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Erratic, unpredictable and unusual: what GPs have learnt about COVID-19

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For many GPs, it’s the unpredictability of the virus that really stands out.

While the telltale signs of COVID-19 include a fever, sore throat or a cough, Dr El-Khoury said many young patients develop incredibly mild symptoms.

“They will say, ‘I don’t have a fever, I have a bit of a sore throat and woke up tired’,” he said.

“Some will have lost their sense of taste and smell.”

And then there are those who are completely asymptomatic.

The Newport GP recounted an incident in mid-August when a woman came to his clinic for a COVID-19 test before visiting a sick relative in Lebanon.

Newport GP Dr Hanna El-Khoury

Newport GP Dr Hanna El-KhouryCredit:Scott McNaughton

The woman felt healthy and, when pressed, could not recall experiencing any COVID-19 symptoms aside from a minor muscle ache, which she put down to a long walk.

“She was positive,” he said. “She did not believe it and said, ‘it is probably false positive’, and then she did another test and it was also positive.”

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Doctors are also coming across unusual symptoms.

Before the pandemic, Dr Pietas Nyamayaro rarely encountered chilblains.

But during the peak of Victoria’s second wave of coronavirus, the Newport GP saw at least one patient a week with the painful red sores on their toes.

“I have been working for 24 years and this year I have never seen so many chilblains,” she said.

Scientists believe the chilblain-like lesions may be linked to an asymptomatic or mild coronavirus infection.

Dr Nyamayaro has also treated patients she suspects are living with the long-term health effects of the coronavirus. Some of these patients never received an official diagnosis because they did not meet the previous strict criteria for testing.

“One of my patients became ill in April and had symptoms of a cold with a cough,” she said.

“She did not meet the criteria for testing because she did not have a fever. She now has fibrosis, which is scarring of the lungs. She has a cough and a rattly chest.”

Catherine Orr, who has treated more than 100 Victorians infected with coronavirus, said that while GPs can somewhat predict who will become very unwell (the elderly and those who are obese, have heart disease or diabetes), young and otherwise healthy individuals were also ending up in hospital.

One of her patients, an international student in her early 20s, was rushed to hospital by ambulance after her situation deteriorated rapidly.

Dr Catherine Orr has treated more than 100 patients with COVID-19

Dr Catherine Orr has treated more than 100 patients with COVID-19Credit:Justin McManus

“She was speaking quite normally and then the next day, she couldn’t get out of the bed,” Dr Orr recalled.

“She had become seriously unwell between 4pm and 10am the next day. So unwell that we called a lights-and-sirens ambulance and she went straight into ICU.”

The West Melbourne GP has also learnt that there’s a cohort of coronavirus patients with mild symptoms that can persist for months.

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“These are people who haven’t necessarily had a severe illness and been admitted to hospital, but they have persistent symptoms: fatigue, chest pain, shortness of breath,” she said.

Dr Billy Stoupas is puzzled by the erratic transmission of COVID-19.

One of Dr Stoupas’ patients tested positive to COVID-19 and had to quarantine with her husband for two weeks.

“Her husband never developed it, which was amazing,” he said. “That was a bit of an eye-opener for me about transmission. You would think the person she lived with would also be positive.”

The Oakleigh GP has also learnt about the fear coronavirus can engender – something he has experienced firsthand.

Dr Stoupas is the father of an 18-month-old girl and is terrified of bringing the virus home.

“I was worried at the end of the day, taking off my scrubs and making sure everything was washed at 60 degrees,” he said. “You may not hold your little one straight away. You are worried when your child gets a runny nose at childcare.”

But like many Melburnians, the GP has adapted to life in a pandemic and now takes extra precautions.

“We screen patients for respiratory illness and exposure risks and always wear appropriate PPE,” he said.

“This has made me a bit more comfortable when I come home at the end of the day.”

What GPs have learnt about COVID-19

  • Its transmission can be erratic and not every close contact will become infected.
  • Some people develop mild symptoms or no symptoms at all.
  • It is associated with unusual symptoms, such as chilblains on the feet and hands.
  • Young, healthy people can become seriously unwell.
  • Some patients have mild symptoms which persist for months.
  • Some patients are left with long-term health effects such as scarring of the lungs.

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