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Symptoms of COVID-19 May Present Differently Among Patients With Spinal Cord Injury

In recent months, the rapid emergence of a novel coronavirus disease (COVID-19) has caused a pandemic crisis. To slow the spread of the disease, health organizations have studied and released information about the most common symptoms that may indicate a COVID-19 infection: fever or chills, cough, and shortness of breath. Researchers at the Centers for Disease Control and Prevention (CDC) estimate that 83 to 99% of typical patients infected with COVID-19 will develop a fever during the course of their illness, and between 59 and 82% will develop a cough. Large-scale public health initiatives have worked to educate communities about these symptoms, encouraging individuals with fever and cough to seek COVID-19 testing and to isolate at home.

However, health care providers who work with special clinical populations—people who have medical characteristics that set them apart from the general population—have discovered that these hallmark COVID-19 symptoms may manifest differently (or not at all) among people with preexisting or underlying health conditions. Specifically, clinicians have found that patients with spinal cord injury (SCI) who are infected with COVID-19 tend to show different disease symptoms than the general population. This non-standard illness trajectory represents a unique challenge for screening, diagnosing, and managing COVID-19 in SCI patients, who already are particularly vulnerable to disease-related complications.

As a result, clinicians are working to identify symptoms of COVID-19 specifically among SCI patients. A team of doctors at the National Hospital for Paraplegics in Toledo, Spain conducted a small study of seven SCI patients who were diagnosed with COVID-19. They determined that the most common symptoms were fever (86% patients) and fatigue (57% patients), followed by shortness of breath and cough. Five of seven (71%) patients were classified as having a “severe” COVID-19 infection, although all of the patients eventually recovered from the illness.

Although the clinicians observed some COVID-19 symptom overlap between the SCI population and the general population, the SCI patients generally exhibited fewer symptoms than typical patients. Additionally, severe illness was significantly more common among SCI patients (71%) than among the general population (about 13%). Because patients with SCI are more vulnerable to severe illness but may display fewer symptoms, clinicians are urged to closely supervise their SCI patients to detect early signs and symptoms of COVID-19, improving patients’ likelihood of surviving a severe infection. Further research is necessary to determine specific disease profiles for other vulnerable populations, including patients with traumatic injury.

Rodríguez-Cola M, Jiménez-Velasco I, Gutiérrez-Henares F, et al. Clinical features of coronavirus disease 2019 (COVID-19) in a cohort of patients with disability due to spinal cord injury. Spinal Cord Series and Cases. (May 2020).

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