Symptoms of COVID 19

By dentist Dr. Richard Mitchell

Updated July 31, 2020

We are all concerned about the symptoms of COVID infection, and the worldwide covid-19 epidemic. But what exactly ARE the symptoms of covid - 19, and is it safe to go back to the dentist yet? What extra precautions might your dentist be taking in his office to avoid infecting you, and ALSO to avoid being infected BY you?

Coronavirus symptomsThe virus

I am working in Spain, and on March 16 2020, the government declared a state of emergency and the country went into lock down until June 21. I received several emails a week from the health department about how to proceed during this period, and the information here is based on advice issued by the Ministry of Health in Spain, the World Health Organization, and the California Department of Public Health.

To clarify 3 things first;

  • The word 'coronavirus' is used to describe any corona virus, and there are several.
  • SARS-CoV-2 is used to describe the new virus that has emerged and caused the current pandemic. It stands for Severe Acute Respiratory Syndrome CoronaVirus 2
  • Covid-19 is the word for the disease that is caused by the new virus, and it stands for Corona Virus Disease 19;  (as it was first identified in the year 2019).

Coronavirus symptomsDoes a mask help?

If you are having a dental problem, and cannot get to see a dentist for whatever reason, you can read some of my tips for home remedies HERE.

Symptoms of COVID 19

But first of all, what are the main symptoms of COVID 19 to be aware of and watch out for? There are several symptoms that may indicate you have been infected, and you may get only one symptom, or more than one;

  • A dry cough
  • A fever
  • Shortness of breath
  • Feeling tired and weak
  • Loss of sense of smell and taste
  • "COVID" toes.
  • Neurological symptoms
  • A red rash on your arms, chest, back, or legs.

Let's take a look at these one by one, and explain exactly what is meant.

A dry cough.

This is when you get a dry, tickly sensation in your throat, as if you've got a bit of dust or fine sand in there, and you have to cough. But the cough doesn't bring anything up. There's no phlegm, nothing. It's a "dry" cough. You might think that this cough would go away in a few minutes. But if it's caused by a coronavirus infection, the cough persists. You just have to keep coughing.

A fever.

The best way to check this is with a modern digital thermometer.

The normal body temperature should be between 97-99 degrees F, or 36.5 to 37.5 degrees C. (Celcius or Centigrade). If you record a temperature above 100.4 degrees F, then you have a fever.

Shortness of breath.

You may feel some difficulty breathing, as if you can't take a full breath properly. You feel a bit breathless, and try to take a deep breath to get some more air, but it doesn't work. You end up feeling that you are having to "work" at breathing, where it is normally something we don't think about doing, it just happens.

Fatigue.

You just feel tired and weak. Some people have reported getting the dry cough, then the next day feeling short of breath, then feeling better after another day or 2, only to wake up with a feeling of total fatigue.

Loss of Smell and Taste.

A lot of people who have contracted the coronavirus have reported that they lost their sense of small and sense of taste. They noticed that, among the other symptoms, they could not smell anything, and could hardly taste anything. Once the fever subsides, these senses return to normal.

COVID toes. 

Another more recent symptom accumulating more anecdotal evidence has been informally called “COVID toes.” It’s the presence of purple or blue lesions on a patient’s feet and toes, most commonly appearing in children and young adults. This is to do with abnormal blood flow in the toes. The new virus seems to affect blood clotting in some people.

Neurological Symptoms

SARS-CoV-2, the coronavirus that causes COVID-19, may cause neurological disorders by directly infecting the brain or as a result of the strong activation of the immune system.

Recent studies have found the novel coronavirus in the brains of fatal cases of COVID-19. It has also been suggested that infection of olfactory neurons in the nose may enable the virus to spread from the respiratory tract to the brain.

Cells in the human brain express the ACE2 protein on their surface. ACE2 is a protein involved in blood pressure regulation and is the receptor the virus uses to enter and infect cells. ACE2 is also found on endothelial cells that line blood vessels. Infection of endothelial cells may allow the virus to pass from the respiratory tract to the blood and then across the blood-brain barrier into the brain. Once in the brain, replication of the virus may cause neurological disorders.

