Additional Symptoms of COVID-19

by Dr. Iva Lloyd, ND

A common question over the last month is whether or not a specific symptom could indicate COVID-19.  The focus of Public Health and the media has been on the three most common symptoms, that is tiredness, fever and cough.  Tiredness is the most common symptom with about 68% of people experiencing it, followed by 60% of people having a dry cough and 56% of people experiencing fever, especially in the early stages of COVID-19.

An interesting symptom that has received a lot of focus over the last few months is loss of smell.  There are a number of research articles that indicate that an early indicator of contracting COVID-19 appears to be anosmia, or loss of smell.  The loss of smell does not appear to be correlated with how severe the symptoms of COVID-19 will be as there are some individuals that only experience a loss of smell, whereas others have digestive and/or respiratory symptoms as well.  Some people experience an altered sense of taste which can be associated with the altered sense of smell.

There are a number of other symptoms that are commonly experienced in those that tested positive for COVID-19.  Digestive symptoms such as loss of appetite, diarrhea and nausea are common in 44% to 55% of individuals that tested positive.  Muscle and joint pain and headaches are also common in about 45% of individuals.

What Does This Mean?

Based on: https://jamanetwork.com/
journals/jama/fullarticle/2765183

Many of the symptoms associated with COVID-19 are common symptoms that people experience all the time.  The chart to the right highlights the frequency (by percentage) that the following symptoms were experienced in 202 individuals with mild to moderate symptoms (age range from 20-89 years with a median age of 56) that tested positive for COVID-19.  The results in this study were similar to those reported in a number of other studies from around the world.

A symptom that is not on the chart, but was the focus of the study was loss of smell and/or taste. The study found that 64% of those that tested positive also reported an altered sense of smell and/or taste.

The presence of any one symptom does not necessarily mean that you are dealing with COVID-19.  For example, many people commonly experience headaches, digestive issues or muscle pain and other symptoms on an ongoing basis.

Four Phases of COVID-19

There are four stages to COVID-19: prevention, infection, inflammation and recovery.  A person's ability to move through the four phases determines how sick they get and how long it takes them to recover, if infected.

1. Prevention.  Public health policy is primarily focused on the prevention phase with their recommendations for social distancing, washing hands, disinfecting surfaces and wearing masks when unwell or unable to social distance.  The naturopathic profession adds to this by emphasizing the importance of focusing on overall health and addressing lifestyle factors as a means of ensuring that you are equipped to handle life challenges, including viruses and other pathogens when you encounter them.  It is also important to work with your naturopathic doctor or other health professional if you have or suspect underlying health issues such as diabetes, cardiovascular disease, chronic inflammation, obesity, respiratory conditions or other lifestyle-related conditions that might impact your ability to heal.
2. Infection.  When someone feels that they have become infected it is important to get tested and to follow the recommendations given.  The chart above highlights the symptoms that may be associated with being infected.  If you do experience any of these symptoms and they are new to you or are accompanied with an overall sense of being unwell, it may be beneficial to get tested.
3. Inflammation.  The inflammatory phase is the one that appears to be the most concerning for COVID-19.  The fatality risk associated with COVID-19 is associated with the tendency in some people for an excessive or persistent inflammatory response. When the inflammatory response is high the symptoms are apparent and if they result in shortness of breath or difficulty breathing it is important to seek medical care directly.  At times, the inflammatory response is more low-grade and persistent. In this case the symptoms are less extreme, but can weaken a person overtime. 
4. Recovery.  The aim of the recovery phase is to resolve inflammation in order to inhibit tissue damage and to restore and optimize functioning in the body.  Continual clinical surveillance, such as blood work, is an important step to ensure that the body has fully recovered after being sick with COVID-19 or any other infection.

When Are Your Symptoms A Concern?

Research continues to point to the fact that the majority of those that have COVID-19 will not have any noticeable symptoms or will experience mild symptoms that resolve without medical intervention. Trusting your innate healing ability is a foundational principle of naturopathic practice.  It is also true that if the body is struggling to recover, you will have symptoms that will help to guide your medical practitioner to determine the cause.

