Are we looking for the wrong symptoms in the bid to beat ?

A sniffle, jet lag and heavy legs: Signs that you might have coronavirus without even realising as medics ask if we are looking for the wrong clues

•  Coronavirus patients have said they suffered a range of different symptoms
• NHS guidelines claim a persistent dry cough and a fever are good indicators 
• Anyone with these symptoms have been asked to self isolate for up to two weeks 
• Experts fear this advice is putting many vulnerable people at risk of the virus
• Coronavirus symptoms: what are they and should you see a doctor?

A new, persistent, largely tickly cough and a temperature measuring above 37C. These, according to official NHS advice, are the two telltale signs of Covid-19. And if we come down with either, we – and our families – must confine ourselves to our homes, sleep in separate beds and turn away all visitors – for at least 14 days.

But, as the number of cases explodes across Britain, patients themselves are reporting altogether different symptoms. 

Over the past week, this newspaper has spoken to sufferers both in the UK and the rest of the world to find out what Covid-19 actually feels like.

As the number of coronavirus patients increases, those who contracted the disease say they suffered far more symptoms compared with the NHS guidelines which suggest the main symptoms are a fever and a cough

And, according to them, it can range from anything from sore eyes to mild tiredness.

For many, the cough and fever crop up a week into their illness, once they’ve unknowingly infected hundreds of others. Dr Edward Wright, virologist and senior lecturer in microbiology at the University of Sussex, says: ‘For every one case with the typical symptoms, five to ten cases may go undetected because their symptoms may be atypical, or they could have none at all.’

All of which begs the question: if the illness can be so varied, how do you know you’ve got it?

Unsurprisingly, one of the most-Googled questions of the past two weeks is: ‘What are the first signs of Covid-19?’ We’re told spotting the signs early is crucial for stopping the spread of infection.

Government advice would suggest that the signs are easy to detect – it’s based on studies showing roughly 82 per cent of sufferers will notice a new, persistent cough, and 98 per cent will have a temperature above 37 degrees.

Yet, patients themselves have described a wide variety of early-stage symptoms, easily mistaken for ‘jetlag’, the effects of an ‘intensive gym workout’ or being ‘generally run down’.

London-based GP Clare Gerada, who tested positive for the virus on Friday, March 13, also simply felt jetlagged at first. She is no self isolating at home

Professor Neil Ferguson of Imperial College in London has been a key figure in the battle against coronavirus, however, he is now recovering from the virus himself 

Lidia Puerta, a 26-year-old former student at Imperial College London who is eight months pregnant, described the early stage as ‘just exhaustion’ and says she put it down to recent travels, or pregnancy.

‘Last weekend I’d just got off a flight from Madrid,’ says Lidia, who tested positive for the virus last Sunday and is in quarantine in a hospital in Singapore, where she lives. And when I arrived home, I felt more exhausted than usual and had a bad night’s sleep, feeling a bit hot and cold. But I didn’t have a fever. It was a bit like jetlag when you have been trying hard to sleep on the plane and you wake up every ten minutes.’

Lidia only sought medical help because she was ‘over-cautious’, having returned from a high-risk area and being eight months pregnant. She says: ‘If I wasn’t pregnant, I probably wouldn’t have rushed to do the test. I would have gone later and probably infected many others instead.

‘About three days after I started to feel unwell, I coughed twice – yes, just twice – at night time, and I’ve had some phlegm.’

Since then, Lidia, who is originally from Spain, says she has been ‘completely asymptomatic’. ‘For me, it felt like tiredness,’ she says. ‘By the third day, I could sleep well.’

Her husband, Junye Huang, who has also tested positive, did not suffer from a cough either.

Tara Jane Langston, 39, from North-West London, contracted the virus over a week ago during a trip to Poland. Doctors thought she had a chest infection but her symptoms quickly intensified, developing into pneumonia at the end of last week

London-based GP Clare Gerada, who tested positive for the virus on Friday, March 13, also simply felt jetlagged at first.

Speaking from her London home where she is self-isolating, the 60-year-old says: ‘I got back from New York on the Sunday morning and by Monday, I had an irritating cough – exactly like I get when I usually come off a flight.

