Presenting symptoms and lab values
The first report of 41 patients confirmed to have COVID-19 in Wuhan, China found that initial symptoms included fever (98%), cough (76%), myalgia or fatigue (44%), sputum production (28%), headache (8%), hemoptysis (5%), and diarrhea (3%). Dyspnea developed in 55% of patients with progression to ARDS in 29% of patients. A total of 13 (32%) patients were admitted to the ICU and 6 patients (15%) died.12 A subsequent report of 138 patients, also from Wuhan, found that 98.6% of patients had fever, 69.6% had fatigue, and 59.4% dry cough. In that cohort, 36 patients (26%) required ICU care, and 6 patients (4.3%) died.6 A larger, multi-institutional characterization of 1099 patients with laboratory confirmed COVID-19 throughout China found that 88.7% of patients developed fever during their hospital admission. The second most common symptom was cough (67.8%). Less frequent were nausea or vomiting (5%) and diarrhea (3.8%). Upper respiratory type symptoms were relatively infrequent with only 13.9% presenting with sore throat and 4.8% of patients with nasal congestion. Of those patients, 5% were admitted to the ICU, 2.3% required mechanical ventilation, and 1.4% died.13 While not initially reported, multiple recent studies have found chemosensory dysfunctions associated with COVID-19,14,15 with one study finding up to 85.6% and 88% showing olfactory and gustatory dysfunction respectively.16 Notably, emerging data has found the asymptomatic carrier rate to be in the range of 17.9-21.7%.17,18 The most common laboratory abnormalities included lymphocytopenia (83.2%), thrombocytopenia (36.2%), and leukopenia (33.7%).13