Any fever is Covid 19? My personal dilemma
Dr Asha N Shah. M.D
Professor of medicine, GCS medical college, Ahmedabad
The answer to this question is yes in the present circumstances. We doctors think that is probably the first possibility that should be kept in mind. Let us see why. We know the symptoms of Covid which are like influenza
Most common symptoms:
Fever
Dry cough
Tiredness
Less common symptoms:
Aches and pains
Sore throat
Diarrhoea
Conjunctivitis
Headache
Loss of taste or smell
Serious symptoms:
Difficulty breathing or shortness of breath
Chest pain or pressure
Loss of speech or movement
Variability in symptoms
There are so many variations in symptoms seen in Covid patients and new symptoms are being discovered. One size does not fit all. Generally the fever is not very high but it is seen that some patients do have very high grade fever .i.e. >102 degree Fahrenheit. Most common symptoms along with fever described are dry cough and tiredness. But cough is absent in many patients, even those with pneumonia. Tiredness is common though. Other less common mentioned symptoms but seen commonly are headache, body ache, diarrhea and lastly loss of taste or smell. The patient may be totally asymptomatic at any age and may be detected by tests. The problem is sometimes patient may not have any symptoms except mild fever and they can directly come with shortness of breath and worsen fast requiring oxygen support or even ventilator support and then they carry guarded prognosis . Occasionally the patient is admitted for fever but may acutely develop clot in blood vessels leading to pulmonary embolism, stroke or heart attack. Occasionally we see X rays with bilateral pneumonia and patient may be relatively asymptomatic. Here comes the importance of viral load which can be known by cycle threshold or CT value in RT PCR report. The longer the CT, lesser is the viral load. This will also decide if admission to hospital is needed along with other factors. This CT is different from CT scan which is also done in Covid patients commonly to know the lung involvement.
Variability in prognosis
The other variability is in prognosis and outcome. It is well known fact that patient with risk factors or co morbidities are at higher risk of adverse outcome but sometimes patient in their thirties or forties may succumb and 70–80 year olds with co morbidities will have minimal symptoms and will recover. Of course there are complex pathophysiological factors play role but till the patient recovers or completes 14 days without complications, you cannot be sure because it is known that patient may suddenly deteriorate around 5–7 days of illness. Another observation is some patients who had pneumonia and recover, may present with breathing difficulty after some weeks or months. This may be due to fibrosis in the lungs and it does not carry favorable prognosis. Late neurologic sequel is also reported and so is prolonged fatigue. We don’t know the long term consequences of the illness yet. Suffice is to say that we don’t know who will get infected irrespective of preventive measures particularly if you are going outside your home, we don’t know who will have severe illness or who will succumb.
Any flu swine flu
The variability of clinical features in Covid makes it very important to take into consideration for any diagnosis. In 2009, swine flu pandemic, we had a slogan “Any flu swine flu” to make people and medical practitioners more aware. There was added line for doctors “give Tamiflu” in suspected flu cases. As Oseltamavir, which is specific drug to treat swine flu was available initially with that brand name. Similarly now “Any fever is Covid 19”is a likely possibility.
Patient’s perspective
I understand now from patient’s perspective because I went through similar scare. I had fever before a couple of days with the usual associated symptoms. Some blood parameters were altered like a viral fever.Till now we never worried about fever but situation is changed. You immediately think that it is likely to be Covid and correctly so but then you panic and the stress it produces to you, your family and loved ones skyrockets. For the first time in your life, in one day fever also you start thinking about “the end”. It is so sudden, so unexpected and out of the blue. You get terrified but try to look stable. You wait for the dreaded night to be over and in the morning get yourself tested. There is a slight rational calmness after the anxiety frenzy. You tell God, if this is how it is going to be, help me. You think about all the things left to be done, all the wonderful things you wanted to see, all the beautiful moments you wanted to experience or which you imagined, all the wonderful things life means, all the happiness you could have experienced, the grief of leaving the loved ones. Oh My God, It was terrible time. I know all these things will happen to everyone some or other time eventually. We all know the truth. It is also easy to tell other people but when it comes to you, it is so hard to do it. It is somehow more futile, as in Covid times you would be just a statistics. One more number among many, but for you and your family it is not statistics. It is 100 %.
By the grace of God, Covid test was negative though some blood parameters were mildly altered but the fever went down .The problem is even after negative covid test, you are not 100 % sure that it is not Covid as the tests have sensitivity of 70 %. So you observe the clinical course for a week. You worry about the reappearance of symptoms as it is known to occur after a latent period. The more you know, the worse it is. I was ok after a week passed.I felt better, normal. Yes, this time escaped probably and that is enough. Nobody knows about tomorrow. I feel complete empathy for all the patients and their family. It is not at all an easy situation. In fact it is the worst nightmare. The very big silver lining is the fact that 98% patients recover. So everything is ok in the world if you or your loved ones are not in the 2 %.
Covid stories
But we have to be cautious and careful. I have heard disturbing true stories and everyone probably would have. The one which I thought very sad was that, grandparents wanted to see their children and grandchildren after few months. So the family of 15 got together for one lunch and within 4–5 days 13 of them turned positive, grandparents hospitalized, grandfather died and grandmother barely recovered. All they wanted was to meet the family. We have to be extremely careful to avoid gatherings at all costs and particularly avoid meals together as you sit together and remove masks. Elderly husband and wife hospitalized together and the husband passed away right in front of the wife or 30 year mother dies leaving small children or the full family of 6 getting positive and in and out of hospital but ultimately recovering. Young, sincere, hard working doctors and health care workers were dying all over the world as mortality is higher in health care professionals as they are exposed to high viral load for prolonged period of time.There are plenty of the stories like these. In western countries we hear the news that thousands of elderly patients living in long term care facilities died alone. All these stories and the Covid pandemic will be remembered for 100 years or forever as Spanish flu is remembered. We had taken the world for granted. We thought normalcy was normal. But now everything is changed and nothing is normal.
Increasing cases
The cases are still increasing. Is it a second wave? The statistics shows that. There was minor decrease in cases in certain places in august but if you see numbers of the country, it is increasing though it did not crossed one lakh figure somehow since many days but ultimately today it did.110000 cases in India in a single day. So we have to live with it still. Till what time, we don’t know. All speculations from scientific to astrological have been proved wrong. Yes, it still holds true “any fever is Covid 19”unless proved otherwise, either by symptoms or by tests. Chickungunya is also now quite common in western parts of the city. It is second important cause of fever now. Dengue is less common .Malaria even less. It is surprising how the Darwin ‘s principle of “survival of the fittest” works for mosquitoes too. As Adies Egypti mosquito which is responsible for dengue and Chikungunya is more rampant, Anopheles mosquito causing Malaria is less prevalent.
We know what to do
Stay safe. That is the only slogan important in this time. Be prepared to be in this situation for a long time. Understandably it is extremely difficult. Work life is difficult too. No socializing, no dining out, no movies in theaters, no visit to see family and friends, no meetings academic or otherwise, no travel ,nothing but just trying to survive. People have endured all the loses like losing the loved ones, economical loss , loss of social life ,loss of peace of mind or all of the above and more. So please take care. We all know how but let us be more attentive to all the safety measures because in this disease, your behavior is connected to the well being of your loved ones. As heard in Hollywood movie”The day after tomorrow”, people have survived ice age, they will survive this too.
Image courtesy IndiaTV news.com
