Fever not always a predominant COVID-19 symptom : AIIMS

A study published in the Indian Council of Medical Research’s (ICMR) Indian Journal of Medical Research states that fever was present as a symptom of Covid-19 only in 17 per cent of the patients out of the 144 observed in the All India Institute of Medical Sciences (AIIMS) Trauma Centre, Delhi, and AIIMS in Jhajjar, Haryana.

“Fever was present in only 17 per cent of our patients, which was far less compared to other reports across the globe, including the Chinese cohort in whom 44 per cent had fever at the time of presentation and 88 per cent developed fever during the hospital stay,” The study stated.

According to the study, “more than 44 per cent of the hospitalised patients were asymptomatic at the time of hospital admission and remained so throughout”.

“Thus, overemphasis on fever as a predominant symptom may lead to several cases being missed. This may be a cause of concern as these asymptomatic patients are potential transmitters of infection in the community,” the study said.

It mentioned that 44.4 per cent “significant proportion” of patients had no symptoms, and, among the symptomatic, 34.7 per cent reported cough, followed by 17.4 per cent reporting fever, while only two per cent reported nasal symptoms.

The earlier listed symptoms of Covid-19 were only fever, cough, sore throat, breathlessness and fatigue. Since then, many new symptoms have been listed in the health ministry’s clinical protocol. In June, the Union Ministry of Health recognised a loss of smell and taste, diarrhoea, and muscle pain as signs of Covid-19.

The present study was aimed to describe the clinicodemographic characteristics and in-hospital outcomes of a group of Covid-19 patients in north India. The study was done between March and April. Researchers, one of whom is Dr Randeep Guleria, director of AIIMS Delhi, have published a paper titled “Clinico-demographic profile & hospital outcomes of Covid-19 patients admitted at a tertiary care centre in north India”.

Study found no correlation with smoking:

An interesting finding that emerged out of the study also points to the fact that when the study was conducted between March-April, the researchers did not find an association between age, gender or even smoking habit to those who caught the Covid-19 infection.

The study found “no significant association” between the severity of the disease with age, sex, smoking status, TLC (total lung capacity) grading or lymphopenia. “However, a significant association was observed between severe disease at presentation and Neutrophil-to-Lymphocyte [N-L] Ratio,” the study said. The N-L Ratio is used to ascertain inflammation in the body.

Nine (6.3 per cent) patients were smokers, with a median smoking index of 200. “None of them had severe disease, or worsening during the hospital course.” the study found.

The study also cautioned: “However, according to a recent systematic review and meta-analysis, smoking appears to be a risk factor for Covid-19 progression with higher prevalence of smoking among Covid-19 patients with severe, progressive disease or intensive care admission.”

Patients’ profile

As per the study, the patients had large male preponderance compared to global data (93 vs. 54.3-73 per cent).

“However, this may be related to the fact that the majority of our patients were part of a public congregation mainly attended by males, which was identified as a Covid-19 hotspot, and patients were identified on active screening,” the study stated.

Of note, two patients were healthcare workers treating Covid-19 patients, and one was a public official with close contact with a Covid-19 patient during work, highlighting the risk associated within healthcare and law enforcement work during an ongoing pandemic.

The mean age of the 144 patients studied was around 40 years, with 93.1 per cent males, and included 10 foreign nationals. Domestic travel to or from affected states (77.1 per cent) and close contact with Covid-19 patients in congregations (82.6 per cent) constituted the most commonly documented exposure.

Treatment

Majority of the patients were treated with supportive care and required only symptomatic treatment i.e, antihistamines (48.6 per cent), vitamin C (47.2 per cent) and paracetamol (20.8 per cent). Azithromycin was prescribed to 29 (20.1 per cent) patients, HCQ was administered to 27 (18.7 per cent) patients and 11 (7.6 per cent) received both HCQ and azithromycin. One patient was prescribed antitubercular therapy on a clinicoradiological basis.

Only one (0.7 per cent) patient required mechanical ventilation. Five (3.5%) patients required oxygen supplementation, while, none of the patients were treated with non-invasive ventilation or high-flow nasal cannula.