Diarrhoea an early COVID-19 sign

A study of COVID-19 patients with mild disease, rather than those with moderate or critical illness, has found a unique subgroup marked by the presence of digestive symptoms, most notably diarrhoea.

The study found that some of these patients only later, or never, presented with respiratory symptoms or fever.

“This study is vital because it represents the 80 per cent or more of patients who do not have severe or critical disease,” explained Dr Brennan Spiegel editor-in-chief of The American Journal of Gastroenterology, where the study was published.

“This is about the more common scenario of people in the community struggling to figure out if they might have COVID-19 because of new-onset diarrhoea, nausea, or vomiting.”

The analysis included 206 patients with low severity COVID-19, including 48 presenting with a digestive symptom alone, 69 with both digestive and respiratory symptoms, and 89 with respiratory symptoms alone.

Between the two groups with digestive symptoms, 67 presented with diarrhoea, of whom about one in five experienced diarrhoea as the first symptom in their illness course.

The diarrhoea lasted from one to 14 days, with an average duration of more than five days and a frequency around four bowel movements per day.

Concurrent fever was found in 62 per cent of patients with a digestive symptom, meaning that nearly one-third did not have a fever.

Patients with digestive symptoms presented for care later than those with respiratory symptoms (16 days versus 11-day delay) and this delay in care is consistent with recent findings that analysed 204 sicker patients from three hospitals in Wuhan, China.

In the analysis of patients with milder COVID-19 symptoms, those with digestive symptoms had a longer total course between symptom onset and viral clearance.

Patients with digestive symptoms were more likely to be faecal virus positive (73 per cent versus 14 per cent) and have a longer overall course of the illness versus those with respiratory symptoms.

“Importantly, digestive symptoms are common in the community, and most instances of new-onset diarrhoea, nausea, vomiting, or low appetite are not from COVID-19,” the authors explained.

“Nonetheless, clinicians should recognise that new-onset, acute digestive symptoms in a patient with a possible COVID-19 contact should at least prompt consideration of the illness, particularly during times of high COVID-19 incidence and prevalence.

“Failure to recognise these patients early and often may lead to unwitting spread of the disease among outpatients with mild illness who remain undiagnosed and unaware of their potential to infect others.”

For the latest advice, information and resources, go to www.health.gov.au, or call the 24-hour National Coronavirus Helpline on 1800 020 080. It operates 24 hours a day, seven days a week. If you require translating or interpreting services, call 131 450. Details of your state or territory public health agency are available at www.health.gov.au/state-territory-contacts.

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Written by Ben

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