Overemphasis on fever as Covid-19 symptom may have led to a large number of cases being missed: AIIMS study

The study, published in the Indian Council of Medical Research’s Indian Journal of Medical Research, noted that fever was present in only 17% of these patients.

Published: 25th July 2020 04:54 PM  |   Last Updated: 25th July 2020 05:29 PM   |  A+A-

fever camp

A health worker checking the temperature at the fever camp near Chepauk in Chennai. (File Photo | R Sathish Babu/EPS)

Express News Service

NEW DELHI: A study of Covid-19 patients, admitted in two facilities under AIIMS-Delhi, has cautioned against overemphasis on fever as a predominant symptom of coronavirus saying that it may lead to several cases being missed.

The study, based on the clinical profile of 144 patients admitted in AIIMS trauma centre and the institution's Jhajjar centre in March-April, was published in the Indian Council of Medical Research’s Indian Journal of Medical Research.

The study report noted that fever was present in only 17% of these patients.

It was far less compared to other reports across the globe, including the Chinese cohort in whom 44 per cent had fever at the time of presentation and 88 per cent developed fever during the hospital stay, the paper said.

“Thus, overemphasis on fever as a predominant symptom may lead to several cases being missed,” the researchers in the study titled “Clinico-demographic profile & hospital outcomes of Covid-19 patients admitted at a tertiary care centre in north India” noted.

For a long time in India, clinical signs like fever, cough, fatigue and breathlessness were publicised by the government as symptoms of the infectious disease. It was only in June that the Union Ministry of Health recognized a loss of smell and taste, diarrhoea, and muscle pain as signs of Covid-19.

The study, however, said that more than 44% of the hospitalised patients were asymptomatic at the time of hospital admission and remained so throughout.

“This may be a cause of concern as these asymptomatic patients are potential transmitters of infection in the community,” the study said.

Also, most symptomatic patients had mild respiratory symptoms such as nasal symptoms, throat irritation and cough, which was different from the reported symptoms in other studies — and only 2 succumbed to the infection.

Though the study does not clearly say it, it gives enough clues to suggest that most of these patients were part of Tablighi Jamaat — a religious congregation in Delhi where the infection had spread in the early period of pandemic in India.

“In this single-centre study of 144 hospitalized patients with confirmed Covid-19 in north India, the characteristic findings included younger age, high proportion of asymptomatic patients, long time to PCR negativity and low need for intensive care unit care,” the authors, which included AIIMS director Dr Randeep Guleria noted.

While majority of the patients were treated with supportive care and required only symptomatic treatment or, antihistamines (48.6%), vitamin C (47.2%) and paracetamol (20.8%), antibiotic azithromycin was prescribed to 29 (20.1%) patients, hydroxychloroquine was administered to 27 (18.7%) patients and 11 (7.6%) received both HCQ and azithromycin.

Only five (3.5%) patients required oxygen supplementation, four (2.8%) patients had severe disease requiring intensive care, one required mechanical ventilation and mortality occurred in two (1.4%) patients.

The time to RT-PCR negativity was 16-18 days.

The paper, however, declared that the differences in symptom profile could be due to the selection bias, as most patients were identified on active screening.

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