When Should I Seek Medical Attention For The Coronavirus Disease (Covid-19)?

Coronavirus is identified as SARS-CoV2 COVID-19. Most viruses enter the human body through the nose, mouth, and eyes. The inhaled virus enters the epithelial cells of the mucosa and then spreads into adjacent mucosal epithelial cells. Eventually, the virus spreads throughout the respiratory tract from the nose to alveoli (lungs). COVID-19 virus produces an excessive immune reaction that leads to severe inflammation of surrounding tissue. Such immune driven inflammation releases a large volume of cytokine that is known as “Cytokine storm.” Cytokine storm causes surrounding tissue swelling, water retention within connective tissue, capillary swelling, and increase inflammation that rapidly spreads within adjacent tissue. The severity of symptoms of such wide-spreading COVID-19 depends on individual immune resistance. The symptoms can be mild to severe in intensity. This article explains about the mild and severe symptoms of coronavirus infection and when to seek medical attention for the Coronavirus disease.

1. Sore Throat-

   The coronavirus, when it enters the human body through the mouth, causes inflammatory changes in the mucosal membrane of mouth, pharynx, and upper breathing tube. Such changes rapidly occur during the initial phase after 3 to 7 days of the incubation period. The viruses attack the mucosal cells of mouth and pharynx that results in the sore throat, also known as pharyngitis. The condition causes pain over the back of the mouth.

2. Running Nose-

   The virus may enter the human body through nose or virus may spread from mouth into the nose. Such spread of COVID-19 causes nasal mucosal inflammation known as rhinitis. The inflammation of the mucosa of the nasal cavity causes swelling of the nasal mucosa that results in blockage of nasal passage and breathing difficulties through the nose. The swollen mucosa starts secreting serous mucosal fluid that is discharged into the nasal cavity. Such a condition follows the running nose with fluid that contains coronavirus SARS CoV2. Nasal secretions become a source of transmission of infection.

3. Cough-

   The infection rapidly spread further down into breathing tubes. Tracheal and bronchial infection causes severe inflammation and increased mucosal secretion. The secretions within the breathing tube cause cough. The air born particles may travel distance of 3 to 6 feet.

4. Body Ache and Joint Pain

   Most patients suffering from coronavirus infection complain of joint pain and body ache.

1. Fever-

   COVID-19 infection disrupts the epithelial cells and causes increased secretion of Cytokine enzyme. The cytokines secreted by inflamed mucosal epithelial cells enter the capillary circulation. The cytokines circulate in the blood vessels. Eventually, cytokine reaches the hypothalamic temperature center in the brain and displaces the temperature sets point at a higher level. The hypothalamic thermoregulatory center is set at normal 37⁰ C in all individuals. The change of temperature set point to higher-level causes fever. Fever is also known as pyrexia.

2. Shortness of Breath (Dyspnea)-

   The inflamed trachea, bronchi, and terminal bronchi secrete mucosa. The mucosal secretions are removed by frequent cough. Simultaneously the mucosal membrane becomes edematous and swollen that results in narrowing of the lumen of trachea, bronchi, and terminal bronchi. The narrowed terminal bronchi filled with mucosal secretions eventually block the exchange of air. The air does not pass into alveoli through blocked bronchioles, and the patient feels breathless or short of breath.

3. Feeling of Unilateral or Bilateral Chest Heaviness-

   A partial or complete blockage of breathing passage causes difficulties in breathing. The individual suffering from such conditions has to work harder to breath in (inspiration) air and breath out (expiration). The prolonged difficulties in breathing cause muscle fatigue of intercostal, abdominal, and some of the back muscles. Such fatigue may cause increased back pain, feeling of bilateral or unilateral chest pressure as well as chest pain.

4. Chest Pain On The Left Side-

   Difficulties in breathing causes decreased oxygen supply to red blood cells. The hemoglobin within the red blood cells carries oxygen to all the organs in the body, including the heart. Decreased oxygen supply to the heart causes chest pain known as angina. Angina pain is felt on the left side of the chest, and pain during hypoxia may cause a heart attack. Angina or heart pain is felt on the left side of the chest. Pain also referred to the left arm and left shoulder.

5. Bluish Discoloration Of Nailbeds, Lips, And Face (Cyanosis)-

   The condition hypoxia is caused by the low volume of oxygen in arterial blood. Hypoxia is caused when less oxygen is transmitted from alveoli in the lung to capillaries that are located in the alveolar mucosal membrane. The hemoglobin within red blood cells picks up the oxygen and carries it to all body tissues and organs. Less oxygen in the blood causes hypoxia, and hypoxic blood causes bluish discoloration of the mucosa. Such conditions are known as cyanosis. Cyanosis causes bluish discoloration of nailbeds, lips, and face.

The individual suffering from mild symptoms like cough, running nose, and throat pain should call their primary care physician and request for the COVID-19 test. COVID-19 swab test is a rapid test, and results are obtained in 12 to 24 hours. The positive test results should follow two weeks of isolation and quarantine. The family of the symptomatic individual who had a positive COVID-19 test should be observed for similar symptoms. An individual should be prescribed a symptomatic treatment and also treatment that is approved by the FDA for coronavirus infection. Primary care physicians may suggest medications for the viral infection that is not approved by the FDA. In such cases, individuals suffering from mild symptoms must gather all information before considering off label medications.

An individual suffering from severe symptoms like fever, cough, chest pain, and breathing difficulties should immediately go to an emergency room as soon as possible. The symptomatic patients will be considered for the COVID-19 swab test and antibody titer if such a test is not already done. An individual with these symptoms will be admitted in the isolation room. He or she may not be able to see spouse, children, and close family members until the individual becomes asymptomatic and considered not transmitting viruses. The patient may be transferred to ICU if peripheral oxygen saturation is lower than 93% and complaining of breathing difficulties. Few of these patients may be considered for positive pressure ventilation using a ventilator. Once individual peripheral oxygen saturation improves, then patients will be transferred to the isolation ward for observation until discharge.

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