5.1  Clinical symptom spectrum
Understanding the otherwise nonspecific clinical signs and symptoms of COVID‐19 is a crucial step toward appropriate management of the disease. Patients mostly complain of fever, non‐productive cough, and body ache or extreme tiredness. In some cases, diarrhea and nausea precede fever by a few days, suggesting that fever might not be the initial manifestation of infection. A small number of patients reportedly had headache, or even developed hemoptysis (Guan et al., 2020; Wang, Hu, et al., 2020). Some patients remained asymptomatic, despite being tested positive for the disease (Chan et al., 2020). According to several studies, infection with SARS‐CoV‐2 in the elderly, especially the male community, is more likely to result in severe alveolar damage and respiratory failure (Chen, Zhou, et al., 2020). Occasionally, the disease may be demonstrated with a fulminant natural history, rapidly progressing to organ dysfunction, and even death in critical cases. Organ dysfunction includes conditions such as shock, ARDS, acute cardiac injury, and acute kidney injury (Huang et al., 2020; Wang, Hu, et al., 2020). From a laboratory point of view, lymphopenia, thrombocytopenia, impaired prothrombin time (PT), and elevated serum levels of CRP stand among the findings that can be reported for patients with COVID‐19 (Chen, Zhou, et al., 2020; Guan et al., 2020; Huang et al., 2020; Wang, Hu, et al., 2020). Overall, any patient with fever and acute respiratory symptoms, who is reported to have lymphopenia or leukopenia on lab examination, should be suspected. A history of travel to Wuhan or having close contact with local residents is a strong indicator for careful management of the patient (Zu et al., 2020). Table 2 represents the criteria for diagnosis of COVID‐19 infected patients (Committee, 2020b; Zu et al., 2020; WWW.ClinicalTrials.gov).
Table 2  Criteria for clinical severity of confirmed COVID‐19 pneumonia
Patient  Clinical findings  CT (imaging findings of pneumonia)  Organ damage
Mild  Negative  None  None
No dyspnea, with or without cough, fever <38°C (quelled without treatment)
No history of chronic respiratory disease
Moderate  dyspnea, with or without cough  Multifocal patchy GGOs with subpleural distribution  None
SpO2 >93% without oxygen inhalation
Severe  Fever  Diffuse heterogeneous consolidation with GGO,  None
Muscle ache  Rapid progression (>50%) on CT imaging within 24–48 hr
Headache
Confusion
Respiratory distress:
RR ≥ 30 times/min
SpO2 < 93% at rest
PaO2/FiO2 ≤ 300 mmHg
Critical  Shock   “Extra pulmonary” organ failure or MODS
Respiratory failure
need mechanical assistance
Intensive care unit is needed
Abbreviations: FiO2, fraction of inspired oxygen; GGO, ground‐glass opacity; MODS, multiple organ dysfunction syndrome; PaO2, partial pressure of oxygen; RR, respiratory rate, SpO2, oxygen saturation.
John Wiley & Sons, Ltd. This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.