If your symptoms come on suddenly AND you feel exhausted or unwell for more than three days it would be worthwhile to contact your medical practitioner or Public Health and get tested.  It may also be concerning if your symptoms are accompanied by a loss or altered sense of  smell that doesn't seem to resolve. This study also highlighted that an altered sense of taste and/or smell often proceeded other symptoms.

In naturopathic practice we acknowledge the "never-well-since" aspect of any illness or accident. Generally speaking the body is designed to handle life's stressors and challenges and to heal, but at times it gets stuck and the body doesn't recovery properly.  This healing process can become stuck due to nutrient deficiencies, other underlying conditions, medications or environmental factors and at times it is unable to heal due to the psychological impact of the injury.  Anytime that a person feels that they have "not been well since  . . . ", it is important to talk to your naturopathic doctor or other health practitioner to figure out what needs to be addressed for the body to heal.  If someone feels that they were unwell earlier this year and that they haven't fully recovered it would be helpful to have laboratory tests done to ensure that the inflammatory phase of COVID-19 was properly resolved and that the body has fully recovered from COVID-19

COVID-19 is a new disease and the information that we have on it is changing and evolving all the time.  What is the most important is your overall health and safety.  If you have any questions, please talk to health practitioner.

Associated Blogs

Don't Wait Until You're Sick To Get Healthy

Food And Immune Health

A Crash Course on Respiratory Health

Reference

Giacomo Spinato, Cristoforo Fabbris, Jerry Polesel, et al. Alterations in Smell or Taste in Midly Symptomatic Outpatients with SARS-CoV-2 Infection. April 22, 2020.  JAMA doi:10.1001/jama.2020.6771

Yanuck SF, Pizzorno J, Messier H, Fitzgerald KN. Evidence Supporting a Phased Immuno-physiological Approach to COVID-19 From Prevention Through Recovery. Integrative Medicine: A Clinician's Journal.  May 2020

Maggini S, Pierre A, Calder P. Immune Function and Micronutrient RequirementsChange over the Life Course. Nutrients. 2018.

Marinosci A, Landis B, Calmy A. Possible Link Between Anosmia and COVID-19: sniffing out the truth.  Eur Arch Otohinolaryngol. 2020 April 17. 1-2.  PMID: 32303881.

COVID-19 Q&A

by Dr. Iva Lloyd, ND

A crisis generally evokes confusion, anxiety and for some fear; and this pandemic is no different. To a large degree, the anxiety is due to the fact that there are so many unknowns - which is understandable as this virus is new.

As a naturopathic doctor, what I find encouraging is that there have been hundreds of research papers  published in the last few months. Doctors and researchers are madly working to understand how to manage COVID-19.  Rest assured that the information we are gathering is helping the medical profession figure out what needs to be done.  I trust the following answers some of your questions:

Q: What are the symptoms of COVID-19? 

A: The most common symptoms of COVID-19 are a fever, dry cough and shortness of breath or tiredness. A person might have additional symptoms such as aches and pains, runny nose, sore throat or diarrhea, but at least two of the three main symptoms are generally present. 

Q: Who can get COVID-19? 

A: Anyone can get COVID-19, but currently older adults that have hypertension, heart disease, diabetes or lung disease are at a higher risk of developing serious complications. It is important that everyone be diligent and take the proper precautions. 

Q: How is COVID-19 spread? 

A: The virus is believed to be spread primarily by person-to-person through respiratory droplets from a sneeze or cough of an infected individual. It can also be transmitted by touching surfaces where infected droplets have recently landed. 

Q: Is the COVID-19 virus airborne?

A: NO! COVID-19 virus is NOT airborne. It is spread through respiratory droplets produced when an infected person coughs or sneezes. The respiratory droplets quickly fall to the ground or on a surface. They only stay in the air for a very short period of time. 

Q: How long do the respiratory droplets last on surfaces?

A: Respiratory droplets can last between two to three days on plastic and/or stainless steel.  Keep in mind, the viral-load (concentration) of the droplets decreases quite quickly. Respiratory droplets can appear on other surfaces (e.g. clothing) but they do not last for very long and are not easily transmitted to someone from these surfaces.

