Six types of coronavirus found, depending on symptoms

The findings could help doctors to predict which COVID-19 patients are most at risk and likely to need hospital care in future waves of the epidemic.

British scientists analysing data from a widely-used COVID-19 symptom-tracking app have found there are six distinct types of the disease, each distinguished by a cluster of symptoms.

A King's College London team found that the six types also correlated with levels of severity of infection, and with the likelihood of a patient needing help with breathing - such as oxygen or ventilator treatment - if they are hospitalised.

The findings could help doctors to predict which COVID-19 patients are most at risk and likely to need hospital care in future waves of the epidemic.

"If you can predict who these people are at Day Five, you have time to give them support and early interventions such as monitoring blood oxygen and sugar levels, and ensuring they are properly hydrated," said Claire Steves, a doctor who co-led the study.

Besides cough, fever and loss of smell - often highlighted as three key symptoms of COVID-19 - the app data showed others including headaches, muscle pains, fatigue, diarrhoea, confusion, loss of appetite and shortness of breath.

The outcomes also varied significantly; some got mild, flu-like symptoms or a rash and others suffered acute symptoms or died.

The study, released online on June 16 but not peer-reviewed by independent scientists, described the six COVID-19 types as:

1) 'Flu-like' with no fever: Headache, loss of smell, muscle pains, cough, sore throat, chest pain, no fever.
2) 'Flu-like' with fever: Headache, loss of smell, cough, sore throat, hoarseness, fever, loss of appetite.
3) Gastrointestinal: Headache, loss of smell, loss of appetite, diarrhoea, sore throat, chest pain, no cough.
4) Severe level one, fatigue: Headache, loss of smell, cough, fever, hoarseness, chest pain, fatigue.
5) Severe level two, confusion: Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain.
6) Severe level three, abdominal and respiratory: Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain, shortness of breath, diarrhoea, abdominal pain.
Patients with level 4,5 and 6 types were more likely to be admitted to hospital and more likely to need respiratory support, the researchers said.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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COVID-19 may infect the respiratory centre of the brains, nervous system says CSIR researchers

A team of researchers at CSIR - Indian Institute of Chemical Biology (IICB), Kolkata has explored the neuro-invasive potential of COVID-19 and suggested that the virus may infect the respiratory centre of the brain, a statement said.

The researchers have also suggested that attention should be focused on the respiratory centre of the central nervous system to learn about mortality due to coronavirus.

The paper published in ACS Chemical Neuroscience and supported by Science & Engineering Research Board (SERB), a statutory body of the Department of Science & Technology (DST), implies that coronavirus could enter the human brain through the nose and reach the olfactory bulb of the brain.

From there, the virus might infect PreBotzinger complex (PBC), the primary centre of the brain that controls the respiratory rhythm generation. This explains that the collapse of the respiratory centre in the brain may be responsible for the breakdown of COVID-19 patients.

The team of researchers comprising Dr Prem Tripathi, Dr Upasana Ray, Dr Amit Srivastava and Dr Sonu Gandhi suggested that while the lung is one of the most infected organs, several other organs, including the brain, are also affected by COVID-19.

This is the first report that highlights that SARS-CoV-2 may target the PBC of the brainstem that controls respiration and causes the respiratory collapse of COVID-19 patients, the statement added.
The scientists have suggested that cerebrospinal fluid of COVID-19 patients and postmortem of the brain of the deceased should be assessed to better understand the route of SARS-CoV-2 entry and its spread to the respiratory centre of the brain.

The PreBotzinger complex functions as the primary respiratory oscillator and it has been proposed as a centre of respiration. It has been earlier shown that disruption of PBC causes lethality due to respiratory failure, suggesting its central role in respiratory rhythm generation.

“It is possible that SARS-CoV-2 may shut down the respiratory centre, and in turn breathing by infecting and destroying the PBC of the brainstem,” it said, adding that this hypothesis needs to be validated for SARS-CoV-2.

Another recent study from a group of scientists at King's College London, UK highlighting that loss of smell was one of the main symptoms of COVID-19 patients, hinting at the involvement of the same route through which coronavirus may enter the brain.

The study highlights that it is important to not only screen the COVID-19 patients for neurological symptoms but also further segregate when the symptom appears.

The researchers have pointed out that while at present, the brain is not considered as the site of the primary or secondary reason for the death of a COVID-19 patient, attention needs to be focused towards the brain''s respiratory centre.

“Postmortem of brain of COVID-19 patients could be assessed to know the route of entry and affected areas including detailed assessment of respiratory centre of the brain,” the statement added.

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New study shows loss of smell may indicate mild to moderate Covid-19

People who experience loss of smell as one of the symptoms of coronavirus are likely to have a clinical course of the disease ranging from mild to moderate, according to a study which might help healthcare providers determine which patients need hospitalisation, PTI reported.

The findings of the study, published in the journal International Forum of Allergy and Rhinology, follow an earlier study which stated that loss of smell and taste were indicators of a coronavirus infection.

Scientists from the University of California (UC) San Diego Health in the United States, said patients who reported loss of smell and taste were 10 times less likely to be hospitalised for the disease when compared to those without the symptom.

