Diarrhoea and loss of appetite could be early signs of coronavirus

By | March 23, 2020

Diarrhoea and loss of appetite could be early signs of coronavirus as scientists find almost half of patients experience one or more digestive symptoms

  • Study of 204 Wuhan residents reveals 48.5 per cent had digestive symptoms  
  • Most also had the normal respiratory issues but seven people did not  
  • Those with digestive symptoms are less likely to be successfully treated and discharged compared to those with just respiratory symptoms
  • Coronavirus symptoms: what are they and should you see a doctor?

Digestive problems such as diarrhoea, vomiting and loss of appetite could be a symptom of coronavirus, a study has found.   

A study of 204 patients in Wuhan, ground-zero for the COVID-19 outbreak, found 99 patients (48.5 per cent) went to hospital with digestive issues as their main ailment. 

The majority of these people did not have underlying digestive diseases. 

Loss of appetite (83 per cent) and diarrhoea (29 per cent) were the main symptoms for patients exhibiting digestive problems. 

Other digestive issues reported include vomiting (0.8 per cent) and abdominal pain (0.4 per cent).  

Most patients did also experience respiratory issues — such as a persistent dry cough or trouble breathing — as well as digestive concerns, but seven patients in the study showed only digestive symptoms.    

A study of 204 patients in Wuhan, ground-zero for the COVID-19 outbreak, found 99 patients (48.5 per cent) went to hospital with digestive issues as their main ailment. Pictured, a patient in a Wuhan hospital on

A study of 204 patients in Wuhan, ground-zero for the COVID-19 outbreak, found 99 patients (48.5 per cent) went to hospital with digestive issues as their main ailment. Pictured, a patient in a Wuhan hospital on 

The study, conducted by Chinese researchers, has been scrutinised by other academics and published this week in the American Journal of Gastroenterology

Researchers studied 107 men and 94 women with an average age of 55 that had all tested positive for COVID-19 between January 18 and February 28. 

WHY DOES CORONAVIRUS CAUSE DIGESTIVE SYMPTOMS?

Chinese researchers believe COVID-19 appears to cause digestive symptoms because SARS-CoV-2 is similar to SARS-CoV and can invade the human body by binding to the human angiotensin converting enzyme 2 (ACE-2) receptor.

This can cause liver tissue injury by making too many liver cells, called hepatocytes, derived from ells in the bile duct.  

Secondly, SARS-CoV-2 indirectly or directly damages the digestive system through an inflammatory response. 

The chain reaction may injure the digestive system.

Ninety-nine had digestive symptoms and 92 of these also suffered with respiratory problems as a result of the infection. 

The researchers add: ‘Among the 105 patients without digestive symptoms, 85 presented only with respiratory symptoms, and 20 neither had respiratory nor digestive symptoms as their chief complain.’

The study also found the digestive issues worsened as the severity of the disease increased.   

Patients without digestive symptoms in this study were more likely to be cured and discharged than patients with digestive symptoms, the scientists say. 

Around a third (34.3 per cent) of patients that did experience digestive problems were discharged by March 5, when the study stopped collecting data.

This figure for successful treatment rises to 60 per cent for people who did not experience digestive symptoms. 

The researchers write in their research: ‘We found that digestive symptoms are a common presenting complaint in patients with COVID-19. 

‘Compared to patients without digestive symptoms, those presenting with digestive symptoms have a longer time from onset to admission and a worse prognosis.’

A doctor puts on an isolation outfit before entering the negative-pressure isolation ward in Jinyintan Hospital, designated for critical COVID-19 patients, in Wuhan in central China's Hubei province in February

A doctor puts on an isolation outfit before entering the negative-pressure isolation ward in Jinyintan Hospital, designated for critical COVID-19 patients, in Wuhan in central China’s Hubei province in February

Currently, deaths relating to coronavirus have exceeded 10,000 as confirmed cases nears a quarter of a million around the world

Currently, deaths relating to coronavirus have exceeded 10,000 as confirmed cases nears a quarter of a million around the world 

Dr Brennan Spiegel, Professor of Medicine and Public Health at UCLA and co-editor of the journal the study was published in, said in a statement accompanying the release of the research: ‘In this study, COVID-19 patients with digestive symptoms have a worse clinical outcome and higher risk of [death] compared to those without digestive symptoms, emphasising the importance of including symptoms like diarrhoea to suspect COVID-19 early in the disease course before respiratory symptoms develop.’

‘This may lead to earlier diagnosis of COVID-19, which can lead to earlier treatment and more expeditious quarantine to minimise transmission from people who otherwise remain undiagnosed.’

