April 1, 2020

Providers have a lot on their plates these days, and hospital departments are adapting to meet the new environment as dictated by the coronavirus pandemic.  The virus, officially known as COVID-19 (CV for our purposes herein), has caused the deaths more than 35,000 people world-wide.  As of this writing, March 30, the United States has registered 143,000 confirmed cases of the disease, making America the new epicenter of CV.  President Trump has extended the government’s guidelines on social distancing by another 2 weeks—to the end of April—with computer modeling estimating the peak of the virus occurring around mid-April.

New Patterns Emerging

During these next several weeks, then, it will be even more critical for hospitals and their staff to have a handle on the signs and symptoms of CV.  Strangely, however, the list of clues to this illness is ever-changing.  Initial reports were that the symptoms of sufferers ranged from a cold to a persistent cough and/or fever.  The more severe cases involved respiratory issues, such as difficulty in breathing and even pneumonia-like conditions.  Over the last couple of weeks, however, we have received reports of new symptoms that are as diverse as completely separate diseases.

For example, we were told several days ago that intestinal issues—such as diarrhea and vomiting—are being reported by some in connection with the onset of the virus.  That is, some patients begin to experience stomach flu symptoms days before they felt the upper respiratory conditions more associated with CV.   Is it possible that a true stomach flu, separate and apart from CV, simply weakened their condition, making the onset of CV more likely?  We are not sure at this point, but many researchers are suggesting that the intestinal issues may be part of one CV strain that some are experiencing, and which may signal that respiratory issues could follow.

In the Pink but Smelling Nothing

Another example of the new symptoms that some are reporting as being connected to CV is pink eye.  Some confirmed CV patients actually experienced the eye condition, technically known as conjunctivitis, just prior to taking on the more common CV symptoms.  So, once again, we seem to have a moving target as to the conditions that clinicians should be looking for to determine if CV may be present.

Perhaps the most interesting pattern that some providers have reported is that patients who end up with a diagnosis of CV previously reported a loss of taste and smell.  From an anecdotal perspective, here are a few comments found on social media speaking to this new potential indicator of CV:

• “Haven’t been able to smell anything for the last 4 days,” tweeted a player with the Utah Jazz who was the first NBA player to test positive for the coronavirus 11 days ago. “Anyone experiencing the same thing?”
• Another tweeter with a confirmed case of coronavirus declared: “If you have lost your sense of taste/smell you may have COVID. That was my ONLY symptom.”
• Another Twitter account contained this revelation: “I know people have been saying this already but I can confirm post-Covid19 I have completely lost my sense of smell, and most of my sense of taste. It’s astonishing. My cup of tea tastes like hot water. Can’t smell my aftershave.”

According to a paper published Friday by Claire Hopkins, PhD, a professor of rhinology at King’s College London, “There have been a rapidly growing number of reports of a significant increase in the number of patients presenting with anosmia [loss of smell] in the absence of other symptoms.  This has been widely shared on medical discussion boards by surgeons from all regions.”  According to Yahoo News, Hopkins asserted that “many countries are now reporting this loss of smell or taste in their patients, including South Korea, China and Italy. In Germany, doctors are reporting that “2 in 3 confirmed cases” of COVID-19 present with anosmia.”

Despite the anecdotal pattern that many clinicians have noted, the World Health Organization (WHO) has yet to verify the correlation of anosmia and CV.  Maria Van Kerkhove, PhD, a member of WHO’s health emergencies program stated: “We’ve seen quite a few reports about people in the early stages of the disease [that] may lose the sense of smell, may lose the sense of taste . . . but this is something that we need to look into to really capture if this is one of the signs and symptoms of COVID-19.”

A Matter of the Heart

Without question, the most concerning new pattern some have detected in the symptomology connected with at least some CV patients involves the heart.  Some patients have presented to the hospital showing signs of a heart attack, but upon closer examination, no heart attack took place.  Instead, it was determined that the coronavirus had somehow inflamed or otherwise affected the heart.

