Symptom Spectrum and the Evaluation of Severity and Duration of Symptoms in Patients with COVID-19

Senol Dane^1* and Murat Akyuz²

^*Correspondence: Senol Dane, Department of Physiology, Faculty of Basic Medical Sciences, College of Health Sciences, Nile University of Nigeria, Nigeria, Email:

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Introduction

The very 1st case of COVID-19 infected in Nigeria was recorded on March 10, 2020. With a constant increment in numbers, all tertiary educational institutions were closed with an order of the Ministry of Education by March 20, 2020, and the government announced the initial lockdown of big cities on March 30, 2020 [1].

Psychological stress due to COVID-19 pandemic can result in fear and worry among people about their health and financial conditions. It can also cause changes in eating patterns, sleeping problems, concentration difficulties, and exacerbation of chronic health problems, mental health conditions, usage of tobacco, alcohol, and other substances [2]. The current pandemic-related coping strategies may harm mental health, such as decreased well-being and increased depression and anxiety symptoms [1,3], insomnia, and anger [4-6]. Also, inactivity due to COVID-19 disease can have a negative effect on physical and mental health and coping with stress and anxiety during isolation time [7,8]. Besides, there were some negative lifestyle changes due to the COVID-19 pandemic [9]. Furthermore, the fairly big changes in food consumption preferences were reported [10]. Also, in another study, there was a significant decrease in family incomes and a significant increase in family expenditures during the pandemic outbreak [11]. Also, Nigerian women entrepreneurs experienced the negative effect of COVID-19 outbreak on their businesses [12].

A wide range of symptoms are found in COVID-19 patients, ranging from mild/moderate to severe, rapidly progressive, and fulminant disease. Symptoms of COVID-19 are non-specific and disease presentation can range from asymptomatic to severe pneumonia. Incidence of asymptomatic cases ranges from 1.6% to 51.7% and these people do not present typical clinical symptoms or signs and do not present apparent abnormalities in lung computed tomography [13-18]. The most common symptoms of COVID-19 are fever, cough, myalgia, or fatigue and atypical symptoms include sputum, headache, haemoptysis, vomiting, and diarrhoea [19,20]. Some patients may present with sore throat, rhinorrhoea, headache, and confusion a few days before the onset of fever, indicating that fever is a critical symptom, but not the initial manifestation of infection [20]. Furthermore, some patients experience loss of smell (hyposmia) or taste (hypogeusia), which are now being considered early warning signs and indications for self-isolation [21,22].

In the present study, three aims were targeted, (1) determination of symptom spectrum and the evaluation of severity and duration of symptoms in patients with COVID-19, (2) determination of the effects of some demographic characteristics on symptom severity and duration and (3) determination of the effects of race (Nigerians and expats) and (4) age group.

Materials and Methods

Participants

Subjects were those who experienced COVID-19 and recovered. All subjects were living in Abuja Nigeria for at least the last one year. Eighty-one subjects were included in the study. All of them accepted to participate in this study (51 men, average age=35.123 years, standard deviation, SD=3.861: 30 women, average age=34.428, SD=4.952). Out of 81 cases, 48 were expat and 33 were Nigerian. Data was collected by using an online survey. The survey was shared by using social media (whatsup groups).

The experimental protocol was by following international ethical standards. The study was performed per under the Helsinki Declaration (1975, revised in 1996-2013) [23]. The aims and objectives of the study were explicitly explained to the participants before the commencement of the study.

The survey consisted of 3 different parts.

Part 1: Demographic information. In this part the demographic information (gender, age, nationality (Nigerian or expat)) was asked.

Part 2: COVID-19 symptom severity. In the questionnaire, each COVID-19 symptom had 4 answer options: if person had not this symptom (0 point), if symptom was mild (1 point), if it was moderate (2 points) and if it was severe (3 points).

Part 3: COVID-19 symptom duration. In the questionnaire, each COVID-19 symptom had 4 answer options: if person had not this symptom (0 point), if duration of symptom was 1-3 days (1 point), if it was 4-6 days (2 points) and if it was 7 or more days (3 points).

Statistical analyses

Measured values are given as a mean +/- standard deviation (SD). Statistical analysis was performed using the software SPSS for Windows, version 26. The student’s (one sample test) t test were used. In one sample, Student’s t test, test value was 1 (mild in severity and 1-3 day in duration).

Results

Symptom spectrum and their severity and duration of patients with COVID-19

Out of 81 patients, 45 had fever, 45 had cough, 55 had general body pain, 46 had loss of smelling, 42 had loss of taste, 55 had fatigue, 19 had eye pain, 51 had headache, 30 had runny nose, 25 had breathing difficulty, 32 had sore throat, 21 had abdominal pain, 23 had shivering, 22 had diarrhoea, 27 had catarrh, 41 had joint pain, 29 had weight loss, 12 had other symptoms (vomiting, loss of voice, sleeplessness, loss of sight, burning tongue, tooth pain, hallucination) (Table 1).

Table 1: Symptom spectrum and their severity of patients with COVID-19.

The disease sequalae or lasting condition was general fatigue in 29 patients, sleep disorder or sleep problem in 10 patients, weight loss in 5 patients, and shortness of breath in 8 patients.

Out of 81 patients, only 3 were experienced endotracheal intubation. Endotracheal intubation was applied 2 days for 2 of them and 4 days for 1 of them.

The severity of fewer (t=0.481, p=0.632), cough (t=0.592, p=0.556), loss of taste (t=0.89, p=0.376), sore throat (t=0, p=1), and join pain (t=0.398, p=0.692) were not statistically different than mild (1 point). Therefore, it can be stated that the severity of these symptoms was approximately mild in patients of the present study (Table 1).

