Lessons from a group of healthcare providers at Cambridge Health Alliance who set up an ambulatory clinic shortly before the pandemic surge reached their community could help pharmacists and others identify patients likely infected with SARS-CoV-2 in the absence of definitive testing. In turn, that could help them guide patients to the OTC products best suited to their ailments and educate patients about when to see a physician.

In an article in the April 13 issue of Mayo Clinic Proceedings, they noted that patients infected with the novel coronavirus presented with a wide range of respiratory and gastrointestinal (GI) symptoms, as well as headache, back pain, myalgia, and fatigue commonly associated with influenza, bronchitis, or GI viruses.

They found that one early indicator of a SARS-CoV-2 infection was loss of smell, which commonly occurred in the first few days of illness. 

While many patients with mild cases recover within 2 or 3 weeks, a significant number deteriorate and start to experience labored breathing. “The onset of dyspnea is the point at which COVID-19 can begin to be discerned from other common illnesses,” they said.

Generally, the downward trend is noticeable 4 to 8 days after symptoms start, but they found that a few patients developed dyspnea somewhat later. The timing of dyspnea distinguishes COVID-19 from other infections with similar presentation. 

Patients with uncomplicated flu seldom develop shortness of breath in the 4 to 8 days after symptoms start, and those with mild dyspnea typically improve gradually. Influenza that develops into viral pneumonia with labored breathing usually does so very quickly. In Pneumocysitis pneumonia, dyspnea slowly develops over an extended timeframe.

Notably, one cause of shortness of breath is related to the coronavirus, but to fear rather than infection, they wrote. In these cases of anxiety-induced dyspnea, the trouble breathing begins nearly simultaneously with first symptoms and is not associated with low oxygen saturation or increased with exertion.

Many patients with dyspnea were managed at home, but some required hospitalization due to dropping levels of oxygen saturation. All COVID-19 patients with dyspnea required close monitoring, indicating that pharmacists should instruct all patients with trouble breathing to contact their physician for evaluation and further instruction.

The team’s experience aligned with previous reports that the factors most closely associated with clinical deterioration were older age, diabetes, cardiovascular disease, obesity, and hypertension. They also found that immigration from Central America and living with multiple family members or multiple families was a risk factor for more severe disease.
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