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The Discrepancies of COVID-19 Symptoms Between Patients With and Without Spinal Cord Injuries (SCIs)

As health care professionals have worked to address the recent COVID-19 pandemic, they have discovered a number of hallmark indications that a patient is infected with the novel coronavirus. The most common indicators include respiratory symptoms (such as cough, shortness of breath, or congestion), fever, fatigue, and loss of taste and/or smell. Clinicians are particularly vigilant for signs and symptoms of COVID-19 infection among high-risk groups, such as those with pre-existing respiratory problems (such as asthma or lung cancer), older adults, those with comorbid conditions (such as heart disease or diabetes), and people who are immunocompromised.

However, COVID-19 patients with spinal cord injury (SCI) are not currently considered a high-risk population, despite the significant health complications associated with this condition. Recent evidence suggests that, much like other high-risk patients, SCI patients are also at high risk of developing severe complications from COVID-19. To complicate the matter, researchers have also discovered that SCI patients infected with COVID-19 may present with different symptoms than the typical hallmark indicators of the illness as described the Centers for Disease Control and Prevention (CDC).

As a result, SCI patients and physicians alike may not recognize that the patient has COVID-19. Injury to the spinal cord is known to disrupt a brain signaling process called thermoregulation, which allows the human body to maintain a steady, healthy temperature. Consequently, SCI patients on average have lower baseline body temperatures, so elevated body temperatures among these individuals may not meet the diagnostic criteria for fever (which is defined as a temperature exceeding 100.4ºF). Moreover, people with SCI often experience poor vasoconstriction, or narrowing of the blood vessels, limiting their ability to visibly shiver in response to fever.

SCI is also known to affect respiratory processes, further obscuring hallmark signs of COVID-19 infection. Respiratory muscles and overall respiratory function are weaker among people with SCI; they may be unable to cough, or they may already experience difficulty breathing as a normal symptom of SCI. Furthermore, these attributes place patients at a higher risk for developing viral pneumonia, pulmonary infection, or acute respiratory distress syndrome (ARDS) as a result of COVID-19.

In addition to the distinct respiratory symptoms associated with SCI, a recent survey of physicians and caregivers to SCI patients indicated that these individuals may also develop neurological symptoms from COVID-19, including spasticity, limb stiffness, and fatigue. Another survey from Spain indicated that seven SCI patients infected with COVID-19 exhibited fewer concurrent symptoms (one or two) than people without SCI (who usually experience three or more). While non-injured COVID-19 patients most commonly experience cough and shortness of breath, the most common symptoms among the SCI patients were fever and weakness.

Given the findings of these studies, COVID-19 patients with pre-existing SCI should be considered a high-risk group because of their complicated respiratory symptoms, lack of common COVID-19 symptoms, and uncommon display of neurological symptoms. Physicians should carefully monitor their SCI patients for non-standard signs and symptoms of COVID-19 and should ensure that SCI patients have access to intensive therapies for the illness, such as mechanical ventilation. Critically, early diagnosis and proper treatment are keys to survival and successful recovery. Clinicians who treat SCI patients are urged to be vigilant for non-respiratory symptoms and signs that the respiratory system has been compromised (such as abdominal muscle weakness, which may occur when failing lungs require additional breathing support from surrounding muscles). Because so little is known about the novel coronavirus, health care providers should proceed with caution and must explore all differential diagnoses before disregarding COVID-19 as a potential diagnosis for a person with SCI.

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