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COVID-19 symptoms follow specific pattern

New study reveals clues

OW Staff Writer | 8/21/2020, midnight

USC researchers have found the likely order in which COVID-19 symptoms first appear: fever, then cough and muscle pain, followed by nausea, and/or vomiting, and diarrhea.

Knowing the order of COVID-19's symptoms may help patients seek care promptly or decide sooner than later to self isolate, according to scientists at the USC Michelson Center for Convergent Bioscience. The information also may help doctors rule out other illnesses, or help doctors plan how to treat patients, and perhaps intervene earlier in the disease.

The study, which appears in the journal Frontiers in Public Health, was led by doctoral candidate Joseph Larsen and scientists Peter Kuhn and James Hicks at the USC Michelson Center's Convergent Science Institute in Cancer.

“This order is especially important to know when we have overlapping cycles of illnesses like the flu that coincide with infections of COVID-19,'' said Kuhn, a USC professor of medicine, biomedical engineering, and aerospace and mechanical engineering. “Doctors can determine what steps to take to care for the patient, and they may prevent the patient's condition from worsening.''

Fever and cough are frequently associated with a variety of respiratory illnesses, including influenza, Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome. But the timing and symptoms in the upper and lower gastrointestinal tract set COVID-19 apart.

“Given that there are now better approaches to treatments for COVID-19, identifying patients earlier could reduce hospitalization time,'' Larsen said.

To determine COVID symptom chronology, the authors analyzed more than 55,000 confirmed coronavirus cases in China collected from Feb. 16-24 by the World Health Organization. They also studied a dataset of nearly 1,100 cases collected from Dec. 11 through Jan. 29 by the China Medical Treatment Expert Group via the National Health Commission of China.

In addition, to compare the order of COVID-19 symptoms to influenza, the researchers examined data from 2,470 cases in North America, Europe and the Southern Hemisphere, which were reported to health authorities from 1994 to 1998.

“The order of the symptoms matter, '' Larsen said. “Knowing that each illness progresses differently means that doctors can identify sooner whether someone likely has COVID-19, or another illness, which can help them make better treatment decisions.''