Clinical presentation of Bulgarian patient with possible COVID-19

Lyubomir Kirov

Keywords: COVID-19, primary care; symptoms, presentation

After its emergence SARS-CoV-2 has infected > 93 million people and lead to > 2 million deaths worldwide (WHO, January 2021). There is currently no definitive treatment, the effect of the vaccines is still not quite well established, and it seems that heard immunity will not be achieved in a year. Early detection and isolation of the infected together with the personal prevention are still in action. On this background there is still not enough research results about symptoms of COVID in primary care, compared to hospital care.

Research questions:
What is the expert opinion of GPs and specialists in the outpatient care about the initial manifestations of COVID, the most common symptoms, complications and how they evolve with time?

Web-based questionnaire with several answers suggested and option for free text comment, 10 days duration (23 November - 02 December 2020), completed by 703 physicians, 94% (n-661) GPs, who present 16% of Bulgarian GPs, providing care to approximately 1 million people.

The most common manifestations according to the proportion of the physicians who voted are: fever (91%); weakness/malaise (80.7%); headache (78%); loss of taste and/or sense of smell (71.6%); myalgia (66.7%); cough, mostly dry (56.9%); sore throat (51.8%).
Diarrhea, nausea and vomiting, difficulty breathing, or shortness of breath are significantly rarer, indicated by 24.9-16.1-11.1% of participants, respectively. Ageusia/anosmia are quite specific for COVID, usually occur after day 3 of the onset of complaints vote 59.5% of participants, on 2-3 day (37%) or day 1 (3.6%). As the only first symptom are pointed fever, weakness, headache, ageusia/anosmia by 74.4-64.1-50.8 and 46.1%, respectively. 56.1% claim that fever duration is 5-10 days and 29.2%-3-5 days usually 37.5-38.0°C (72.4%). Worsening may happen after 8 (46.5%) or 5 days (46.1%) of onset.

Ageusia/anosmia and prolonged fever may strongly support the presence of uncomplicated COVID in primary care.

Points for discussion: