SFMC physician questions coronavirus symptom 'order'

The Saint Francis Medical Center hospitalist credited with developing a comprehensive hospital response to COVID-19 said Wednesday a recent University of Southern California study on coronavirus “order” doesn’t entirely square with her experience.

The USC study examined research from more than 55,000 confirmed cases of coronavirus in China and nearly 2,500 reported incidents of positive COVID-19 sufferers scattered across the world.

The conclusion is there is a certain reliable order in which COVID-19 symptoms appear, which may aid in earlier detection and possibly help in the more rapid treatment of patients.

USC’s study, published in the journal Frontier Public Health, road-mapped the following sequence: fever first, then cough, then muscle pain. Other symptoms — nausea and vomiting — come later, followed by diarrhea.

“We do see diarrhea in 20-to-25% of sufferers, which tend to be the most severe (COVID-19) cases,” said hospitalist Dr. Gretchen E. Price, DO, who has been with Saint Francis five years.

Price submitted a six-page proposal to Saint Francis administrators highlighting a thorough plan for a hospital unit to support coronavirus care.

Price, a native of Ellsinore, Missouri, said fever cannot always be depended upon to signal the onset of COVID-19.

“The numbers vary, but 50-to-75% of COVID sufferers present with fever,” Price said.

“If 100% had fever, it would be easier to tell folks to stay home, but plenty (of people) don’t exhibit high temperatures,” she said.

Price also disputes one specific USC finding.

“I’ve had very few (COVID-19 patients) with vomiting,” said Price, 39.

“Nausea, yes, loss of appetite, yes, but vomiting tends to be more associated with upper GI infection and with Influenza-B, for example,” she added.

Price noted with flu season coming this winter, it would be ideal to have a clear and inviolable step-by-step pathway of COVID-19 symptoms to more easily diagnose the coronavirus.

“It’s a challenge to get ahead of this,” conceded Price, while noting real progress since the pandemic began.

“Our understanding of the virus has improved significantly since March,” she said.