‘It was a bit like something was stuck in my throat. But other than that, I was absolutely fine, so I didn’t think anything of it.’

Dr Gerada’s initial symptoms were so mild, she went to work on Monday. It was 48 hours after the first warning signs that things took a turn for the worse.

‘The cough just wasn’t going, and because it was dry, scratchy and became more painful, I realised it was different to flu or anything else I’d experienced before,’ says Dr Gerada, who is the former chair of the Royal College of General Practitioners.

‘Around the second day, I developed a vice-like headache. I decided to work from home and started to feel unbearably hot. But when I went to bed, I couldn’t stop shivering. I had several blankets on me, I was wearing a thermal vest and pyjamas and was still freezing cold. Five minutes later, I was baking hot and kicking all the blankets off me.

‘For the next two days, all I could do was sleep. I lost weight because I couldn’t stomach anything. Even when I got a bit better a few days in, it still felt like the worst hangover in the world. It was the worst I have ever felt.’

Despite this, Dr Gerada managed to treat herself at home with paracetamol only.

One 43-year-old patient, who does not wish to be named for fear it could jeopardise his job, likened his initial symptoms to an intensive exercise regime.

One patient said he only developed the tell-tale coronavirus cough a week after contracting the disease 

He said: ‘I came home last Friday, feeling absolutely fine and enjoyed Saturday playing games in the garden with my fiancée and two-year-old. But then, on Sunday morning, I woke up feeling achy all over. It was as if I’d done a high-intensity workout at the gym – everything hurt.

‘I still managed to get around the house and run after my little girl, but every time I moved my legs, they felt ridiculously heavy, as though they weighed a ton.’

Why everyone’s talking about… Paracetamol 

I’m just off to get some paracetamol since the NHS has recommended it to treat the symptoms of coronavirus… Make sure you’ve got enough cash. A 32-pack of pills in one Birmingham store has risen from £1.39 to £9.99 because of demand. Sounds as if we need to update the corny old joke ‘Why are there no painkillers in the jungle?’ Answer: ‘Because the parrots ate them all!’ 

But this is much too serious a subject for jokes! 

OK, paracetamol’s catchy pharmaceutical name is N-acetyl-p-aminophenol. It was first synthesised in 1877, by the chemist Harmon Northrop Morse, who grew up in the Green Mountains of Vermont. But it took another decade to be tried clinically on humans. Even then it was slow to catch on, probably because it turned some patients’ skin blue – due, it’s thought, to contamination. It was rediscovered in 1947. Even in normal times, 200million packets a year are sold in the UK. 

What’s it good for? 

Reducing fever, pain relief, tackling headaches, possibly improving exercise performance. You can even clean a scorched iron with it; just rub a tablet on the hot surface and stains come off. Last week, Bond girl Olga Kurylenko claimed she was recovering from coronavirus after doctors gave her nothing but paracetamol. 

How does it work? 

No one knows. Maybe it inhibits the production of certain hormones, or perhaps it affects receptor cells. Some scientists think it’s a placebo and that chalk is just as good. One study said turmeric is as effective; another – which we definitely choose to believe – said a couple of pints of beer would do an equal job. Needless to say, that last research came from a British university… 

Any side-effects? 

Not usually, if you stick to recommended doses. But too much can lead to liver or kidney damage and even death. Studies have found the painkiller (known as acetaminophen in America) may inhibit the feeling of empathy, and dampen feelings of rejection, so it could be said to heal a broken heart. 

Abnd for animals? 

It is extremely toxic to cats. And deadly to snakes – having been used to kill off an invasive species on the Pacific island of Guam. Dead mice pumped full of the drug were dropped from helicopters into the forest, each with a tiny parachute. 

Let’s hope supplies don’t run out

Fingers crossed – because India, the world’s main supplier of generic drugs, has restricted the export of 26 pharmaceutical ingredients and the medicines made from them, including paracetamol. 

STEVE BENNETT 

The supposed tell-tale cough came almost a week after the original complaints.

So are we watching out for the wrong symptoms?