The severity of generalized body pain (t=2.998, p=0.004), loss of smell (t=2.512, p=0.014), fatigue (t=3.999, p=0.00), headache (t=2.646, p=0.01) were statistically significantly higher than mild (1 point). Therefore, it can be stated that these symptoms were moderate or severe (Table 1).

The severity of runny nose (t=-2.234, p=0.043), breathing difficulty (t=-4.331, p=0.00), abdominal pain (t=-5.253, p=0.00), shivering (t=-4.593, p=0.00), diarrhea (t=-4.951, p=0.00), catarrh (t=-2.06, p=0.043), weight loss (t=-5.828, p=0.00) were statistically significantly lower than mild (1 point). Therefore, it can be stated that the severity of these symptoms was less than mild (Table 1).

The duration of fewer (t=0.546, p=0.586), cough (t=1.227, p=0.224), loss of taste (t=1.045, p=0.299), headache (t=1.668, p=0.099), sore throat (t=-0.74, p=0.462, join pain (t=0.00, p=1) and weight loss (t=-0.92, p=0.36) were not statistically different than 1-3 days (1 point). Therefore, it can be stated that the duration of these symptoms were approximately 1-3 days in patients of the present study (Table 2).

Table 2: The duration of symptoms of COVID-19.

The duration of generalized body pain (t=3.651, p=0.00), loss of smell (t=2.101, p=0.039) and fatigue (t=3.776, p=0.00) were statistically significantly higher than 1-3 days (1 point). Therefore, it can be stated that the duration of these symptoms were 4 or more days (Table 2).

The durations of runny nose (t=-2.229, p=0.047), breathing difficulty (t=-4.272, p=0.00), abdominal pain (t=-7.928, p=0.00), shivering (t=-5.433, p=0.00), diarrhea (t=-6.902, p=0.00) and catarrh (t=-2.329, p=0.042) were statistically significantly lower than 1-3 days (1 point). Therefore, it can be stated that the duration of these symptoms was less than 1-3 days (Table 2).

Gender related differences in symptom severity and duration

There were gender related differences in only loss of smell and loss of taste symptoms. The percentage of patients with loss of smell (47.1% in men and 73.3% in women) and loss of taste (43.1% in men and 66.7% in women) was higher in women than in men (respectively, chi square=5.314, p=0.036; chi square=4.189, p=0.041). Also, severity of loss of smell was higher in women (1.157 ± 1.254) than in men (1.066 ± 1.257) (t=2.877, p=0.005). Duration of loss of smell (t=3.286, p=0.002), loss of taste (t=3.364, p=0.001), fatigue (t=2.59, p=0.01) and headache (t=1.996, p=0.049) symptoms was higher in women than in men (Table 3). There was no gender related difference in other symptoms of COVID-19.

Table 3: Gender related differences in the duration of COVID-19 symptoms.

Race related difference

There was no race related (Nigerian or expat) in symptom spectrum, symptom severity and symptom duration in the present study.

Age related difference

Only breath difficulty was statistically significantly higher in 35-45 age group (chi square=17.792, p=0.013). For other symptoms, there were not statistically significand age related differences.

Discussion

As of today (03/27/2021), Nigerian COVID-19 statistics are following: Total number of cases=162.388, Total number of deaths=2.039, Total number of recovered patients=149.986, The number of active cases=10.363, The number of serious/critical cases=10, Total number of cases per 1 million population=774, The total number of deaths per 1 million population=10 [24]. These statistics show that COVID-19 cases and deaths in Nigeria are quite low compared to other world countries.

In the present study, the severity of fewer, cough, loss of taste, sore throat, and join pain were not different than mild the severities of these symptoms were approximately mild. The severities of generalized body pain, loss of smell, fatigue, headache was higher than mild these symptoms were moderate or severe. The severities of runny nose, breathing difficulty, abdominal pain, shivering, diarrhea, catarrh, weight loss was lower than mild the severities of these symptoms were so weak.

The duration of fewer, cough, loss of taste, headache, sore throat, join pain and weight loss were not different than 1-3 days the duration of these symptoms were approximately 1-3 days. The duration of generalized body pain, loss of smell and fatigue were higher than 1-3 days the durations of these symptoms were 4 or more days. The durations of runny nose, breathing difficulty, abdominal pain, shivering, diarrhoea and catarrh were lower than 1-3 days, the duration of these symptoms was less than 1-3 days.

Out of 81 patients, only 3 were experienced endotracheal intubation for a short time. These results show us that the severity and duration of COVID-19 symptoms were very low, and the disease can be easily overcome.

Duration and severity of loss of smell and loss of taste and durations of fatigue and headache symptoms was higher in women than in men. These results can be attributed the gender related differences in depression [3,25] and anxiety [1,3]. In previous studies, the relationships of some environmental and hereditary factors such as gender, education, physical abnormalities, handedness, marital status, visual memory, and salivary testosterone with some psychologies including selfesteem, alexithymia, depression [25-28,29-32].

There was no race related (Nigerian or expat) in symptom spectrum, symptom severity and symptom duration. Already, there is no country, race, ethnicity, or religion related differences in COVID-19 mediated infections and deaths [33].

Only breath difficulty was higher in 35-45 age group. In a recent study, all age groups are susceptible to COVID-19 infection, but the elderly and those with certain preexisting health conditions are particularly prone to severe disease [34].

Conclusion

These results show that COVID-19 cases in Nigeria are quite low compared to other world countries. In general, the severities and durations of COVID-19 symptoms were so weak.

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