It is human nature to want to name an illness. This allows patients to come to terms with their symptoms and prognosis. It also permits physicians to adopt a course of treatment. In the case of COVID, diagnosing the disease presents pitfalls as well as opportunities.
First, the pitfalls. As new diseases evolve, many of the symptoms associated with them are not unique and can be associated with a range of other diseases or problems that are only concomitant with the original problem and not in a direct causal relationship. This is especially true as diseases move from acute to chronic.
Take fatigue, for example. In initial consultations, 31% of patients with COVID report fatigue. Over a number of consultations with COVID patients, fatigue is a subsidiary reason in 14% of visits and a major problem in 20% of all consultations. In long COVID sufferers, after six months, 80% of patients report fatigue. But fatigue is the main reason for a visit in 7% of all patients who present to a physician.
Which came first, the COVID or the fatigue?
Physicians should ask the same question about headaches and dizziness. They are frequent symptoms reported in association with COVID-19, but they are not specifically related to the SARS virus family to which COVID belongs. Headache is a common symptom that of course is not exclusively tied to COVID. In one year of follow-up, nearly half of all patients visit physicians reporting at least one episode of persisting headache and dizziness. Even the patients who don’t seek medical treatment because of dizziness report a previous episode when questioned.
Depression is yet another condition where the relationship between symptoms and COVID is not always clear. The prevalence rates of depression in COVID patients range from 8% to 50%, depending on which of the 12 published studies you read. Studies also report 30% of patients with diabetes suffer from depression. Diabetes is a major COVID risk factor. So, are these patients depressed because they have diabetes, or for another reason, and did their depression predate their contraction of COVID?
Nearly half of the patients presenting in primary care consultations have more than one set of symptoms. So, the pitfall primary care doctors must avoid is assuming that nonspecific symptoms are always associated with COVID even in patients who have been diagnosed with the disease.
Primary care physicians should recognize the opportunities long-term consultations with COVID patients presents, especially where clinical intervention does not yet result in a diminution or disappearance of a major feature of a disorder, such as with long COVID. Because patients may interact with physicians for much longer periods of time, it allows additional clinical complications and/or problems to surface. Asking questions about non-specific symptoms for whatever reason may help uncover dormant problems. Labelling them all as COVID related may not be helpful.
Conversely, a COVID diagnosis may open the door for patients to broach questions they might not otherwise feel comfortable raising with even their long-term family physician. Depression, anxiety and cognitive disfunction are only a few examples of stigmatized conditions that patients may feel freer to discuss under the COVID umbrella.
While not every nonspecific symptom equals COVID, a COVID diagnosis may deepen the patient-physician relationship and provide patients with a higher level of care.