Experiencing a sudden loss of sense of smell or taste is currently highly suggestive of the coronavirus infection, medics have observed.
While the loss of one’s sense of smell or taste can be attributed to any other infection, some people in various parts of the world, including Kenya, have reported this as the first symptom they experience before being confirmed to have the coronavirus.
This has necessitated updating of the list of signs and symptoms of Covid-19 and a serious consideration of this disease as more than a respiratory disease as earlier reported across the world, but a systemic one.
Dry cough
The major common symptoms associated with Covid-19 have been fever, dry cough and difficulty in breathing. Chief Administrative Secretary for Health Mercy Mwangangi, during the daily Covid-19 media briefing on Tuesday, confirmed the new signs and symptoms being exhibited by Covid-19 patients in the country.
“New evidence is emerging across the world that this disease is actually a systemic disease that has effects on your heart, kidneys, clotting of the blood and the coagulation of the blood,” she said.
According to Rodney Adam, an infectious disease expert at Aga Khan University Hospital, the big question that hospitals are facing across the world is whether they have enough oxygen and critical care beds.
“The symptom list has been updated a bit. The big three early on in China were cough, shortness of breath and fever. We know that a minority will have all three of those. A majority will have cough, but not always,” Prof Adam explains.
“There is an increased recognition that some people will be truly asymptomatic with no symptoms at all. There is a debate of what percentage that is, so we can say maybe 20 to 30 per cent or even more, depending on what set of data you look at.”
Adam further mentions that there are also less common symptoms that are emerging as days go by.
“Inability to taste or smell is fairly common and highly-specific for Covid. If someone comes in with a new onset of those symptoms it is highly suggestive for Covid.
There are other symptoms that are not so common, like a running nose.”
On Monday, World Health Organisation (WHO) officials said that although scientists don’t have a complete answer yet, patients who recovered from Covid-19 could get coronavirus again, alluding that their immunity may wane after a few months.
“What we don’t know is how strong that protection is and for how long it will last, so there are a number of studies underway that are trying to answer these questions,” Maria Van Kerkhove, WHO’s Covid-19 technical lead and an infectious disease epidemiologist, said.
WHO has included loss of smell and taste as the less common symptoms of Covid on April 17. Data from Covid Symptom Tracker, a smartphone-based app in the UK and US, shows that 30 to 80 per cent of confirmed cases reported loss of smell or taste.
Despite the new emerging signs and symptoms of the coronavirus, it largely remains a respiratory disease that eventually becomes the primary cause for one to need hospitalisation.
Blood pressure drops
“One of the things that we see in severely ill patients is that they have respiratory symptoms, but they also have new fever. Their blood pressure drops, but that actually is their immune response to the virus rather than the virus per se,” Adam explains.
He adds: “We are starting to understand more about this disease, for example the pancreas and its association with diabetes. It turns out that it is very common for people who will present with Covid and require hospitalisation that they will have diabetes that they did not know about. One of the questions then is was this unrecognised diabetes or was it induced with the virus? We will know the answer in a month or two, but both appear to be true.”
This is following anecdotal reports by doctors across the country who have been noting sudden onset of unexplained high blood sugar levels in people presenting to hospital, who are later diagnosed to have the coronavirus.
From the Ministry of Health’s data, one-third of Covid-19 related deaths have been associated with a co-existence of both diabetes and hypertension. Eighteen per cent had only hypertension and 14 per cent of deaths had only diabetes as a co-morbidity.
The Angiotensin-converting enzyme 2 (ACE2), which serves as an entry point for SARS-CoV-2, the coronavirus-causing Covid-19 is highly expressed in organs such as the lungs, pancreas, spleen, liver, kidney, and brain, in addition to the oral and nasal surfaces.
With this, the virus may injure the cells responsible for insulin, affecting insulin secretion.
This then leads to high blood sugar levels that clinically may be diagnosed as new onset diabetes that is complicated to manage due to the presence of the virus in the system. Some of these patients can also present with the life-threatening complications of diabetes.
As of Tuesday July 14, out of the total 10,791 confirmed cases, 15 per cent, which is 1,601 cases, exhibited symptoms. Cough (at 39 per cent) and fever (30 per cent) were the predominant symptoms. Twenty per cent presented difficulty in breathing, 11 per cent had headache, 7 per cent showed running nose and 7 per cent exhibited sore throat.
Data from Kenya National Bureau of Statistics shows that 15 per cent of Kenyan households have a member who is ailing from diabetes and 18.5 per cent have a member with pre-existing medical conditions, which include heart diseases, HIV/Aids, cancer and high blood pressure.
In Kenya, according to the Kenya National Diabetes Strategy report 2010-2015, diabetes prevalence is estimated to be 3.3 per cent.
However, over 60 per cent of people diagnosed to have diabetes in Kenya usually present to the health care facility with seemingly unrelated complaints.
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