Carol Yan, a rhinologist from the UC Sand Diego Health and first author of the study, said, “One of the immediate challenges for health care providers is to determine how to best treat persons infected by the novel coronavirus.”

Yan said that it appears that loss of smell may predict that a SARS-CoV-2 infection will not be as severe, and less likely to require hospitalisation.

Other studies have stated age and underlying medical conditions such as chronic lung disease, serious heart conditions, diabetes and obesity as the risk factors for COVID-19.

The current study includes a retrospective analysis done on data of 128 out of 169 COVID-19 patients between March 3 and April 8, 26 of whom required hospitalisation.

Researchers said that patients who were hospitalised for treatment were less likely to report loss of smell (anosmia) — 26.9 per cent compared to 66.7 per cent for COVID-19-infected persons treated as outpatients. Similar percentages were observed for loss of taste (dysgeusia)

“The site and dosage of the initial viral burden, along with the effectiveness of the host immune response, are all potentially important variables in determining the spread of the virus within a person and, ultimately the clinical course of the infection,” said Adam S DeConde, study co-author.

Scientists suggested that if the virus initially concentrates in the nose and upper airway, it might result in an infection which is less severe and sudden in onset, decreasing the risk of overwhelming the host immune response, respiratory failure and hospitalisation.

The study said that loss of smell may also indicate a robust immune response which has been localised to the nasal passages, limiting effects elsewhere in the body.

Scientists cited the limitations of the study and said that they relied upon self-reporting of anosmia from participants, posing a higher chance of recall bias among patients once they had been diagnosed with the disease, adding that patients with more severe respiratory disease may not be as likely to recall or recognise the loss of smell. Hence more expansive studies were needed to validate the results.

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Can coronavirus damage the brain?

The full spectrum of the symptoms experienced by those infected with the SARS-CoV-2 is not fully known yet. Recently, research has pointed towards the neurological symptoms witnessed in COVID-19 patients.

Now, in an investigation of hospitalised COVID-19 patients in Wuhan, researchers have recorded the neurological manifestations of the disease. Their findings were published in the journal JAMA Neurology on April 10. They conclude that neurological symptoms can be noticed in a “notable proportion” of the patients and are not uncommon.

Neurological manifestations of the coronavirus (COVID-19)

In their investigation, researchers studied 214 COVID-19 patients between January 16 and February 19 and noted that over 36.4 per cent of them showed neurologic symptoms, more commonly in patients with severe infection.

They have categorised the symptoms into three categories — central nervous system manifestations which include dizziness, headache, impaired consciousness, acute cerebrovascular disease, ataxia (loss of full control of body movements) and seizures; peripheral nervous system manifestations which include taste and smell impairment, vision impairment and nerve pain; and skeletal muscular injury manifestations.
 
How can the coronavirus (COVID-19) affect the brain?

The SARS-CoV-2 virus binds itself to a receptor in the human cells called ACE2. This is also the receptor for SARS-CoV. ACE2 is present in other human organs as well, including the nervous system and skeletal muscles. Therefore, it is possible that the virus can lead to the person showing neurological symptoms through direct or indirect mechanisms using the ACE2 receptor.

Even so, it is not yet clear if the virus affects the skeletal muscles by binding with the ACE2 receptors or through some other route.

Further, the autopsy report of some COVID-19 patients showed that the brain tissue was hyperemic (congestion of blood in an organ), edematous (accumulation of watery fluids in cells or tissues) and some neurons showed degeneration.

Even so, such symptoms are not exclusive to the SARS-CoV-2 virus, neurological injury has also been reported in patients of SARS and MERS. An editorial in JAMA Neurology notes that in the case of SARS, the reports of neurological complications were limited and they appeared in patients two to three weeks into the course of illness.

So does COVID-19 affect the brain?

The researchers note that out of the 214 patients they studied, 126 had a nonsevere infection and 88 patients had severe infection. Overall, 78 patients showed neurological manifestations of the disease.

Compared to the nonsevere cases, the severe cases were older and had more comorbidities such as hypertension. Such patients also showed fewer “typical symptoms” of the disease such as fever and cough, while they were more likely to have neurological symptoms such as acute cerebrovascular disease, impaired consciousness and skeletal muscle injury.

Further, these neurological symptoms were seen early in the illness in COVID-19 patients, as opposed to similar manifestations seen in the case of some SARS patients.

Significantly, some of these patients reported themselves to the hospitals without any typical symptoms of the disease such as fever and cough, and presented themselves only with neurological symptoms. “Therefore, for patients with COVID-19, we need to pay close attention to their neurologic manifestations, especially for those with severe infections, which may have contributed to their death,” the researchers note.

An article in The New York Times said that specialists have observed neurological symptoms in COVID-19 patients in Germany, France, Austria, Italy and Holland. The report says, “Some doctors have reported cases of patients who were brought in for treatment because of their altered mental state, and who ultimately tested positive for Covid-19, although they had none of the classic symptoms like fever or cough,”, which is in line with what the researchers have observed in some patients in Wuhan as well.

Even so, further research needs to be done to understand why certain symptoms such as loss of smell or taste occur, to see if they are clinical manifestations of the disease itself or occur due to an inflammatory response in some patients.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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