Loss of smell, taste added as symptoms of coronavirus disease

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The Union health ministry has revised its clinical management protocol for coronavirus disease (Covid-19) to include the loss of the sense of smell and taste along with fever, cough, sore throat and shortness of breath as symptoms, while also adding that children may not be reporting fever and cough as frequently as adults. Muscle pain, diarrhoea, expectoration (coughing up phlegm), and fatigue have also been added to the protocol released on Saturday.

HT reported on Thursday that the government was considering the revision to include loss of smell and taste as the symptoms for diagnosis and testing of the disease.

“Older people and immune-suppressed patients, in particular, may present with atypical symptoms such as fatigue, reduced alertness, reduced mobility, diarrhoea, loss of appetite, delirium, and absence of fever. Children might not have reported fever or cough as frequently as adults,” says the revised document released on Saturday.

A health ministry official underlined Covid-19 is a new disease and fresh information on it keeps emerging daily. “The ministry is constantly reviewing the evidence, both nationally and globally, to update its protocols. The current one is being released today [Saturday] based on the latest information available on the disease,” said the official, who did not wish to be named.

The first Covid-19 testing criteria was fixed in January and included symptoms such as fever, cough, and breathlessness. In May, gastrointestinal issues such as diarrhoea or vomiting were also added to the list. Until the revision, there were 13 clinical symptoms and signs in the specimen referral form and included fever, cough, diarrhoea, vomiting, abdominal pain, breathlessness, nausea, haemoptysis (coughing up of blood), body ache, sore throat, chest pain, nasal discharge and sputum. Any patient with one or more symptoms was to get tested for Covid-19.

In April and May, the World Health Organization, some European countries, the US, and Australia, added loss of smell and taste as one of the key Covid-19 symptoms.

An article published in the medical journal Lancet last week said the prevalence of loss of smell and taste was three-fold higher in individuals testing positive (65.03%) than in those testing negative (21·71%), for the disease suggesting that people with such symptoms should self-isolate.

Experts here have been asking for updating the clinical features for some time.

“The move by the ministry of health is in the right direction. There is growing concern among the public about asymptomatic people. Among the asymptomatic, a major subgroup comprises people who might be having atypical symptoms such as loss of smell, taste and weakness. Earlier these were not fitting the case definition of Covid-19, and therefore were not tested… with this expansion... we can prevent the spread aggressively…,” said Dr Giridhara Babu, the life course epidemiology head at the Indian Institute of Public Health, Public Health Foundation of India.

Dr GC Khilnani, a pulmonologist, said a number of people have been reporting to hospital emergencies with non-specific symptoms such as loss of smell and taste, and diarrhoea etc. “So it [the revision] makes sense to include these [symptoms] also.”

The revised document has also underlined certain risk factors that include age (over 60) and underlying non-communicable diseases such as diabetes, hypertension, cardiac disease, chronic lung, cerebro-vascular, chronic kidney diseases, immune-suppression and cancer.

“This category will need extra care, and if it is managed well then in the long run, we will be able to bring down the death rate even further,” said Dr Khilnani.

India’s case fatality rate is currently 2.86% as compared to the global 5.5%.

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