A paper this month in the BMJ reviewed clinical studies on the early detection of symptoms and signs likely to lead to COVID-19 pneumonia, when monitoring patients in the community.
Summary of key findings and advice
- Most people with COVID-19 will have resolution of symptoms without a significant clinical event. Typical symptoms are similar to the common cold or influenza and begin to improve within two to three days.
- The early detection and correction of hypoxia is likely to be one of the key determinants of disease progression.
- A patient with any of the following symptoms requires urgent clinical contact: shortness of breath, confusion, persistent fever.
- Other symptoms with a predictive value for disease progression are: dyspnoea, fatigue, dry cough, chest tightness, abdominal pain, diarrhoea, vomiting.
- In COVID-19 pneumonia, low oxygen levels can sometimes occur without breathlessness; this can be detected by pulse oximetry and requires urgent medical attention. This is termed “silent hypoxia” and may be associated with other symptoms such as confusion, altered mental state or severe/exertional fatigue. People with silent hypoxia appear to have a poorer prognosis.
- Observations including pulse, respiratory rate, blood pressure, temperature and oxygen saturations are likely of high value in detecting a patient who is deteriorating due to COVID-19 or other presentations, e.g. bacterial pneumonia, sepsis, pulmonary embolism; oxygen saturations are the most predictive of COVID-19 progression
- Chest x-ray has limited clinical value in a community setting.
- Clinical examination is of uncertain value, but an "eye ball" assessment is useful.
- Blood tests are usually not required but monitoring CRP can be useful, especially if point-of-care testing is available; a level >30 mg/L may indicate progression and a risk of viral pneumonia, it is less reliable in people aged >75 years – use a lower threshold of > 20 mg/L.
- Duration of symptoms is not predicative as deterioration was found to occur at any stage of the illness.