Covid-19 may be life-threatening even without ‘typical’ symptoms

People who develop serious complications arising from the SARS-CoV-2 infection do not necessarily experience the symptoms most commonly associated with Covid-19, such as cough, shortness of breath, and a sore throat.

“As medical understanding of Covid-19 develops globally, studies are increasingly indicating that the condition can present in widely diverse ways,” said Dr Adri Kok, a specialist physician and president of both the International Society for Internal Medicine and the Faculty of Consulting Physicians of South Africa.

“In addition to asymptomatic [showing no symptoms] carriers of the virus, it has been observed that some patients do not exhibit the respiratory symptoms that are most typical of Covid-19, and yet they develop sudden and potentially life-threatening complications as a result of the viral infection.”

Dr Kok said that internationally, cases have been documented of patients seeking emergency medical care after suffering a stroke or a heart attack, or various types of organ failure, and testing then reveals them to be Covid-19 positive.

“As more studies become available, we are realising that Covid-19 is an extremely varied and unpredictable condition. There are reports of even young people suffering a stroke, which occurs when a part of the brain is deprived of oxygen due to a blood clot, as a first indication that they have Covid-19.”

Although this virus primarily affects the upper airway and then the lungs due to droplet spread, Covid-19 may set in motion a series of reactions in the body, which may attack the small blood vessels that are crucial to the functioning of other organs, including the heart, kidneys, and brain,” she said.

“Sometimes, the body has an overzealous reaction to an infection, known as a ‘cytokine storm’, which can lead to serious complications in some cases where people have contracted Covid-19.

Cytokines are proteins that our bodies release to communicate with various cells to coordinate bodily responses, as is the case when our immune system stimulates inflammation to fight infection, or clotting to help repair damaged tissues.”

It has been suggested that in some Covid-19 patients who progress to a more advanced stage of the illness, a cytokine storm causes a physiological change in the pneumocytes of the lungs, and this then has a pro-thrombotic or clot-causing effect, potentially leading to abnormal clotting in small blood vessels. This blood clotting is known as thrombosis.”

Apart from stroke, Covid-19 positive patients can also present with cardiovascular damage such as acute ischaemic heart disease or pulmonary embolism, a medical emergency caused by a blood clot blocking an artery in the lung, or other organ dysfunction related to thrombosis, including acute kidney failure.

“In addition, it has been observed that Covid-19 can significantly deplete blood oxygen levels, even though the patient may not initially feel symptoms of respiratory distress, which is known as ‘silent hypoxia’.

By the time people seek medical assistance, their condition may already be serious, with a low oxygen concentration recorded.”

She stressed that all South Africans should take Covid-19 very seriously.

When it is necessary for you to go out, it is important to protect yourself and others as far as possible. Wear a face mask, sanitize your hands and practice social distancing and other precautions in line with government guidelines and regulations.

“Although our numbers of positive cases have increased slowly and have not rocketed as in some countries, we are unfortunately still expecting cases to surge.”

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