‘A cough and fever are reliable indicators of this particular virus,’ says Dr Wright.

‘Coronaviruses usually result in a fever and high temperature, which are the physical signs that the immune system is kicking in and attacking the virus.

‘It’s only once the virus replicates, slightly further into the infection, that it can cause damage to the upper respiratory tract, which can result in a cough and soreness.

‘If you are younger and healthier, your immune system will be more alert to intruders and respond quickly. So you may be more likely to experience more significant fever-like symptoms faster.

‘But we don’t know for certain why some feel symptoms faster than others. That’s why community-testing people that don’t have symptoms is a good idea, so we can spot people before they develop symptoms and are infectious.’

Equally challenging are the Covid-19 patients who experience few to no symptoms.

Karen Whitaker, a 35-year-old lawyer from Cape Town, bypassed the recommended temperature checks on a flight home from Munich, thinking she was fever-free, so couldn’t be infected.

‘I had a little dry cough but the symptoms didn’t develop further,’ she says. ‘I only coughed a few times. I decided to have the test [privately] mainly to prove that I was negative because I was anxious to get back to work.’

Even now, almost two weeks after contracting the virus in Germany, she says: ‘I feel surprisingly OK, if a little tired.’

Lots of other sufferers feel just ‘coldy’. One 47-year-old woman from Vo in Northern Italy – one of the regions most affected – said: ‘It was just like influenza and it quickly passed.’

The woman, a bar owner, took just two days to recover.

Infectious-disease expert Dr Neil Ferguson, who is advising the Government on Covid-19, was well enough to do a radio interview at the peak of his illness.

‘I developed a slight, dry but persistent cough and self-isolated even though I felt fine,’ he tweeted on Wednesday.

He added later: ‘At four o’clock in the morning, I got a high fever, which is somewhat better now but I still feel fairly grotty.’

The virus is said to be fatal in roughly two per cent of cases, however experts say that it’s too early to give an accurate fatality rate – and figures vary depending on the country and specific health system.

Those who are older and with heart disease or other serious conditions are most badly affected. But eight out of ten sufferers may experience a mild illness.

Last week, American researchers claimed some patients were reporting ‘nausea or diarrhoea’ – despite many symptom-checkers that have been published indicating this was rare. Other German reports document patients who feel, ‘like they have a cold’.

So should those with even the slightest sniffle take serious precautions? Perhaps, says Jonathan Ball, Professor of Molecular Virology at Nottingham University.

‘There is emerging data that suggests that in as many of 70 per cent of cases the infection will present with symptoms similar to a common cold.

‘It wouldn’t be unreasonable to assume they can easily transmit the virus.

‘Based on Government advice – which specifies a persistent cough and raised temperature – most of the people who can potentially transmit will not be aware of the risk they pose to others and will not self-isolate.’

Dr Neil Ferguson was well enough to do a live radio interview while suffering from the illness. He said: ‘I developed a slight, dry but persistent cough and self-isolated even though I felt fine’

Dr Wright agrees: ‘Coronaviruses in general, of which there are seven different kinds, cause cold-like symptoms such as runny noses and muscle aches.

‘With this particular type, a cough and fever seem to be particularly common, but you don’t always get those.

‘If you have just a runny nose, there’s a chance you could just have the common cold virus. But there’s also a chance you could test positive for Covid-19.’

There are plenty of patients, however, who would describe their illness as anything but ‘mild’.

And not all, despite what’s being said about the ‘vulnerable’, have underlying health conditions – or are over 65.

On Friday, a gym-going mother-of-two took to social media to share her ordeal, posting videos of herself in hospital with the virus, describing every breath as a ‘battle’.

Tara Jane Langston, 39, from North-West London, contracted the virus over a week ago during a trip to Poland. Doctors thought she had a chest infection but her symptoms quickly intensified, developing into pneumonia at the end of last week.

She was admitted to Hillingdon Hospital and tested for Covid-19.

In a harrowing WhatsApp video clip, she points to a nasal tube providing her with oxygen and says: ‘Anyone who is thinking of taking any chances, just take a look at me. I’m in the intensive care unit. I can’t breathe without this.’

