Coronavirus: Why second week of COVID-19 is most scary for patients

As doctors around the world diagnose and care for a growing number of COVID-19 patients, they’ve found the second week of the virus is the most scary for sufferers.

Natalie Brown

@natalieisbrown

3 min read

April 8, 2020 - 12:51PM

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As doctors around the world diagnose and care for a growing number of people infected with COVID-19, distinct patterns have emerged, giving clues about how patients respond to the disease.

More than 81,000 people around the world have died, close to 300,000 have recovered and nearly 1.5 million people have been infected with the potentially-deadly coronavirus.

And one case of infection – British Prime Minister Boris Johnson – has revealed the “slow burn” nature of the disease, co-host of the ABC’s Coronacast podcast, Dr Norman Swan, said on this morning’s episode.

The 55-year-old’s health has deteriorated significantly as he enters the second week of being diagnosed with COVID-19 – typical of what’s called the “second-week crash”, Dr Swan explained.

“This is the reason why we try and reduce the coronavirus in the community as much as possible, because it’s relatively unpredictable who in the younger age groups get it, and they don’t necessarily have to have other diseases or diagnoses.”

British PM Boris Johnson’s sudden deterioration in condition is what’s called the ‘second-week crash’. Picture: AFP

Mr Johnson’s experience shows the dangers people often face in the later stages of trying to fight off the virus, Dr Swan said.

Director of critical-care research at Montefiore Medical Centre, Michelle Gong, said in a Q&A with the Journal of the American Medical Association COVID-19 patients often seem to be “doing OK, and then at around the five-to-seven-day mark they start to get worse and then develop respiratory failure”.

The onset, she said, “can be very abrupt”.

The incubation period of COVID-19 (that is, the time between exposure to the virus and the onset of symptoms) ranges from 1 to 14 days, according to estimations by the World Health Organisation (WHO).

At first, people infected with the virus experience mild symptoms such as a slight cough, slight fever or a headache.

Usually during the second week, they’ll either start improving or suddenly decline – and for those whose symptoms get worse, it can quickly escalate to a trip to the emergency department.

“It seems like there’s a period of time where the body is trying to sort out whether it can beat this or not,” critical care pulmonologist Dr Ken Lyn-Kew told NBC News.

And sometimes, patients start to feel better before their health quickly deteriorates.

“That’s what we’re seeing with these patients who get a lot worse,” Dr Lyn-Kew said.

“They’re doing OK, and then all of a sudden they’re really fatigued, a lot more shorter of breath and having chest pains.”

Intensive care specialist Professor Hugh Montgomery told Leigh Sales on last night’s 7:30 it’s around day 10 to 12 the majority of people experiencing the “second-week crash” will become short of oxygen.

“The oxygen levels in their blood will fall,” Professor Montgomery explained, leading to patients potentially becoming “blue and panting”. While some cases become better once they’ve been administered supplemental oxygen, he said others worsen and will go on to a “tight-fitting mask to help inflate the lung with more oxygen”.

While a sudden decline in condition is more likely among elderly people and those with pre-existing health conditions, Dr Swan said it’s pretty typical people outside the “70 plus age group get it” despite not having any risk factors, and that’s “the scary thing about this”.

Infectious diseases expert from North Carolina, Dr Christopher Ohl advised people need to keep a watchful eye on their symptoms, even if they’re beginning to feel like they’ve recovered.

“Be aware of what’s going on,” Dr Ohl told NBC. “If your symptoms start to get worse after you’ve been feeling better, then you need to contact your doctor. That’s probably something that doctors need to treat as an emergency.”

WHAT ARE THE SYMPTOMS OF CORONAVIRUS?

The symptoms of coronavirus can range from a mild cough to pneumonia.

According to the WHO, the most common symptoms of COVID-19 are fever, tiredness and a dry cough. Some patients may have aches and pains, nasal congestion, a runny nose, sore throat or diarrhoea. These symptoms are usually mild and begin gradually.

There are also some people who become infected but don’t develop any symptoms and don’t feel unwell.

Around one out of every six people who gets COVID-19 becomes seriously ill and develops difficulty breathing, while most people (about 80 per cent) recover from the disease without needing special treatment.