The wide array of symptoms has implications for the testing strategy
In January 2020, coronavirus SARS-CoV-2 was identified as the cause of an outbreak of severe pneumonia, now known to be a complication of the coronavirus disease 2019 (covid-19).1 Since then, the spread of covid-19 has increased exponentially, with the World Health Organization declaring a pandemic on 11 March.2 By 15 April, more than 1 900 000 cases and 123 000 deaths had been reported worldwide.3
Severe acute respiratory illness with fever and respiratory symptoms, such as cough and shortness of breath, comprise the working case definition used to select people for viral testing. This strategy captures typical symptomatic presentation, but imperfectly identifies unusual manifestations, such as patients without respiratory symptoms or only very mild symptoms. One widely cited modelling study concluded that up to 86% of cases might have been missed in China,4 and reports of patients with unusual presenting symptoms are rising worldwide.
Author：Pauline Vetter, Diem Lan Vu, Arnaud G L’Huillier, et al.