Pandemic Perspective #31 October 24, 2020

            Medicine’s Great Imitators now include COVID-19.

            Since late in the 19th century medical students were warned that syphilis, at that time a disease without a cure, could mimic a host of other diseases. Sir William Osler’s well-known aphorism, “The physician who knows syphilis knows medicine” was still being taught during my medical school years in the late 1950s. By the time that lupus was recognized as a serious disease, especially among young women, its various manifestations and resemblances to other diseases made it known as another Great Imitator. Although SARS-CoV-2 emerged barely a year ago it has earned that sobriquet as well.

            The classic features of COVID-19 are fever, cough and shortness of breath. Perhaps as many as one-half of its victims don’t have these symptoms at all yet some of them have developed heart and lung damage. We have all been subjected to temperature screening by one of those hand-held electronic thermometers but the disease may progress for a day or two with complaints merely of headache and fatigue, and no fever. Early in the pandemic the senses of smell and taste were noted to have diminished markedly in some patients, sometimes slowly or never to return. These losses may occur in as many as one-half of patients in some population groups.

            Almost everyone develops a couple of viral illnesses in any given year whose symptoms include fever, cough, runny nose, redness of the eyes, headache, sore muscles, vomiting, diarrhea and a rash. All of these occur in COVID-19 as well so that unless there is shortness of breath severe enough to warrant at trip to the local emergency room where coronavirus testing will be done there is no way of knowing that the pandemic virus is the cause.

            Like syphilis, lupus and a host of other diseases, the SARS-CoV-2 virus can affect the brain. It may cause a generalized inflammation of the brain known as encephalitis or it may affect the nerves, causing paralysis that begins in the feet and travels upward, sometimes paralyzing the muscles that make breathing possible.

            Pediatricians were surprised last spring when they encountered children who had what came to be known as MIS-C, multisystem inflammatory syndrome-children. Not long afterward the condition was described in adults.

            Without doubt, more surprises are in store. Dr. Osler would salivate at the thought of another Great Imitator!