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Clinical features of covid-19

BMJ 2020; 369 doi: https://doi.org/10.1136/bmj.m1470 (Published 17 April 2020) Cite this as: BMJ 2020;369:m1470

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  1. Pauline Vetter, medical doctor123,
  2. Diem Lan Vu, medical doctor234,
  3. Arnaud G L’Huillier, medical doctor35,
  4. Manuel Schibler, medical doctor234,
  5. Laurent Kaiser, professor1234,
  6. Frederique Jacquerioz, medical doctor367
  1. 1Geneva Centre for Emerging Viral Diseases, Geneva University Hospitals, 1211 Geneva 14, Switzerland
  2. 2Division of Infectious Diseases, Geneva University Hospitals, 1211 Geneva 14, Switzerland
  3. 3Laboratory of Virology, Geneva University Hospitals, 1211 Geneva 14, Geneva, Switzerland.
  4. 4University of Geneva, Faculty of Medicine, 1205 Geneva, Switzerland
  5. 5Pediatric Infectious Diseases Unit, Department of Child and Adolescent Medicine, Geneva University Hospitals and Medical School, Geneva, Switzerland
  6. 6Division of Tropical and Humanitarian Medicine, Geneva University Hospitals, 1211 Geneva 14, Geneva, Switzerland
  7. 7Primary Care Division, Geneva University Hospitals, 1211 Geneva 14, Geneva, Switzerland.
  1. Correspondence to: P Vetter pauline.vetter{at}hcuge.ch

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.

Non-respiratory symptoms

Case series report gastrointestinal symptoms in 2-40% of patients,56 and diarrhoea can be the initial manifestation of infection.7 Whether SARS-CoV-2 leads to such symptoms directly by infecting the gastrointestinal tract, indirectly by …

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