Red Rash

It has recently been recognized that some people may just get a red rash as pretty much the only symptom of covid-19. Some authorities are requesting that this be officially stated by the World Health Organization.

covid-19 symptoms - skin rashSkin rash; image courtesy news.sky.com
Coronavirus symptomsHand washing is very important

Symptoms of COVID 19 -
Why it's worse than normal influenza

There are 3 main reasons why this new virus is so much worse than normal seasonal 'flu.

1. The seasonal influenza (or "flu") virus that crops up each year changes slightly from year to year. However many people have some degree of protection from previous exposures. While this may not prevent them from getting 'flu at some time, it means that the symptoms are not so severe.

With  covid - 19, humans have NO previous exposure and therefore no resistance to the virus. This is NOT a virus that has infected humans before, and so we have no degree of immunity at all. If you are exposed to the virus, you are highly likely to get infected.

2. During a normal 'flu outbreak, each person with 'flu can be expected to infect about 1.5 other people - on average. With the Coronavirus, current figures suggest that each person with the covid-19 virus will infect at least 3 other people. That's almost 3x as many people.

3. This virus started spreading at an exponential rate. Just click on this link to see the figures at worldometer.info, and be sure to scroll down the page, past the figures, to see the graphs of cases. That was an exponential curve. The numbers were doubling every few days in the first month.

4. The death rate;  WHO Director-General Tedros Adhanom Ghebreyesus said that globally the seasonal flu kills far less than 1% of those infected, while about 4% - 5 % of reported COVID-19 cases have died.

So the total number of people who will eventually die from this new virus is likely to be hundreds of thousands worldwide.

Update July 31,  2020 - global deaths from Covid-19 infection is now reported to be almost 700,000, (that's over half a million deaths) while over 17 million people worldwide have been infected. That is a death rate of over 4%.

And in India, Central America and Brazil the rates are still rising.

Symptoms of COVID 19 -
Who is most at risk?

Approximately 80% of people who become infected have mild to moderate symptoms. Some people get the infection but experience no symptoms and show no signs of infection. These are the 'silent spreaders',  who spread the virus without realizing it.

But around 14% have more serious symptoms, especially men.

You are more at risk of developing serious symptoms of COVID  if you fall into one of these groups;

  • You are over 60 years of age
  • You have a pre - existing medical condition, such as high blood pressure, diabetes, heart disease, lung disease or cancer.
  • You are overweight.

It seems that the older you are (over 60), the higher the risk. Rather oddly, children do not seem to develop symptoms anything like as severe as adults.

HOWEVER, being younger (say 30 years old) and fit (being a marathon runner or training for an Iron Man triathlon) is no guarantee that you will have only a mild infection. There are documented cases of people like this needing to spend 2 weeks in an intensive care unit, on a ventilator. This disease is unpredictable, and CAN kill even young people.

According to the BBC on July 9 2020;  "A June 17 study published in the New England Journal of Medicine focused on potential genetic factors in severe cases of COVID-19 with respiratory failure. The study involved nearly 2,000 patients with COVID-19 at seven hospitals located in Spain and Italy. Researchers observed that type O blood was associated with slightly more protection from the virus, while those with type A blood may be more vulnerable to the disease."

Symptoms of COVID 19 -
How to protect yourself

To dispel one myth immediately - normal face masks offer only very minimal protection. And that is only for a short time, until they become a little damp. Then they are useless in terms of protecting you from getting the virus. However they DO reduce the virus being expelled by you, if you are already infected. This protects others, and reduces transmission of the virus between people by about 65%.

To give you protection against inhaling the virus from someone else, the mask has to be a high-filtration mask that seals against the skin all the way round, like an N95 mask.

There are many other myths about eating garlic, saline solutions for your nose, and taking antibiotics. All are useless against the covid-19 virus.

SO, what actually works?

First, avoiding direct contact with anyone else, such as shaking hands, hugging and kissing. The virus is transmitted very easily by direct contact. Try to keep a minimum 6 feet distance from anyone else - admittedly not easy on public transport! If you cannot maintain a 6 feet gap from others, wear an N95 standard face mask.