On March 27, Health News reported that a 64-year-old patient arrived at a hospital with an apparent heart attack.  An electrocardiogram revealed an ominous heart rhythm, and the patient had high blood levels of a protein called troponin, a sign of damaged heart muscle. “Doctors rushed to open the patient’s blocked arteries, but found that no arteries were blocked.  The patient was not having a heart attack. The culprit was the coronavirus.”  The article went on to assert that there have been similar reports across the country and internationally involving a connection between coronavirus and cardiac issues.  Health News then proceeded to ask the following questions:

• What should doctors do these days when they see patients with apparent heart attacks? Should they first rule out coronavirus infection, or is that a waste of valuable time for the majority of patients who are actually having heart attacks?
• Should every coronavirus patient be tested for high blood levels of troponin to see if the virus has attacked the heart?

“We were thinking lungs, lungs, lungs,” said Dr. John Rumsfeld, chief science and quality officer at the American College of Cardiology, as it concerns the target of the coronavirus. “Then all of a sudden we began to hear about potential direct impact on the heart.”

A report on heart symptoms among coronavirus patients in Wuhan, China—the original epicenter of the outbreak—was published in JAMA Cardiology late last week.  The study found that 20 percent of patients hospitalized with CV had some evidence of heart damage, though many did not have a history of heart problems.  The risk of death among these patients was determined to be more than four times higher than other CV patients.

New Clues in the Case

With all these reports of evolving symptoms connected with CV, it makes one wonder if the disease is designed (naturally or otherwise) to mutate into different strains at certain intervals.  Where will it stop?  What will be the next pattern to emerge?  While WHO has provided a list of the current accepted symptoms for CV, as seen here, hospital staffs may want to include in their triage procedures for patients coming into the emergency room screening questions involving some of the other symptoms discussed in this article.  Does the patient have conjunctivitis?  Has he or she lost their sense of taste or smell?  Your employees may need to be screened for these, as well.  These may turn out to be tell-tale signs of the early stages of CV.

MiraMed will continue to provide you important updates on the coronavirus and other issues impacting hospitals.  If you have questions or suggested topics, please contact us as info@miramedgs.com.

April 1, 2020

Providers have a lot on their plates these days, and hospital departments are adapting to meet the new environment as dictated by the coronavirus pandemic.  The virus, officially known as COVID-19 (CV for our purposes herein), has caused the deaths more than 35,000 people world-wide.  As of this writing, March 30, the United States has registered 143,000 confirmed cases of the disease, making America the new epicenter of CV.  President Trump has extended the government’s guidelines on social distancing by another 2 weeks—to the end of April—with computer modeling estimating the peak of the virus occurring around mid-April.

New Patterns Emerging

During these next several weeks, then, it will be even more critical for hospitals and their staff to have a handle on the signs and symptoms of CV.  Strangely, however, the list of clues to this illness is ever-changing.  Initial reports were that the symptoms of sufferers ranged from a cold to a persistent cough and/or fever.  The more severe cases involved respiratory issues, such as difficulty in breathing and even pneumonia-like conditions.  Over the last couple of weeks, however, we have received reports of new symptoms that are as diverse as completely separate diseases.

For example, we were told several days ago that intestinal issues—such as diarrhea and vomiting—are being reported by some in connection with the onset of the virus.  That is, some patients begin to experience stomach flu symptoms days before they felt the upper respiratory conditions more associated with CV.   Is it possible that a true stomach flu, separate and apart from CV, simply weakened their condition, making the onset of CV more likely?  We are not sure at this point, but many researchers are suggesting that the intestinal issues may be part of one CV strain that some are experiencing, and which may signal that respiratory issues could follow.

In the Pink but Smelling Nothing

Another example of the new symptoms that some are reporting as being connected to CV is pink eye.  Some confirmed CV patients actually experienced the eye condition, technically known as conjunctivitis, just prior to taking on the more common CV symptoms.  So, once again, we seem to have a moving target as to the conditions that clinicians should be looking for to determine if CV may be present.

