Coronavirus symptoms and other clinical features of the infection are very variable. Because the young and immunocompetent patients may not present with any symptoms, the disease is likely to be missed. This could result in the rapid spread of the infection. The WHO has classified coronavirus infection to be a public health emergency of international concern due to the increasing number of cases across most of the world. A recent article published the clinical characteristics of more than a thousand laboratory-confirmed cases of COVID-19 (Wuhan Coronavirus infection) [Ref]. This article is a simplified version of the above-cited article. The aim is to identify and diagnose patients with confirmed Coronavirus infection at the earliest so as to avoid its spread.

Demographics of the patients with Coronavirus infection:

Among all the diagnosed cases, 93.6% of the patients required hospitalization and the mortality rate was found to be 1.4% (death occurred in 15 patients).

Ages of the confirmed Coronavirus patients:

• Aged 50 to 64, 28.9% of the population.
• The patients' ages ranged from 35 to 58, with a median age of 47.
• Only 0.9% of the patients were under the age of 14, compared to 15.1% who were 65 years or older.
• The majority of patients (55.1%) ranged in age from 14 to 49.

Children under the age of 14 have the lowest risk of contracting the coronavirus.

Gender of the patients:

• 41% of the patients infected with Coronavirus were females.

Exposure/ Possible mode of transmission during the last two weeks:

• 43.9% of the studied patients who were infected with COVID-19 infection were living in Wuhan.
• 31.3% were not living in Wuhan but had recently visited Wuhan.
• 1.9% of the patients had contact with wildlife.
• 72.3% interacted with Wuhan inhabitants

Most infections spread from the city of Wuhan

Incubation Period of Coronavirus:

The time between the potential earliest date of exposure to the infection source and the appearance of symptoms is known as the incubation period. Myalgia, tiredness, fever, and weariness were symptoms. The incubation period ranged from 2 to 7 days, with a mean of 4 days.

Individuals who visit from an endemic area to a non-endemic area should be quarantined for a period of seven days.

Symptoms of Coronavirus infection among individuals with positive COVID-19 infection:

Fever in Coronavirus infection:

A temperature of 37.5 C or higher in the axilla was considered to be fever.

• 43.8% of the patients had a fever on admission.

  • 56.2% had a temperature of less than 37.5 C.
  • 22% of the patients had a temperature of 37.5 C to 38 C.
  • 18.2% had a temperature of 38.1 C to 39 C
  • Only 3.9% of the confirmed cases had a temperature greater than 39 C.

• 88.7% of the patients were documented to have a fever during hospitalization

  • 9.9% had a temperature of less than 37.5 C.
  • 30.9% of the patients had a temperature of 37.5 C to 38 C.
  • 46.9% had a temperature of 38.1 C to 39 C
  • Only 12.3% of the confirmed cases had a temperature greater than 39 C.

Most patients develop a fever but high-grade fever is not a hallmark of Coronavirus infection.

Upper respiratory tract symptoms in Coronavirus infection:

• Conjunctival congestion and red eyes were present in 0.9% of the patients.
• Nasal congestion was present in only 4.8% of the patients
• A sore throat was present in 13.9% of the patients

Patients with coronavirus infection rarely experience upper respiratory tract symptoms, in contrast to the majority of other viral infections.

Lower Respiratory tract symptoms in Coronavirus infection:

• 67.8% of the patients had a cough
• 33.7% had phlegm (sputum) production.
• 18.7% of the patients developed shortness of breath.
• 0.9% of the patients had blood in the sputum (hemoptysis)

When a patient has a coronavirus infection, lower respiratory symptoms are more prevalent than upper respiratory symptoms.

Antimalarial medications (such as hydroxychloroquine and chloroquine) are thought to limit the illness to the upper respiratory tract and lower the likelihood of pneumonia linked to COVID-19. Thus, the prevention of Coronavirus infection involves the use of antimalarial medications.