The reason why otherwise healthy individuals become so desperately unwell from this virus is currently unknown, according to Dr Wright.

‘We don’t have a clear picture why some people may have mild disease, and others severe,’ he says. ‘It could be to do with genetics but it could be to do with the virus replicating more rapidly, killing more cells.

‘There is an argument that, in some young people, the immune system may not be developed.

‘Perhaps it hasn’t seen as many viruses as an older person’s would, so it could be slow at detecting it.’

For Dr Gerada, the severity of her illness has, oddly, restored her faith in her body.

‘It made me realise that this is a horrible, horrible virus but, for most people, our body can fight it,’ she says.

‘The immune system is incredible. If my 60-year-old body can get me through it, that bodes well for the rest of us.’

Q&A: Can newborn babies get it and do mums-to-be need to self isolate?  

Q: Are pregnant women more at risk from Covid-19?

A: The Government : now advises that pregnant women should be particularly stringent in following social distancing measures, as they are considered at increased risk of suffering severe illness from the coronavirus.

This mean significantly reducing face-to-face contact with others, avoiding gatherings with friends and family and working from home.

The Royal College of Obstetricians and Gynaecologists last week made a statement to reassure women that this was more a precautionary measure. They said: ‘Generally, pregnant women do not appear to become more severely unwell than the general population with coronavirus. The majority [of mothers-to-be] will experience only mild or moderate cold/flu like symptoms.’

However, they do say that, as this is a new virus, how it may affect everyone is not yet clear.

‘We do know that pregnancy, in a small proportion of women, can alter how the body handles infections.

‘It’s something midwives and obstetricians are used to dealing with.

‘What has driven the decision made by officials [to put pregnant women on the risk list] is a desire to be very cautious.

‘There is a theoretical risk to the baby’s growth and a risk of premature birth should the mother become unwell, and social distancing will reduce that risk,’ they conclude.

Despite this, it is important pregnant women ‘do things that are necessary in daily life, such as taking their children to nursery and continuing to attend antenatal appointments.’

Although ‘if a woman is infected with coronavirus, she should let her maternity care unit know and put herself in self isolation.’

Q: I read that a newborn baby in London had tested positive for Covid-19 – can it be caught in the womb?

A: This month, two cases of babies being ‘born with coronavirus’ have been reported.

In both cases, it remains unclear whether transmission was prior to, or soon after birth.

Another report from China of four women with Covid-19 who gave birth, found no evidence of the infection in their newborns.

Dr David Evans, vice-president of the Royal College of Paediatrics and Child Health and consultant neonatologist at North Bristol NHS Trust, says: ‘An unborn baby is very unlikely to be exposed during pregnancy – based on the current evidence we have.

‘So far, there have been no confirmed cases of the baby being infected in the womb or of any babies being born with defects because of the mother being infected.

‘Transmission of the virus is most likely to occur post-birth, so it’s really important that the whole family and any visitors follow the government advice and make sure they wash their hands as often as possible.

‘Anyone who has any coronavirus-like symptoms – however mild – should stay well away from the baby and mother – and from anyone else.’

Very few children, including infants, have been reported to get Covid-19. Research suggests that in those who do, half had mild symptoms such as a cough, sore throat, runny nose and sneezing, and sometimes fever. In some cases children had only nausea, vomiting, stomach pain and diarrhoea.

There have been a handful of deaths reported in infants and children in China, but where details were available, all appeared to have other health problems.

Q: I live in a remote part of the countryside. Surely, I’m not at risk?

A: Dr Simon Clarke, associate professor of cellular microbiology at the University of Reading, says: ‘If you live in the countryside and have ever had a cold, then you can also get Covid-19.

‘Every time you go out, meeting friends, go shopping, or going to work you could pick up the virus or pass it on to someone else.

‘The density of the population is lower than that, say, in London, so it’s less likely that Covid-19 will spread as quickly.

‘And if you do need a doctor or a hospital, it can be more difficult. Everyone in the country must change their behaviour if we are to successfully beat this disease – no-one should think this problem is not for them.’

 

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