The exact reason the virus affects the digestive system remains unknown, but the academics believe it could be similar to how SARS damages the system.

The virus binds to a receptor on human cells called ACE and can trigger the body to make too many liver cells called hepatocytes. 

This can lead to liver tissue injury. It is also thought the SARS-CoV-2 indirectly or directly damages the digestive system through an inflammatory response damaging the digestive system. 

The researchers warn more research is needed to understand how the novel coronavirus affects the human body and studies with larger sample sizes are necessary.

WHAT DO WE KNOW ABOUT THE CORONAVIRUS?

What is the coronavirus? 

A coronavirus is a type of virus which can cause illness in animals and people. Viruses break into cells inside their host and use them to reproduce itself and disrupt the body’s normal functions. Coronaviruses are named after the Latin word ‘corona’, which means crown, because they are encased by a spiked shell which resembles a royal crown.

The coronavirus from Wuhan is one which has never been seen before this outbreak. It has been named SARS-CoV-2 by the International Committee on Taxonomy of Viruses. The name stands for Severe Acute Respiratory Syndrome coronavirus 2.

Experts say the bug, which has killed around one in 50 patients since the outbreak began in December, is a ‘sister’ of the SARS illness which hit China in 2002, so has been named after it.

The disease that the virus causes has been named COVID-19, which stands for coronavirus disease 2019.

Dr Helena Maier, from the Pirbright Institute, said: ‘Coronaviruses are a family of viruses that infect a wide range of different species including humans, cattle, pigs, chickens, dogs, cats and wild animals. 

‘Until this new coronavirus was identified, there were only six different coronaviruses known to infect humans. Four of these cause a mild common cold-type illness, but since 2002 there has been the emergence of two new coronaviruses that can infect humans and result in more severe disease (Severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) coronaviruses). 

‘Coronaviruses are known to be able to occasionally jump from one species to another and that is what happened in the case of SARS, MERS and the new coronavirus. The animal origin of the new coronavirus is not yet known.’ 

The first human cases were publicly reported from the Chinese city of Wuhan, where approximately 11million people live, after medics first started publicly reporting infections on December 31.

By January 8, 59 suspected cases had been reported and seven people were in critical condition. Tests were developed for the new virus and recorded cases started to surge.

The first person died that week and, by January 16, two were dead and 41 cases were confirmed. The next day, scientists predicted that 1,700 people had become infected, possibly up to 7,000. 

Where does the virus come from?

According to scientists, the virus almost certainly came from bats. Coronaviruses in general tend to originate in animals – the similar SARS and MERS viruses are believed to have originated in civet cats and camels, respectively.

The first cases of COVID-19 came from people visiting or working in a live animal market in Wuhan, which has since been closed down for investigation.

Although the market is officially a seafood market, other dead and living animals were being sold there, including wolf cubs, salamanders, snakes, peacocks, porcupines and camel meat. 

A study by the Wuhan Institute of Virology, published in February 2020 in the scientific journal Nature, found that the genetic make-up virus samples found in patients in China is 96 per cent identical to a coronavirus they found in bats.

However, there were not many bats at the market so scientists say it was likely there was an animal which acted as a middle-man, contracting it from a bat before then transmitting it to a human. It has not yet been confirmed what type of animal this was.

Dr Michael Skinner, a virologist at Imperial College London, was not involved with the research but said: ‘The discovery definitely places the origin of nCoV in bats in China.

‘We still do not know whether another species served as an intermediate host to amplify the virus, and possibly even to bring it to the market, nor what species that host might have been.’  

So far the fatalities are quite low. Why are health experts so worried about it? 

Experts say the international community is concerned about the virus because so little is known about it and it appears to be spreading quickly.

It is similar to SARS, which infected 8,000 people and killed nearly 800 in an outbreak in Asia in 2003, in that it is a type of coronavirus which infects humans’ lungs. It is less deadly than SARS, however, which killed around one in 10 people, compared to approximately one in 50 for COVID-19.

Another reason for concern is that nobody has any immunity to the virus because they’ve never encountered it before. This means it may be able to cause more damage than viruses we come across often, like the flu or common cold.

Speaking at a briefing in January, Oxford University professor, Dr Peter Horby, said: ‘Novel viruses can spread much faster through the population than viruses which circulate all the time because we have no immunity to them.

‘Most seasonal flu viruses have a case fatality rate of less than one in 1,000 people. Here we’re talking about a virus where we don’t understand fully the severity spectrum but it’s possible the case fatality rate could be as high as two per cent.’

