covid-19: what it feels like

sunnybrook health sciences centre in toronto was the first canadian hospital to see cases of covid-19. internal medicine and infectious diseases physician dr. jerome leis has seen it from the beginning. the first patient was confirmed on jan. 25 and a second confirmed was confirmed on feb. 26.

symptoms from least to most severe

least severe.  these are people with barely any symptoms. symptoms could be mistaken for the common cold, and could be so insignificant that patients don’t seek medical attention at all. leis calls these ‘subclinical.’

more symptomatic .the most typical symptoms are respiratory, like dry coughs, sore throat, and fever. leis says other symptoms like diarrhea are quite uncommon. “what’s challenging is those symptoms may be absent and will develop after a few days,” he says. “people can have really mild symptoms and then progress to the more classic respiratory symptoms.”

localized infection without pneumonia . the next subset of patients have all of the above symptoms including localized infection to the upper respiratory tract without any pneumonia. this was the case with the second patient who was confirmed at sunnybrook this week.

infection with pneumonia . there are patients who develop a lower respiratory tract infection — i.e., pneumonia — but symptoms are still clearly very mild. even though chest x-rays look significantly abnormal, they don’t feel shortness of breath, don’t require supplemental oxygen or any real any intervention. leis says the first patient in canada was the “perfect example” of this type of patient. “although he was already on the spectrum of more severe disease, in the end, he did well for himself and the self-limited pneumonia got better on its own without requiring much medical intervention,” he says.

most severe . these are patients who have pneumonia and develop shortness of breath, respiratory failure, and acute respiratory distress syndrome (ards). patients are unable to breathe because there is inflammation and fluid filling up the air sacs in their lungs. the fluid and inflammation is caused by lymphocytes (the main immune cell against viruses) mobilizing into the lower part of the lung as a “very exuberant immune response to the virus.” once ards develops, the mortality rate goes up significantly and the need for critical care and life support is increased.

“ even with life support, there is a subset of people on a ventilator who will continue to fail and die of their illness,” says leis. “inflammation of the lungs can start to spread and affect other vital organs, like the kidney and liver. there are cases in literature of multi-organ failure. at that point, the mortality rate is extremely high.”

early literature, including two studies from china that have done autopsy investigations on patients have suggested covid-19 may have the same pathophysiology as sars, where lymphocytes were also present on the lower lung on the autopsy of patients.

however, the mortality rate of covid-19 is around 2%, whereas the overall fatality rate of sars was around 10%. in comparison, mers had a fatality rate of around 34% and ebola, an estimated 50% .

what to do if you have symptoms

while most people believe that hospitals are the best place to get tested, but this is not the case. leis reminds people to think of public health as a resource to help determine what your next steps should be if you think you may have the virus as opposed to adding to the patient burden in hospitals. for example,  if you are in toronto, leis recommends calling public health ontario’s hotline (416-338-7600) to review symptoms by phone and receive instructions on how to self-isolate.