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New Delhi, Jun 13: Loss of smell or taste has been added to the list of COVID-19 symptoms, according to the revised clinical management protocols released by the Union Health Ministry on Saturday.

The ministry said that coronavirus-infected patients reporting to various COVID-19 treatment facilities have been reporting symptoms like fever, cough, fatigue, shortness of breath, expectoration, myalgia, rhinorrhea, sore throat and diarrhea.

They have also complained of loss of smell (anosmia) or loss of taste (ageusia) preceding the onset of respiratory symptoms.

Older people and immune-suppressed patients in particular may present with atypical symptoms such as fatigue, reduced alertness, reduced mobility, diarrhoea, loss of appetite, delirium, and absence of fever, the ministry said.

Children might not have reported fever or cough as frequently as adults.

The US's national public health institute, the Centers for Disease Control and Prevention (CDC), had in early May incorporated "a new loss of taste or smell" in the list of COVID-19 symptoms.

According to the data from Integrated Health Information Platform and Integrated Disease Surveillance Programme, portal case investigation forms for COVID 19 (n=15,366), the details on the signs and symptoms reported are (as on June 11), fever (27 per cent), cough (21 pc), sore throat (10 pc), breathlessness (8 pc), Weakness (7 pc), running nose (3pc ) and others 24 pc.

According to the health ministry, people infected by the novel coronavirus are the main source of infection.

Direct person-to-person transmission occurs through close contact, mainly through respiratory droplets that are released when the infected person coughs, sneezes, or talks.

These droplets may also land on surfaces, where the virus remains viable. Infection can also occur if a person touches an infected surface and then touches his or her eyes, nose, or mouth.

The median incubation period is 5.1 days (range 2–14 days). The precise interval during which an individual with COVID-19 is infectious is uncertain.

As per the current evidence, the period of infectivity starts 2 days prior to onset of symptoms and lasts up to 8 days.

The extent and role played by pre-clinical/ asymptomatic infections in transmission still remain under investigation.

Karnataka on Saturday reported 12 new cases, the highest in a single day so far, taking the tally in the state to 76.

Late at night, the Mysuru district commissioner said five more people had tested positive in the district. But it was yet to be confirmed by the state health department.

Of the cases, 41 are from Bengaluru, eight from Chikkaballapur, while Uttara Kannada and Dakshina Kannada districts have seven each.

Interestingly, the highest number of patients are those from Dubai or those who had transit travel via Dubai. Out of 76 cases, 17 cases (22%) have travel history to Dubai, the capital of Emirate of Dubai and the most populous city in the United Arab Emirates (UAE).

Medical Education Minister Dr K Sudhakar, who is also in-charge of COVID-19 operations, said that Dubai has been a major concern as far as Karnataka COVID-19 patients are concerned. “Most of the positive cases have come through Dubai suggesting something amiss there,” he said. 

Echoing the same, Dr Prakash Kumar, Joint Director, Communicable Diseases, Department of Health and Family Welfare, said, “The layover in Dubai is around six to seven hours. We are seeing Dubai to be the new epicentre of the virus as far as India is concerned.”

UAE was initially not on the list of countries from where passengers were screened. It was added much later when clusters of patients with travel history to Dubai began popping up all over the country.

Patient-19 has infected the maximum so far.

Out of the 12 cases that tested positive on Saturday, five are contacts of Patient 19. All of them are being treated at a Chikkaballapur hospital. Two of them are from Hindupur, Andhra Pradesh, and three are residents of Gauribidanur taluk in Chikkabalapur district.

P19, a 31-year-old man from Chikkaballapur, had travelled to Mecca, Saudi Arabia, and returned to India on March 14. Existing patient clusters suggest that P19 had infected the maximum number of people. Officials did not reveal how many people he originally travelled with to Mecca.

Amid the rise in cases, Jawaid Akhtar, Additional Chief Secretary (Health), maintained that the state had not reached stage 3. But he had no definitive answer as to how the Mysuru patient contracted the virus despite health officials he was in touch with not testing positive.

Health Commissioner Pankaj Kumar Pandey said around 1,000 primary contacts of all positive cases have been classified as high-risk and low-risk. The high-risk patients are in government hospitals while the low-risk ones in quarantine facilities.