Second, wash your hands with hot water and soap for at least 20 seconds. And do it every 30 minutes. Normal soap contains fats which dissolve the virus shell, so is very effective. Alcohol-based hand sanitizers also work, but not as well as soap and water!

Third, do NOT touch your face, especially mouth, nose and eyes with your hands. This is something we all do without noticing or thinking about it. But touching your face with a finger that has virus on it will allow easy entry into your body.

Fourth, avoid touching any surfaces in public that others have touched, like ATM buttons or touchscreens, elevator buttons, door handles, railings, tables, and even bank notes. Use contactless card payments at the supermarket where possible. Even better, do your grocery shopping online and get home delivery.

If you cannot avoid this sort of contact, use a hand sanitizer frequently, and wash your hands with soap and water as soon as possible. And don't touch your face.

Fifth, avoid crowded situations as far as possible, such as supermarkets, public transport such as buses, trains and aircraft, and places with many visitors like museums, cinemas and restaurants/bars. If you cannot avoid busy places, wear an N95 standard face mask.

To protect yourself, assume that every other person is infected - even if they seem well.

To protect others, assume that YOU are infected.

This will break the chain.

Coronavirus symptomsBe the one who breaks the chain!

Symptoms of COVID 19 -
Is it safe to visit your dentist?

A dental office is normally a place you would think would be on top of infection control procedures - and that is true. But covid-19 is different.

For example, if a person infected with symptoms of covid - 19 coughs or sneezes into their hand, and then uses the door handle into the dental office, touches the reception desk, uses the restrooms, and touches a magazine in the waiting room, these surfaces are sources of infection with the virus.

Inside the dentist's room, disinfection procedures will already cover virus contamination. BUT now there is a need to minimize the spread of the virus in the first place. How is that done?

  • Cancelling ALL routine treatment appointments.
  • Only making appointments for emergencies.
  • ALL staff (including reception) wearing eye protection, proper high-filtration face masks, head covering,  and gloves.
  • Limiting use of dental equipment that generates aerosols, such as high-speed drills and ultra-sonic scalers.
  • Using a 30-second disinfectant mouthwash before any contact with the dentist.
  • The dentist may use a 'rubber dam' (like a little surgical drape) over your teeth during treatment.
  • Minimizing use of intra-oral X-rays; Panoramic (external) X-rays are preferred.
  • Only allow the patient into the treatment room. Accompanying friends and relations should wait outside, preferably outside the entire office.
  • Remove all magazines and newspapers from the waiting room.
  • Moving waiting room chairs further apart - minimum 6 feet.
  • Limiting waiting time in the waiting room to less than 5 minutes - if the dentist is running late, the patient should leave the premises until the dentist is ready.

What about the Ibuprofen problem?

Otherwise known as Nurofen or Advil, this has been the subject of fake news and scaremongering. According to the BBC, there have been several What'sApp messages circulating that purport they "have a doctor in the family who has been sent information by a lab in Vienna that says Ibuprofen is dangerous."

THIS IS UNTRUE.

The fact is that Ibuprofen belongs to a class of drugs called 'non-steroidal anti-inflammatory drugs'. The important point here is that they are anti-inflammatory.

This means that Ibuprofen exerts it's effects by suppressing inflammation in your body - that is your body's natural immune response. And if your immune response is suppressed, there is a possibility that an infection could last a little longer. BUT this is pure speculation at the moment, and medical opinion is divided.

The World Health Organization recommends sticking to painkillers containing Paracetamol. It's just a precaution, but it's such a simple choice to make.

Remember, if you are having a dental problem, and cannot get to see a dentist for whatever reason, you can read some of my tips for home remedies HERE.

Here is a link to recent guidance from the California Department of Public Health regarding the opening of dental offices in California, for dentists.

I hope my guide to the symptoms of COVID and protection has been helpful. I am updating it every day as the worldwide situation evolves, so check back regularly to find out the current recommendations.

HERE is a link to the British General Dental Council's Symptoms of Covid-19 page.

Best wishes.

UPDATED JULY 31,  2020

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