lung injury (previously known as acute respiratory disease syndrome [ARDS]) and multi-organ failure.
    • What that means is the capillary bed (where the oxygen gets into the blood) and the alveolar spaces (the tiny little sacks through which oxygen is exchanged) are damaged and inflamed. Their lungs become stiff and don’t exchange gas and they die a hypoxic (not enough oxygen) death

According to the above source, 81% of patients experience mild symptoms, 14% have a severe disease requiring hospitalisation, and 5% of patients become ‘critical’.

According to research in The Lancet, patients with COVID-19 who tend to fare worse include those who are older, and those who have underlying comorbidities such as hypertension and cardiovascular disease.

It is currently unclear whether patients who undergo that rapid deterioration are those who had a more severe illness to begin with, or whether people with mild illness are as likely to go downhill.

The minority of people who develop an acute lung injury and survive, or those who develop secondary bacterial pneumonia, may end up with permanent pulmonary fibrosis.

Remember though, the vast majority of patients with COVID-19 recover from the illness

Read full article on: racgp.org.au

Dr Lachlan Soper

Australia “flattening the COVID-19 curve” means the time to running out of ventilators will be later

If our infection rate continues to slow,as it appears to have been doing over the past few days, there’s a chance our hospital system may cope better with the pandemic than original modelling was showing.
The number of new cases coming in from overseas, and the local spread of infections are both slowing.
This may mean that the Australian capacity for ventilated beds may not hit the wall in mid April as many people had been modelling.
A small ray of sunshine in dark times.
 

Read full article on: theconversation.com

Dr Lachlan Soper

Likely ICU bed use for COVID 19 in comparision with influenza

This article looks at the impact on ICU beds due to seasonal flu and the comparative effect of COVID-19’s impact on this if we don’t act.

A bad flu season can result in 2500 ICU admisisons. Depending on how many Australians are infected, Australia is predicted to have between 250-000 and 750-000 ICU admissions (and for double the usual ICU time) from COVID 19.

Normally there are around 161-000 ICU admissions in Australia. These people will still get sick, as well as the COVID 19 patients.

There is a desperate need to “flatten the curve” and source more ICU beds, this is why elective surgery in Australia is about to shut down.

Read full article on: abc.net.au

Dr Lachlan Soper

Impact of influenza compared with COVID 19 – COVID 19 is far far more deadly!

The International Journal of Infectious Diseases looked at how many people in Italy got and died from influenza over 4 winter flu seasons from 2013/14 to 2016/17.

In each of those Winter flu seasons, it is estimated there were 5-290-000 cases of influenza-like-illness in Italy. In a population of 60million. That means that influenza infects about 9% of the Italian population each season.

During this study period, on average about 12 to 41 people / 100-000 died from influenza. So in a population of 60 million, that is about 17-000 deaths per year from influenza in Italy. That is 0.028% of the population

Thus far with COVID 19 Italy has had 84-000 cases with 9100 deaths (half the annual influenza deaths already), and this is only 33 days after they reached their 100th case, this is 10.5% of people dying. That equates to COVID 19 having a 370-fold increased death rate compared with influenza for those infected in Italy! And considering they have reached peak capacity of all their ventilators, that death rate may sadly rise!

Read full article on: sciencedirect.com

Dr Lachlan Soper

All Intensive Care Units in Australia (ICU’s) are predicted to be at peak capacity in 10 days time! Medical Journal of Australia

COVID-19 modelling predicts that Australian ICUs will be at capacity in just 10 days if case numbers continue to climb at the current rate.

“ICU capacity will be exceeded at around 22,000 COVID-19 cases sometime around 5 April if public health measures fail to curb the rate of growth”

Read full article on: mja.com.au

Dr Lachlan Soper

COVID 19 Symptom checker

Below is the link to the HealthDirect Coronavirus Symptom Checker:

Click on the yellow box.

It then asks questions about your basic details, emergency symptoms, your state you live, if you work in health, what your symptoms are and if any are severe.

It then advises what to do.

This is what the nurses on the Health Direct helpline will likely work through.

Read full article on: Healthdirect.gov.au

Dr Lachlan Soper

COVID 19 the basics

Coronaviruses are a family of viruses that can cause mild illnesses from the common cold to those as fatal as MERS & SARS.

It is spread by respiratory droplets from close contact or direct contact with infected secretions (usually on things people touch).

Symptoms: fever, cough, body ache, fatigue, chest tightness, short of breath, headache.

Incubation period 1-14 days (usually 5-7 days)

80% of cases are mild, 15% severely unwell, 5% need ICU

There is a greater than 6% chance of death if: diabetes, lung disease, cardiovascular disease, >70yo

Death is from: sepsis, respiratory failure, heart failure, coagulopathy (failure of the clotting system in your blood), kidney failure…

Dr Lachlan Soper

Testing Criteria for COVID 19

This link outlines those who will be tested for Coronavirus 19

Medicos cannot test people outside of these criteria due to a lack of testing equipment. With the increase in cases, new medical data and arrival of testing equipment the testing criteria does change.

A suspect case must fulfill:

The epidemiological plus clinical criteria in category A; or category B; or C.

Read full article on: racgp.org.au

Dr Lachlan Soper

COVID 19 – worldwide spread data

For those interested in the spread, fatality rate and recovery rate from coronavirus 19. This world map from Johns Hopkins University and Medical is very helpful.

Note: the recovery data is the one most likely to be inaccurate, for many reasons, including lack of resources, many countries are not testing for recovery.

It appears that the worldwide confirmed cases of coronavirus 19 (those not formally diagnosed are much higher) increases by about 10% / day

Read full article on: coronavirus.jhu.edu

Dr Lachlan Soper