Q: Why the 6 Foot Rule?

A: You never know when you may cough or sneeze and the six-foot rule is based on the fact that respiratory droplets from a sneeze or cough may travel up to six feet. Social distancing is primarily about protecting you from a cough or sneeze.  Coughing and sneezing into a tissue or into your sleeve is important to contain the spread of respiratory droplets. 

Q: What is Social Distancing? Why is it important? 

A: Social distancing, quarantines and self-isolation are terms in wide use during the COVID-19 pandemic. Social distancing involves avoiding crowds and keeping a safe distance between you and others when shopping or going for a walk.  It is a preventative measure through limiting inter-personal contact. Until we understand more about COVID-19, it is important to follow the social distancing guidelines set by your government.

Q: How can I protect myself from COVID-19?

A: The best way to prevent illness is to avoid being directly exposed. Four things to keep in mind:

1. The most important is to avoid close contact with anyone who is showing symptoms of COVID-19 or who has been diagnosed with COVID-19.
2. Wash your hands frequently especially after coughing or sneezing and being in public places. Wash your hands with soap and water for at least 20 seconds. If soap and water is not available, use hand sanitizer.  Avoid touching your eyes, nose, and mouth with unwashed hands after touching surfaces that others would have commonly touched. 
3. Practice social distancing. 
4. Maintain a healthy lifestyle. 

Q: If you have symptoms or if you have tested positive for COVID-19, is it important to self-quarantine? 

A: YES.  First and foremost, if you have symptoms of COVID-19 it is important to call your local public health for testing. Anyone who has symptoms or has been tested positive MUST self-quarantine as directed by public health, usually for 14 days.  When self-quarantining it is imperative that you stay home, avoid visitors, and stay at least six-feet away from other people in the household. It is also important to avoid sharing things like towels and utensils and that you use standard hygiene measures. Ask friends and family to do your shopping and drop groceries or other supplies outside your door, in order to limit personal contact. If your symptoms worsen, call public health and they will direct you further.

Q: How long is the COVID-19 incubation period?

A: FIVE days! The time between exposure and showing symptoms of the COVID-19 virus can be 1-14 days. Most commonly it is about 5 days. 

Q: What is flattening the curve? Why is it important?

A: Flattening or slowing the rate of infection helps prevent overloading of local healthcare providers. Social distancing helps to spread out the rate of people with severe symptoms so that the hospitals are able to effectively manage the situation and it gives researchers and other medical professions more time to understand how to manage COVID-19.

Q: Can I get the COVID-19 virus from my pet?

A: NO! There is no evidence that pets can carry the COVID-19 virus. However like any surface that an infected person sneezes or coughs on, infected droplets can be carried on pet fur for a short period of time. Anytime you happen to cough or sneeze on your pet, please wipe their fur down with a damp towel before another family member or another person interacts with them.

Q: Who should wear a facemask?

A: If you are sick wear a facemask when you are around other people and before entering a public place or a healthcare provider's office. A facemask minimizes the chance that a cough or sneeze will affect others. If you are unable to wear a mask, or do not have one, it is important to follow the proper hygiene protocol for a cough or sneeze and to avoid close contact with others.  If you are NOT sick it is only necessary that you wear a facemask if you are caring for someone who is sick. 

Q: Is it helpful to wear gloves?

A: Gloves are necessary for those in the service industry, especially with those involved with food preparation or handling. For the general population, gloves are not necessary.  Gloves, whether they are latex, cloth or winter gloves, can all carry the virus. When you touch a surface that has respiratory droplets from the virus then the virus may be transferred to your gloves. My experience is that people are more likely to touch their face while wearing gloves than they are to touch their face if they are hanging onto a disinfectant wipe or tissue.  Keep in mind, healthcare workers have an increased risk of exposure and wearing gloves is important for them.

Q: What is the overall mortality rate of COVID-19?

