Q & A on COVID-19: Medical information

1. What are the symptoms of COVID-19 infection

Symptoms of COVID-19 vary in severity from having no symptoms at all (being asymptomatic) to having fever, cough, sore throat, general weakness and fatigue and muscular pain and in the most severe cases, severe pneumonia, acute respiratory distress syndrome, sepsis and septic shock, all potentially leading to death. Reports show that clinical deterioration can occur rapidly, often during the second week of disease.

Recently, anosmia – loss of the sense of smell – (and in some cases the loss of the sense of taste) have been reported as a symptom of a COVID-19 infection. There is already evidence from South Korea, China and Italy that patients with confirmed SARS-CoV-2 infection have developed anosmia/hyposmia, in some cases in the absence of any other symptoms.

2. Are some people more at risk than others?

Elderly people above 70 years of age and those with underlying health conditions (e.g. hypertension, diabetes, cardiovascular disease, chronic respiratory disease and cancer) are considered to be more at risk of developing severe symptoms. Men in these groups also appear to be at a slightly higher risk than females.

See links to national guidelines on the treatment of patients with serious and life threatening conditions during COVID-19 under external resources

3. Are children also at risk of infection and what is their potential role in transmission?

Children make up a very small proportion of reported COVID-19 cases, with about 1% of all cases reported being under 10 years, and 4% aged 10-19 years. Children appear as likely to be infected as adults, but they have a much lower risk than adults of developing symptoms or severe disease. There is still some uncertainty about the extent to which asymptomatic or mildly symptomatic children transmit disease.

4. What is the risk of infection in pregnant women and neonates?

There is limited scientific evidence on the severity of illness in pregnant women after COVID-19 infection. It seems that pregnant women appear to experience similar clinical manifestations as non-pregnant women who have progressed to COVID-19 pneumonia and to date (as of 25 March), there have been no maternal deaths, no pregnancy losses and only one stillbirth reported. No current evidence suggests that infection with COVID-19 during pregnancy has a negative effect on the foetus. At present, there is no evidence of transmission of COVID-19 from mother to baby during pregnancy and only one confirmed COVID-19 neonatal case has been reported to date.

ECDC will continue to monitor the emerging scientific literature on this question, and suggests that all pregnant women follow the same general precautions for the prevention of COVID-19, including regular handwashing, avoiding individuals who are sick, and self-isolating in case of any symptoms, while consulting a healthcare provider by telephone for advice.

5. Is there a treatment for the COVID-19 disease?

There is no specific treatment or vaccine for this disease.

Healthcare providers are mostly using a symptomatic approach, meaning they treat the symptoms rather than target the virus, and provide supportive care (e.g. oxygen therapy, fluid management) for infected persons, which can be highly effective.

In severe and critically ill patients, a number of drugs are being tried to target the virus, but the use of these need to be more carefully assessed in randomised controlled trials. Several clinical trials are ongoing to assess their effectiveness but results are not yet available.

As this is a new virus, no vaccine is currently available. Although work on a vaccine has already started by several research groups and pharmaceutical companies worldwide, it may be many months or even more than a year before a vaccine has been tested and is ready for use in humans.

6. When should I be tested for COVID-19?

Current advice for testing depends on the stage of the outbreak in the country or area where you live. Testing approaches will be adapted to the situation at national and local level. National authorities may decide to test only subgroups of suspected cases based on the national capacity to test, the availability of necessary equipment for testing, the level of community transmission of COVID-19, or other criteria.

As a resource conscious approach, ECDC has suggested that national authorities may consider prioritising testing in the following groups:

  • hospitalised patients with severe respiratory infections;
  • symptomatic healthcare staff including those with mild symptoms;
  • cases with acute respiratory infections in hospital or long-term care facilities;
  • patients with acute respiratory infections or influenza-like illness in certain outpatient clinics or hospitals;
  • elderly people with underlying chronic medical conditions such as lung disease, cancer, heart failure, cerebrovascular disease, renal disease, liver disease, diabetes, and immunocompromising conditions.

7. Where can I get tested?

If you are feeling ill with COVID-19 symptoms (such as fever, cough, difficulty breathing, muscle pain or general weakness), it is recommended that you contact your local healthcare services online or by telephone. If your healthcare provider believes there is a need for a laboratory test for the virus that causes COVID-19, he/she will inform you of the procedure to follow and advise where and how the test can be performed.

8. Do persons suffering from pollen allergy or allergies in general have a higher risk to develop severe disease when having COVID-19?

A large proportion of the population (up to 15-20%) reports seasonal symptoms related to pollen, the most common of which include itchy eyes, nasal congestion, runny nose and sometimes wheezing and skin rash. All these symptoms are usually referred to as hay fever, pollen allergy or more appropriately allergic rhinitis. Allergic rhinitis is commonly associated with allergic asthma in children and adults.

Allergies, including mild allergic asthma, have not been identified as a major risk factor for SARS-CoV-2 infection or for a more unfavourable outcome in the studies available so far. Moderate to severe asthma on the other hand, where patients need treatment daily, is included in the chronic lung conditions that predispose to severe disease.

Children and adults on maintenance medication for allergies (e.g. leukotriene inhibitors, inhaled corticosteroids and/or bronchodilators) need to continue their treatment as prescribed by their doctor and should not discontinue their medication due to fears of COVID-19. If they develop symptoms compatible with COVID-19, they will need to self-isolate, inform their doctor and monitor their health as everyone else. If progressive difficulty breathing develops, they should seek prompt medical assistance.

9. How can we differentiate between hay fever/pollen allergy related respiratory symptoms and COVID-19 infection?

Many people with COVID-19 have mild, flu-like symptoms (see above question 1), which are rather common and need to be distinguished from similar symptoms caused by common cold viruses and from allergic symptoms during springtime.

The following table presents a comparison of the most common symptoms of all three conditions according to their reported frequency.

It is good to bear in mind that the definitive diagnosis of COVID-19 is not clinical, but through laboratory testing of a sample from the nose or mouth.

Table: comparison of common symptoms between common cold, hay fever and COVID-19

Illness

Common cold

Hay fever

(pollen allergy)

COVID-19

Fever

±

Sometimes

usually <38.5°C

No

+++

Yes, (maybe high grade)

Cough

+

Sometimes

±

Sometimes

+++

Yes, persistent dry cough

Runny/stuffy nose

++

Yes

+++

Yes

±

Sometimes

Sneezing

++

Yes

+++

Yes

±

Sometimes

Headache

+

Yes

+

Yes

+++

Yes

Myalgia

No

No

++

Yes

Anosmia

(loss of smell)

±

Sometimes

±

Sometimes

±

Sometimes

Conjunctivitis

±

Sometimes, depends on the virus

+++

Yes

++

Yes

Skin rash

No

++

Yes

No

Fatigue

±

Sometimes

±

Sometimes

+++

Yes

Difficulty breathing

No

±

Sometimes, esp. if allergic asthma

++

Yes, in moderate to severe cases accounting for about 20% of infected

N/V/D

No

No

±

Sometimes

Relieved by antihistamines

+

Antihistamines are included in OTC cold medications to relieve runny nose

+++

Yes

No

 

10. Should people who suffer from pollen allergy self-isolate if they develop typical hay fever symptoms?

No, there is no more reason for people suffering from pollen allergy to self-isolate if they develop their typical hay-fever symptoms than for anyone else. They should continue following the general guidance for physical distancing and seek medical advice if their symptoms get worse, if they develop fever or progressive difficulty breathing.