Cough, fever most common initial symptoms of COVID-19

Patients with coronavirus disease 2019 (COVID-19) often have fever and cough on presentation, according to research published online Feb. 28 in the New England Journal of Medicine.

Wei-jie Guan, Ph.D., from the First Affiliated Hospital of Guangzhou Medical University in China, and colleagues extracted data for 1,099 patients with laboratory-confirmed COVID-19 from 552 hospitals in China through Jan. 29, 2020.

The researchers found that the primary composite end point occurred in 6.1 percent of patients, including 5.0, 2.3, and 1.4 percent who were admitted to the intensive care unit, underwent invasive mechanical ventilation, and died, respectively. Of the patients, only 1.9 percent had a history of direct contact with wildlife. Almost three-quarters (72.3 percent) of nonresidents of Wuhan had contact with residents of Wuhan, including 31.3 percent who had visited the city. Fever (43.8 percent on admission, 88.7 percent during hospitalization) and cough (67.8 percent) were the most common symptoms, while diarrhea was uncommon (3.8 percent). There was a four-day median incubation period. Ground-glass opacity was the most common radiologic finding with chest computed tomography (CT) on admission (56.4 percent); 17.9 percent of patients with nonsevere disease and 2.9 percent with severe disease had no radiologic or CT abnormality. In 83.2 percent of the patients, lymphocytopenia was present on admission.

"Some patients with COVID-19 do not have fever or radiologic abnormalities on initial presentation, which has complicated the diagnosis," the authors write.

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