Gastrointestinal symptoms in Coronavirus infection:

• Nausea and vomiting were found in 5% of the patients.
• Diarrhea was found in 3.8% of the patients.

Gastrointestinal symptoms are infrequent in Coronavirus infection

Musculoskeletal symptoms in Coronavirus infection:

• 13.6% of the patients had a headache
• Fatigue was reported by 38.1% of the patients.
• 14.9% reported muscular pains and pain in the joints.
• 11.5% of the patients reported chills.

Fatigue and other skeletal manifestations are not very uncommon in Coronavirus infection

Clinical signs in Coronavirus infection:

Clinical signs were found infrequently.

• 1.7% of the patients had throat congestion
• 2.1% had swollen tonsils
• 0.2% of the patients had lymphadenopathy and a rash each.

Cough, Fever, Sputum production, Fatigue are the most common symptoms of Coronavirus infection.

Radiologic findings in Coronavirus infection:

The chest radiograph was abnormal in 59.1% of the confirmed cases.

• Bilateral patchy shadowing: 36.5%
• Ground glass opacity was found in 20.1% of the radiographs
• Interstitial abnormalities: 4.4%
• 28.1% of the radiographs had a local patchy shadowing

Chest CT was abnormal in 86.2% of the patients:

• 41.9% of the CT scans had a local patchy shadowing
• Bilateral patchy shadowing: 51.8%
• Ground glass opacity was found in 56.4% of the Chest CT scans
• Interstitial abnormalities: 14.7%

Laboratory findings in Coronavirus infection:

• White-cell count:

  • mean count: 4700/ul
  • less than 4000//ul: 33.7% of the patients
  • more than 10000//ul: 5.9% of the patients

• Lymphocyte count:

  • Median: 1000//ul
  • less than 1500/ul: 83.2% of the patients

• Platelets count:

  • Median: 168,000//ul
  • less than 150,000/ul: 36.2% of the patients

Leukopenia and lymphopenia, in particular, along with thrombocytopenia were the predominant finding on blood CBC report of the patients

• Procalcitonin ≥0.5 ng/ml: 5.5%

• Median hemoglobin was 13.4 gm/dl

• C-reactive protein ≥10 mg/liter: 60.7%

A positive C-reactive protein and a negative procalcitonin were found in most of the patients.

• Lactate dehydrogenase ≥250 U/liter: 41%

• Creatine kinase ≥200 U/liter: 13.7%

• Creatinine ≥133 μmol/liter: 1.6%

• Aspartate aminotransferase >40 U/liter: 22.2%

• d-dimer greater than or equal to 0.5 mg/liter: 46.4%

• Alanine aminotransferase >40 U/liter: 21.3%

• Total bilirubin greater than 17.1 μmol/liter: 10.5%

LDH and D-dimers were elevated in almost half of the patients.

Complications of Coronavirus infection in the confirmed cases:

The most common complication that developed in patients with COVID-19 infection was pneumonia. Pneumonia developed in 91.1% of the patients and is the most dreaded of the complications as it may lead to ARDS. Other complications were very rare. These included:

• Septic shock in 1.1% of the patients
• Acute respiratory distress syndrome in 3.4% of the patients
• Acute renal failure in 0.5% of the patients
• Disseminated intravascular coagulation in 0.1% of the patients
• Rhabdomyolysis in 0.2% of the cases.

Most patients were treated with intravenous antibiotics and Oseltamivir. Oxygen inhalation was required in 41.3% of the patients. 18.6% were given glucocorticoids, 13% were given intravenous immunoglobulins, 5% required intensive care support while 2.3% required mechanical ventilation.

In Conclusion:

The clinical features of COVID-19 (Coronavirus infection) are very subtle. Most patients develop a low-grade fever, fatigue, and a dry cough. Leukopenia and lymphopenia, elevated CRP and low procalcitonin levels are the prominent laboratory features. Most patients develop pneumonia as a complication that is evidenced by an abnormal chest radiograph or a CT scan of the chest. The calculated mortality in this cohort of patients is 1.4%.