CDC adds 6 COVID-19 symptoms to its list, but many doctors and hospitals already were using them

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The U.S. Centers for Disease Control and Prevention has added six symptoms to its list of those associated with COVID-19, but doctors say the symptoms weren’t recently discovered and the nation’s top health agency has just updated its list of possible symptoms.

The CDC added the six additional possible symptoms of COVID-19 to three previously listed symptoms. New are: chills, repeated shaking with chills, muscle pain, headache, sore throat, and loss of taste or smell. Previously just fever, cough, and shortness of breath were officially listed as known symptoms.

Although many news outlets publicized the new list of symptoms over the weekend, the changes were made without fanfare on April 17, updating a list of three symptoms that previously had been highlighted on the CDC website, according to the CDC site’s history on the internet archive.

Dr. Emily Landon, hospital epidemiologist at the University of Chicago Medical Center, said the hospital long has been using the updated possible symptoms as indicators of COVID-19, including on official documents aimed at the hospital’s own health care workers, so they could seek care if presenting with symptoms less obvious than fever, cough, or shortness of breath.

“We’ve been using all of these for a long time,” Landon said, adding that she’s pleased the CDC updated its list because it may encourage more people, or those with varied or less common symptoms, to seek medical care.

“I think it’s right to spell it out,” she said. “We want to spell it out so that people really understand that they need to get care.”

Dr. Kiran Joshi, senior medical officer for the Cook County Department of Public Health, was on the team that handled Illinois’ first case of COVID-19 in January, which was widely regarded at the time as the second confirmed case in the United States and the first instance of person-to-person transmission, he said.

“We saw early on really this thing of how people could be really fairly asymptomatic and still have had it. And we saw, over the months, we’ve seen a number of patients presenting in a number of ways with a variety of symptoms that look and feel a lot like the garden variety flu,” Joshi said.

Both Joshi and Landon said many of the new symptoms, such as chills or chills with repeated shaking, are among clear indicators of an influenza-like illness, or those that are common with a virus that produces fever.

“Your body thinks it’s cold, so you shiver and you have the repeated shaking that comes from shivering,” Landon said. “So adding those is kind of redundant with fever. Muscle aches also could fall under the same umbrella. You generally just ache or feel sore or weak with a fever, and muscle pain also can be common because you really do use a lot of muscles to shiver, especially if shivering for an extended time.”

Joshi said the addition that most stood out to him on the new CDC guidelines is the loss of taste or smell. He and Landon each said they were reading papers out of China in the earlier days of COVID-19 that warned loss of taste or smell may be among symptoms for some with coronavirus.

“I had the strange circumstance of having a colleague who was reporting that exact symptom and he tested positive,” Joshi said. “And the next day I think the paper describing loss of taste or smell was published, so it’s clearly very real.”

Landon and Dr. Susan Bleasdale, an associate professor of clinical medicine at the University of Illinois at Chicago, said although the CDC has just recently updated its list, they added loss of taste or smell to their guidelines in early March.

“You may notice it more as ‘My orange juice tastes funny,’ rather than explicitly saying you’ve lost your sense of smell or taste,” Landon said.

With more than 55,000 people dead from COVID-19 in a month’s time in the United States alone, Joshi said it’s obvious not everyone will have all the symptoms or even a combination of some of the more common symptoms. He thinks the CDC wanted to include what’s now known based on new cases.

Diarrhea has also been a common symptom Bleasdale and other doctors have noticed. Though it isn’t yet among the CDC’s official COVID-19 symptoms, it is another example of doctors working together to identify possible symptoms.

“Headache is something that by itself had not become a trigger but we’re seeing more people have headaches as one of the first signs,” Bleasdale said.

Bleasdale looks at the addition of new symptoms to the CDC’s official list as a positive move that can only improve care and result in more people realizing they have or had COVID-19, which helps improve accuracy in the data that’s so critical to tracking the pandemic’s spread.

“Having the CDC’s criteria expanded helps to get more people tested, so they know,” Bleasdale said.

In a statement, Dr. Ngozi Ezike of the Illinois Department of Health, said the added symptoms have been commonly seen for some time. But that doesn’t mean the updated list isn’t useful.

“As we have seen more cases of this novel coronavirus, we have been able (to) learn more about the symptoms,” Ezike said in the statement. “We know COVID-19 can affect individuals differently, but the initial diagnostic symptoms gave doctors and other medical providers the road map for identification.”

There are some symptoms that call for immediate intervention, Joshi said. Chief among them are shortness of breath, labored or troubled breathing, pain in the chest, or thinking becoming unclear. Some people have reported bluish lips, or a general change in color, he said.

“Those are all signs that you could be getting much sicker and I would want anyone with those signs or symptoms to get medical attention immediately,” he said.

It’s important not to think of the CDC’s list as exhaustive or finalized.

“We will continue to see changes that are brought to light by the ongoing research around COVID-19 so it’s very possible this could change … it’s still early,” Joshi said.


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