Early stage nonclinical pulmonary disorder in COVID-19 may present asymptomatic and fuel the contagion

Abstract

Evidence shows that pulmonary problems in coronavirus disease 2019 (COVID-19) may set off from vascular injury that progresses to physiological disturbances through a compromised gas exchange, following an infection with the severe acute respiratory syndrome coronavirus 2. In this process, inefficient gas exchange in the alveolar could precipitate silent nonclinical hypoxemia. Unfortunately, patients with “silent hypoxemia” do not necessarily experience any breathing difficulty (dyspnea) at the early stage of COVID-19 while the disease progresses. As a result, several asymptomatic, presymptomatic and patients with mild symptoms may escape quarantine measure and thus continue to spread the virus through contacts. Therefore, early diagnosis of “silent hypoxemia”, which attracts no clinical warnings, could be an important diagnostic measure to prevent acute respiratory distress syndrome from the risk of pulmonary failure among the presymptomatic and as a screening tool in the asymptomatic who are hitherto potential spreaders of the virus.

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“…Rapid diagnostic kits such as the antigen rapid test or the SARS-CoV-2 reverse-transcription polymerase chain reaction (RT-PCR) test may yield false positive results. Adedokun [41] described the clinical entity termed "silent hypoxemia" where patients can be completely asymptomatic or minimally symptomatic, but subsequently deteriorate insidiously without warning, sometimes to the extent of progression to respiratory failure without the warning of respiratory distress. Pulse oximetry can screen asymptomatic patients with low oxygen saturations for further workup, which additionally has the benefit of being portable and easily administered.…”

The Short-Term Outcome and Risk Factors Associated with the Outcome of Severe Covid-19 Disease – Retrospective Evaluation of Single-Centre Experiences from the Second Covid-19 Wave in Sri Lanka

“…Silent hypoxemia is a feature of Covid-19 pneumonia which can present as a respiratory failure without warning signs such as dyspnea [26]. The significant lung involvement in silent hypoxemia has been described as a high CT (computed tomographic) severity score [26,27]. The pathophysiology of hypoxia in Covid-19 disease is related to deficient oxygen-exchanging capacity in the presence of diffuse pulmonary infiltrates [28].…”

“…The pathophysiology of hypoxia in Covid-19 disease is related to deficient oxygen-exchanging capacity in the presence of diffuse pulmonary infiltrates [28]. Patients with silent or symptomatic hypoxemia were found to have poor outcomes [26,27]. We also confirmed a high mortality risk (OR: 4.182; 95% CI: 1.971-8.872) and need for ICU management (OR: 2.436; 95% CI: 1.304-4.552) among patients with low peripheral oxygen saturation.…”

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“…SARS-CoV-2 infection causes a series of systemic symptoms, such as fever, fatigue, dry cough, diarrhea, or even no symptoms at all [11][12][13]. Severe cases may involve organ dysfunction, including ARDS, acute cardiac injury, acute kidney injury, and even death, particularly when the patients have underlying diseases like hypertension, diabetes, and heart disease [12][13][14][15] (Figure 1). In addition, over 40% of COVID-19 patients have asymptomatic infection [16,17].…”