Such symptoms — especially diarrhoea and vomiting — were seen in swine flu patients as well.
The doctors discussed two cases. Rafique (name changed), a 54-year-old diabetic, underwent treatment for stomach ache and loose motion for three days before testing positive for Covid via RT-PCR. He had no fever or signs of respiratory distress — two ‘standard’ coronavirus symptoms.
The second patient, Rishab, first approached doctors with complaints of severe abdominal pain and vomiting. A lab investigation indicated swelling of the pancreas — medically termed as pancreatitis. Doctors, who were unable to find what had caused the condition, then asked the 27-year-old to undergo a CT scan.
The report revealed signs of Covid pneumonia around the lungs. And an RT-PCR test that followed, confirmed the illness.
Doctors said the two patients are not isolated cases. Quite a few individuals who went on to test positive for Covid, they said, had come in with only GI symptoms such as diarrhoea, vomiting and stomach ache. Most did not exhibit fever or other flu-like symptoms, commonly considered as the earliest warning signs.
“Absence of fever is a hallmark of atypical presentations of Covid-19, in which patients only show GI symptoms. I have been seeing quite a few patients with such baffling presentations,” said Ruby Hall Clinic’s physician, Abhijit Lodha.
This emerging subset of patients – with non-specific Covid symptoms – has become a challenge for doctors, particularly general practitioners.
“Our GPs are often the first point of care for many. They will have to quickly determine if these symptoms are flare-ups of underlying disease or the result of SARS-CoV-2 infection,” Lodha said.
Doctors will have to maintain a high degree of suspicion to ensure early diagnosis and prevent transmission, Lodha said.
Infectious diseases expert Parikshit Prayag said, “Diarrhoea, nausea, vomiting and stomach pain must be kept in mind as possible Covid symptoms. Doctors should keep a high index of suspicion when patients show symptoms. About 5% of patients in our programme have had GI symptoms. But it is rare to have only GI symptoms. Also, we have seen GI complications, like pancreatitis, during Covid.”
Diagnosing gastrointestinal symptoms that precede respiratory problems has become extremely necessary for early detection.
“The most common GI symptom being reported is diarrhoea, followed by nausea or vomiting and abdominal pain,” said Jitendra Oswal, deputy medical director of Bharati hospital, a dedicated Covid facility.