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Timing of dyspnea may be one of the most important hallmarks of COVID-19 coronavirus infection, especially for clinicians seeing patients in an ambulatory setting, experts argued.

In COVID-19, , although it can be as much as 10 days after the onset of symptoms, wrote Pieter Cohen, MD, of Cambridge Health Alliance and Harvard Medical School in Boston, and colleagues in a preprint in the Mayo Clinic Proceedings.

In March 2020, the authors set up an ambulatory care clinic in Massachusetts, specifically to deal with patients who had symptoms of the illness, and gain an understanding of its typical presentation, the authors wrote.

But COVID-19 may be difficult to distinguish due to its constellation of symptoms, and Cohen told 乌鸦传媒 that for clinicians seeing patients in ambulatory settings, they could see anything from a mild runny nose to very dramatic, flu-like symptoms like myalgia.

"Where we need to focus attention is that, in general, shortness of breath takes time to develop. As soon as someone starts reporting 'I had this illness ... and now I have new shortness of breath,' start watching their symptoms over the next 72 hours."

Cohen said clinicians should especially be looking for when the shortness of breath began, and if it's worsening as the days progress. But because most patients do not have a high-quality oximeter at home, a majority of this information can be taken through a patient's history.

Some examples of questions may be "is there anything you can't do today that you could do yesterday" or even "what are you able to do at home," Cohen noted.

"Sometimes patients get out of breath speaking to us on the phone, and you can hear it that way," he said.

However, the authors noted that dyspnea related to COVID-19 presents differently from dyspnea associated with other illnesses. In post-viral pneumonia different from COVID-19, for example, increasing fever and productive cough may be symptoms of worsening illness, whereas in COVID-19, worsening dyspnea may be without productive cough. Likewise, dyspnea would improve gradually over the course of an uncomplicated influenza infection, not get worse.

Then there are patients who think they have COVID-19, which the authors described as anxiety plus viral-type symptoms. But they noted key markers to distinguish patients with anxiety-related dyspnea with shortness of breath related to COVID-19.

"With anxiety, onset is often immediately after the first symptoms of infection while with SARS-CoV-2 [the virus that causes COVID-19] dyspnea occurs several days after the initial symptoms begin," the authors wrote. "Patients with COVID-related anxiety often describe the sensation of not being able to get enough air into their lungs, while with SARS-CoV-2 infection dyspnea is consistently worse with exertion."

While the researchers noted that dizziness occurs with both conditions, similar to dyspnea, it is more present when an anxious patient is at rest, and more present with exertion when a patient has COVID-19. The authors added that a pulse oximeter to show normal oxygen saturation can help confirm anxiety-related shortness of breath.

In fact, they noted, onset of dyspnea several days after non-specific viral symptoms, plus "precipitous drops in oxygen saturation especially with exertion" .

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