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Did Over-estimating Fever as Symptom Affect Initial Covid-19 Response? Yes, Says AIIMS Study

For Representation: A policeman gets his nasal swab sample taken for Covid-19 test. (AP Photo/Mahesh Kumar A.)

For Representation: A policeman gets his nasal swab sample taken for Covid-19 test. (AP Photo/Mahesh Kumar A.)

A study conducted by AIIMS shows that only 17% patients had fever in the initial days of the pandemic sometime in March-April.

Did we miss Covid-19 patients in the early days of the pandemic? Possibly. A study conducted by the All India Institute of Medical Sciences (AIIMS) now reveals that fever was never actually a predominant symptom of the disease caused by the novel coronavirus.

The study, published in ICMR’s research arm, the Indian Journal of Medical Research (IJMR), shows that only 17% patients had fever in the initial days of the pandemic sometime in March-April.

The study on 144 hospitalised patients was carried out from March 23 to April 15 at the Delhi-based AIIMS. The research paper, titled ‘Clinico-demographic profile & hospital outcomes of Covid-19 patients admitted at a tertiary care centre in north India’, has been co-authored by director Dr Randeep Guleria with 28 others.

“Fever was present in only 17% of our patients, which was far less compared to other reports across the globe, including the Chinese cohort in whom 44% had fever at the time of presentation and 88% developed fever during the hospital stay,” the research paper accessed by News18 said.

It goes on to add that 44% of the patients were asymptomatic at the time of admission. A large number of asymptomatic patients is both good news and bad news. While on the one hand it shows that many patients are developing immunity to the infection, it also shows that as early as March-April, there were silent spreaders.

Both public and commercial establishments, including airports, hospitals and shopping centres, relied heavily on thermal body scans and hand-held thermometers to regulate the movement of people in the early days of the pandemic, bringing into question the efficacy of the move when fever was not a dominating symptom.

The study was aimed at describing the clinical demographic characteristics and in-hospital outcomes of a group of Covid-19 patients in north India.

The mean age of the 144 patients studied was around 40 years, with 93.1% males, and included 10 foreign nationals. Domestic travel to or from affected states (77.1%) and close contact with Covid-19 patients in congregations (82.6%) constituted the most commonly documented exposure.

Nine patients were smokers, while comorbidities were present in 23 patients, of which diabetes was the most common underlying healthcare condition.

A significant proportion (around 44%) of the patients had no symptoms. Those who had symptoms complained of cough as the most common symptom, while fever was the most uncommon. Nasal symptoms were present in 2% patients. Majority of the patients were managed with supportive treatment with hydroxychloroquine and azithromycin given on a case-to-case basis. Only five patients required oxygen supplementation, four required intensive care, one required mechanical ventilation and mortality occurred in two patients. The patients were recovering in 16-18 days, said the research.

Speaking to News18, Dr Randeep Guleria said each day is a learning process and that there needs to be a wider lens for studying the symptoms of Covid-19. The infection is much more systemic than what was believed earlier, he said.

“We had young people with strokes and they turned out to be Covid-19 patients. We had patients with heart attack who turned out to be Covid-19 patients. I had a patient who came to me with diarrhoea, no respiratory symptoms and he thought because of the lockdown the drinking water that he was consuming was not fresh which was leading to diarrhoea. He has no respiratory symptoms. He has ongoing diarrhoea for five to seven days. We are seeing Covid-19 patients with conjunctivitis, eye involvement. These are extra-pulmonary manifestations and we have to have a high index of suspicion and low threshold for testing as we go along,” he added.

first published:July 25, 2020, 12:59 IST