A: It is going to take awhile to figure out the actual mortality rate (the number of people who may die if they catch COVID-19).  The World Health Organization (WHO) currently suspects that the mortality rate is around 3.4%. It currently appears higher in some countries (such as Italy), but is also much lower in other countries.  As the testing for COVID-19 has primarily focused on those that have symptoms, there is a chance that the mortality rate will decrease as we learn more about this virus.

Q: How many people who get infected will have significant symptoms?

A: Research currently indicates that about 80% to 90% of those that have the virus will be asymptomatic or will have mild or moderate symptoms. Which means that about 10% to 20% will have concerning symptoms that will require medical intervention or hospitalization. That being said, it is important for everyone to practice proper hygiene and social distancing.

Q: How many people will someone who is sick infect?

A: Reproductive rate is a measurement of how many people an infected person will infect. For example, the reproductive rate for the common flu (Influenza) is one - which means that for each person that is sick they will infect one other person. Recent research is indicating that the reproductive rate for COVID-19 is between 2 and 2.5.  There is speculation that as we learn more about COVID-19 the reproductive rate may actually decrease closer to that of the flu. 

Q: How long is someone who is infected able to infect someone else?

A: It is generally believed that someone who is showing symptoms can affect someone else for about 10 days. The term viral shedding relates to the ability of the virus to move from one part of the body to another (i.e., from your hands to your mouth) and from an infected person to the environment (i.e., from an infected person's hands to a hard surface) where it can affect others.  The current research indicates that it less likely that someone who is symptom-free will affect others with the virus.

Q: What is the difference between COVID-19 and SARS-CoV-2?

A: COVID-19 stands for Coronavirus Disease 2019. It is the name of the disease. SARS-CoV-2 stands for SARS (Severe Acute Respiratory Syndrome) Coronavirus 2 and it is the name of the virus.

Q: What is the source of SARS-CoV-2?

A: Based on the analysis of the virus, the source is from a dead animal. The transfer from animal to human would have occurred at a meat or fish market when humans were interacting with meat - NOT a live animal and NOT from a pet. At this time, the actual animal source has not been found but many are working tirelessly to figure it out. Part of the "unknown" factor for SARS-CoV-2 is that it originated from an animal and hence humans do not have the same natural immunity to this virus.

Q: How can your naturopathic practitioner help?

A: The naturopathic community is here to help you through this pandemic. Check out our blog "A Crash Course on Respiratory Health" The focus of naturopathic practice is to provide:

• Health Promotion: guidance on a healthy lifestyle
• Prevention: reinforcing the importance of hygiene and social distancing
• Supportive Care: providing guidance on how to support your overall health. Currently there are no proven treatments - conventional or naturopathic - for COVID-19.
• Recovery: helping patients recover and reestablish their health if they have had any symptoms.

Q: What is best to do when home in self-isolation or quarantine for a couple of weeks?

A: Situations like this are a good reminder of the importance of a healthy lifestyle. Here are some tips while in self-isolation:

• First and foremost, create a routine. Plan out your day. Avoid the tendency to sit around and watch movies or television all day.  
• Exercise is important. This might be a great time to focus on stretching, walking (even if it is around your house) or other activities you can do at home.
• Work on a project. Take the time to clean out the garage, paint a room in the house, clean out those closets that you never get to, or other tasks at home.
• Eat healthy.  This is a time to focus on healthy eating. Avoid filling up on junk food and high starch foods. To help the body stay healthy, eat your fruit and vegetables, adequate protein and healthy starches. 
• Keep in touch with friends and family. Self-isolation and quarantine can be quite uncomfortable for may people. It is important to reach out to others. 
• Mindfulness and meditation are very helpful in times of stress.  If you are not familiar with these coping strategies there are a number of apps that you can download and enjoy.
• Limit the amount of time that you are listening to the news. Think of news, especially "bad news" as a challenging workout for your mind. Like any muscle, it can handle a bit, but it can't handle too much!

By ensuring a holistic approach to this problem, we will get through this pandemic together. As new information and research is available the global health care community will master this infection as it has all others.

If you have any questions, please call to speak to one of the naturopathic doctors in our clinic.