Iraj Salehi Abari1* and Shabnam Khazaeli2
1Rheumatology Research Center, Tehran University of Medical Sciences, Iran
2General Practitioner, Genetic Consultant, Canada
*Corresponding author: Iraj Salehi Abari, Rheumatology Research Center, Tehran University of Medical Sciences, Iran
Submission: August 21, 2020;Published: September 28, 2020
ISSN 2639-0531Volume2 Issue5
The COVID-19 is a new contagious viral/immunological systemic disorder with predominantly respiratory features caused by human infection with SARS-CoV-2. From the time the virus enters the body to the time of initial symptoms of the disease, it is called the incubation period which ranges from one day to fourteen days. Initial presentation in the patients with mild COVID-19 is including mild fever, dry cough, fatigue and then body ache, anosmia, and lack of taste. About 40% of patients with COVID-19 are asymptomatic and, 40%; mild, 15%; severe, and 5% are critical COVID-19. A negative SARS-CoV-2 test does not rule out the diagnosis of COVID-19 and that a positive test does not necessarily indicate a COVID-19 diagnosis. The normal lungs in HRCT scan with a negative SARS-CoV-2 test does not preclude that the person has COVID-19. Patients may contract COVID-19 without any risk factors and have no symptoms. The authors conclude that to reject or confirm the diagnosis of COVID-19 by performing a SARS-CoV-2 kit test and the HRCT scanning of lungs may not be the gold standard for diagnosis of COVID-19. In other words, history is the key to COVID-19 diagnosis. Therefore, in this article, twenty cases of COVID-19 are presented, in most of which the diagnostic test of SARS-CoV-2 and HRCT scan of the lungs are negative.
Keywords: SARS-CoV-2 test; COVID-19; HRCT scan of lungs
The novel Coronavirus disease or COVID-19 is a new contagious viral/immunological systemic disorder with predominantly respiratory features caused by human infection with SARS-CoV-2, which is rapidly spreading from person-to-person all around the world as a pandemic. This virus is super-saturated for hours to days in many places/spaces, so that a moment’s presence and breathing in such places/spaces is enough to get COVID-19. Not only sneezing, coughing, shaking hands and kissing can cause COVID-19, but also talking and breathing normally and even gas passing from the intestine can cause the disease [1-3]. From the time the virus enters the body to the time of initial symptoms of the disease, it is called the incubation period which ranges from one day to fourteen days. Initial presentation in the patients with mild COVID-19 is including mild fever, dry cough, fatigue and then body ache, anosmia, and lack of taste. About 40% of patients with COVID-19 are asymptomatic and, 40%; mild, 15%; severe, and 5% are critical COVID-19 [4-6]. Real-Time, Reverse Transcriptase Polymerase Chain Reaction test, or in short RT-PCR test is the gold-standard diagnostic test for the detection of COVID-19. A positive RT-PCR test in a patient with viral symptoms/signs in ENT and lung with or without other organ's involvement indicates the presence of an active COVID-19. However, a positive RT-PCR in an asymptomatic person suggests three conditions including subclinical COVID-19, pre-symptomatic COVID-19 within the incubation period, and carrier state. It can also show false-negative results in; late phase of inactive COVID-19, very early phase of COVID-19 in which the virus replication has not yet started, a case of COVID-19 in which the sample is taken from a site that does not contain the virus or sample is collected with errors [4-6]. A positive COVID-19 IgM antibody test shows both active COVID-19 and recently improved COVID-19, whereas a positive COVID-19 IgG antibody test not only shows the recent previous COVID-19 but also reveals the body's immune protection against re-infection [4-6]. Elevated ESR/CRP along with low lymphocyte count and abnormal liver function tests are compatible with mild to moderate cases of COVID-19 [4-6]. All symptomatic individuals who are suspected of having COVID-19, should undergo Chest-X-Ray, and even if CXR is normal; in them HRCT scanning of lungs is recommended. All asymptomatic individuals who have a positive result for COVID-19 diagnostic test should undergo imaging too. It is important to know that during the first four days of the illness, lung involvement in imaging is limited to one lobe in one-third of cases and not seen at all in one-fifth of cases [4-6]. We need to know that getting a very accurate history is the mainstay in the diagnosis of COVID-19, while COVID-19 diagnostic tests and HRCT scanning of lungs are tools to confirm or reduce it [4-6].
A positive history including acute respiratory symptoms following a recent trip to a red zone in novel Corona epidemic or recent contact with a patient of COVID-19 strongly is in favor of the diagnosis of COVID-19 even if the COVID-19 diagnostic test is negative and lung imaging is normal. Knowledge of the list of clinical findings and risk factors for COVID-19 is essential for screening and diagnosis. The list of Clinical findings includes: fever, dry cough, hoarseness, shortness of breath, fatigue, sneezing, runny nose, sore throat, nasal congestion or stuffy nose, sputum, chest pain, anosmia and lack of taste, cold or flu diagnosis over the past four weeks. The list of Risk factors includes: contact with a COVID-19 patient within recent four weeks, travelling to Red zones within the recent four weeks, working in the live animal market, contact with a patient who has died due to unknown pneumonia within recent 4 weeks, contact with a live animal market worker, and failure to follow the principles of prevention of becoming infected with SARS-CoV-2, contact with someone who has traveled to Red zones within recent four week, living in Red zone of the city, contact with someone who has contacted with a COVID-19 patient within recent four weeks, and maybe close contact with pets [4-6].
Introducing 20 real cases of COVID-19: Do you think the following patients have COVID-19?
Like other diseases in internal medicine, the clinical/paraclinical judgment of an expert Internist and/or Infectious Disease Specialist is the gold standard for diagnosis of COVID-19, of course in consultation with other medical professionals. We all know that a negative SARS-CoV-2 test does not rule out the diagnosis of COVID-19 and that a positive test does not necessarily indicate a COVID-19 diagnosis, and it is positive in carriers of virus too. Also, the normal lungs in HRCT scan, even with a negative SARS-CoV-2 test cannot rule out COVID-19. Many patients have COVID-19 without any risk factors. And many patients have no symptoms but have COVID-19. Therefore, it is simplistic for us to reject or confirm the diagnosis of COVID-19, only by performing a SARS-CoV-2 kit test and the HRCT scanning of lungs. For these reasons, the corresponding author concluded that to regulate the diagnosis of COVID-19 and to establish the same and coordinated decisions around the world regarding the diagnosis of COVID-19, it is necessary to provide a very sensitive and accurate Diagnostic Criteria for diagnosing this disease.
Negative medical history, normal clinical examination, negative SARS-CoV-2 kit tests, and normal HRCT scanning of the lungs alone and even all together cannot rule out the diagnosis of COVID-19. But of all the above tools, medical history is the most reliable way to identify COVID-19 and its diagnostic key. Based on the above facts, the corresponding author of the article (ISA) has provided a Diagnostic Criteria for COVID-19, which is called the Persian Gulf Criteria .
© 2020 Iraj Salehi Abari. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.