Perhaps the most interesting pattern that some providers have reported is that patients who end up with a diagnosis of CV previously reported a loss of taste and smell.  From an anecdotal perspective, here are a few comments found on social media speaking to this new potential indicator of CV:

• “Haven’t been able to smell anything for the last 4 days,” tweeted a player with the Utah Jazz who was the first NBA player to test positive for the coronavirus 11 days ago. “Anyone experiencing the same thing?”
• Another tweeter with a confirmed case of coronavirus declared: “If you have lost your sense of taste/smell you may have COVID. That was my ONLY symptom.”
• Another Twitter account contained this revelation: “I know people have been saying this already but I can confirm post-Covid19 I have completely lost my sense of smell, and most of my sense of taste. It’s astonishing. My cup of tea tastes like hot water. Can’t smell my aftershave.”

According to a paper published Friday by Claire Hopkins, PhD, a professor of rhinology at King’s College London, “There have been a rapidly growing number of reports of a significant increase in the number of patients presenting with anosmia [loss of smell] in the absence of other symptoms.  This has been widely shared on medical discussion boards by surgeons from all regions.”  According to Yahoo News, Hopkins asserted that “many countries are now reporting this loss of smell or taste in their patients, including South Korea, China and Italy. In Germany, doctors are reporting that “2 in 3 confirmed cases” of COVID-19 present with anosmia.”

Despite the anecdotal pattern that many clinicians have noted, the World Health Organization (WHO) has yet to verify the correlation of anosmia and CV.  Maria Van Kerkhove, PhD, a member of WHO’s health emergencies program stated: “We’ve seen quite a few reports about people in the early stages of the disease [that] may lose the sense of smell, may lose the sense of taste . . . but this is something that we need to look into to really capture if this is one of the signs and symptoms of COVID-19.”

A Matter of the Heart

Without question, the most concerning new pattern some have detected in the symptomology connected with at least some CV patients involves the heart.  Some patients have presented to the hospital showing signs of a heart attack, but upon closer examination, no heart attack took place.  Instead, it was determined that the coronavirus had somehow inflamed or otherwise affected the heart.

On March 27, Health News reported that a 64-year-old patient arrived at a hospital with an apparent heart attack.  An electrocardiogram revealed an ominous heart rhythm, and the patient had high blood levels of a protein called troponin, a sign of damaged heart muscle. “Doctors rushed to open the patient’s blocked arteries, but found that no arteries were blocked.  The patient was not having a heart attack. The culprit was the coronavirus.”  The article went on to assert that there have been similar reports across the country and internationally involving a connection between coronavirus and cardiac issues.  Health News then proceeded to ask the following questions:

• What should doctors do these days when they see patients with apparent heart attacks? Should they first rule out coronavirus infection, or is that a waste of valuable time for the majority of patients who are actually having heart attacks?
• Should every coronavirus patient be tested for high blood levels of troponin to see if the virus has attacked the heart?

“We were thinking lungs, lungs, lungs,” said Dr. John Rumsfeld, chief science and quality officer at the American College of Cardiology, as it concerns the target of the coronavirus. “Then all of a sudden we began to hear about potential direct impact on the heart.”

A report on heart symptoms among coronavirus patients in Wuhan, China—the original epicenter of the outbreak—was published in JAMA Cardiology late last week.  The study found that 20 percent of patients hospitalized with CV had some evidence of heart damage, though many did not have a history of heart problems.  The risk of death among these patients was determined to be more than four times higher than other CV patients.

New Clues in the Case

With all these reports of evolving symptoms connected with CV, it makes one wonder if the disease is designed (naturally or otherwise) to mutate into different strains at certain intervals.  Where will it stop?  What will be the next pattern to emerge?  While WHO has provided a list of the current accepted symptoms for CV, as seen here, hospital staffs may want to include in their triage procedures for patients coming into the emergency room screening questions involving some of the other symptoms discussed in this article.  Does the patient have conjunctivitis?  Has he or she lost their sense of taste or smell?  Your employees may need to be screened for these, as well.  These may turn out to be tell-tale signs of the early stages of CV.

MiraMed will continue to provide you important updates on the coronavirus and other issues impacting hospitals.  If you have questions or suggested topics, please contact us as info@miramedgs.com.