If the death rate is truly two per cent, that means two out of every 100 patients who get it will die. 

‘My feeling is it’s lower,’ Dr Horby added. ‘We’re probably missing this iceberg of milder cases. But that’s the current circumstance we’re in.

‘Two per cent case fatality rate is comparable to the Spanish Flu pandemic in 1918 so it is a significant concern globally.’

How does the virus spread?

The illness can spread between people just through coughs and sneezes, making it an extremely contagious infection. And it may also spread even before someone has symptoms.

It is believed to travel in the saliva and even through water in the eyes, therefore close contact, kissing, and sharing cutlery or utensils are all risky. It can also live on surfaces, such as plastic and steel, for up to 72 hours, meaning people can catch it by touching contaminated surfaces.

Originally, people were thought to be catching it from a live animal market in Wuhan city. But cases soon began to emerge in people who had never been there, which forced medics to realise it was spreading from person to person. 

What does the virus do to you? What are the symptoms?

Once someone has caught the COVID-19 virus it may take between two and 14 days, or even longer, for them to show any symptoms – but they may still be contagious during this time.

If and when they do become ill, typical signs include a runny nose, a cough, sore throat and a fever (high temperature). The vast majority of patients will recover from these without any issues, and many will need no medical help at all.

In a small group of patients, who seem mainly to be the elderly or those with long-term illnesses, it can lead to pneumonia. Pneumonia is an infection in which the insides of the lungs swell up and fill with fluid. It makes it increasingly difficult to breathe and, if left untreated, can be fatal and suffocate people.

Figures are showing that young children do not seem to be particularly badly affected by the virus, which they say is peculiar considering their susceptibility to flu, but it is not clear why. 

What have genetic tests revealed about the virus? 

Scientists in China have recorded the genetic sequences of around 19 strains of the virus and released them to experts working around the world. 

This allows others to study them, develop tests and potentially look into treating the illness they cause.   

Examinations have revealed the coronavirus did not change much – changing is known as mutating – much during the early stages of its spread.

However, the director-general of China’s Center for Disease Control and Prevention, Gao Fu, said the virus was mutating and adapting as it spread through people.

This means efforts to study the virus and to potentially control it may be made extra difficult because the virus might look different every time scientists analyse it.   

More study may be able to reveal whether the virus first infected a small number of people then change and spread from them, or whether there were various versions of the virus coming from animals which have developed separately.

How dangerous is the virus?  

The virus has a death rate of around two per cent. This is a similar death rate to the Spanish Flu outbreak which, in 1918, went on to kill around 50million people.

Experts have been conflicted since the beginning of the outbreak about whether the true number of people who are infected is significantly higher than the official numbers of recorded cases. Some people are expected to have such mild symptoms that they never even realise they are ill unless they’re tested, so only the more serious cases get discovered, making the death toll seem higher than it really is.

However, an investigation into government surveillance in China said it had found no reason to believe this was true.

Dr Bruce Aylward, a World Health Organization official who went on a mission to China, said there was no evidence that figures were only showing the tip of the iceberg, and said recording appeared to be accurate, Stat News reported.

Can the virus be cured? 

The COVID-19 virus cannot be cured and it is proving difficult to contain.

Antibiotics do not work against viruses, so they are out of the question. Antiviral drugs can work, but the process of understanding a virus then developing and producing drugs to treat it would take years and huge amounts of money.

No vaccine exists for the coronavirus yet and it’s not likely one will be developed in time to be of any use in this outbreak, for similar reasons to the above.

The National Institutes of Health in the US, and Baylor University in Waco, Texas, say they are working on a vaccine based on what they know about coronaviruses in general, using information from the SARS outbreak. But this may take a year or more to develop, according to Pharmaceutical Technology.

Currently, governments and health authorities are working to contain the virus and to care for patients who are sick and stop them infecting other people.

People who catch the illness are being quarantined in hospitals, where their symptoms can be treated and they will be away from the uninfected public.

And airports around the world are putting in place screening measures such as having doctors on-site, taking people’s temperatures to check for fevers and using thermal screening to spot those who might be ill (infection causes a raised temperature).

However, it can take weeks for symptoms to appear, so there is only a small likelihood that patients will be spotted up in an airport.

Is this outbreak an epidemic or a pandemic?   

The outbreak was declared a pandemic on March 11. A pandemic is defined by the World Health Organization as the ‘worldwide spread of a new disease’. 

Previously, the UN agency said most cases outside of Hubei had been ‘spillover’ from the epicentre, so the disease wasn’t actually spreading actively around the world.

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