Extrapulmonary clinical manifestations of COVID-19: an umbrella review of meta-analysis

Since its emergence, the coronavirus disease 2019 (COVID-19), compared to other coronavirus diseases throughout history, has generated large waves of infection with symptoms such as fever, chills, cough, fatigue, headache, and sore throat appeared. Despite many efforts and gains through meta-analyses of the symptoms of COVID-19 thus far, there has been a need of summarized concise information for clinicians. This review presents a summary of recent meta-analyses by categorizing the various extra-pulmonary clinical symptoms of COVID-19 according to organ systems. The article focuses on six groups: generalized symptoms such as fever (prevalence rate, 71% to 91%), fatigue (prevalence rate, 32% to 58%), and myalgia (20% to 33%), neurologic symptoms (headache [8% to 44%], dizziness [7% to 10%], confusion [5% to 11%], and impaired consciousness [2% to 7%]), psychiatric symptoms (anxiety or agitation [15% to 45%], post-traumatic stress disorder [20% to 41%], sleep disorder [35% to 82%], and depression [21% to 42%]), cardiovascular symptoms (chest pain [8% to 13%], palpitation [9.3%], arrhythmia [1.9%], arrhythmias [18.4%], angina [10.2%], myocardial injury [10.3%], myocardial infarction [3.5%], and acute heart failure [2.0%]), gastrointestinal symptoms (anorexia [20.0% to 27%], nausea or vomiting [5% to 10%], diarrhea [7% to 17%], and abdominal pain [4% to 9%]), and olfactory, gustatory/oral, and ocular symptoms (ocular symptoms [11.2%], olfactory dysfunction [38% to 53%], and gustatory dysfunction [7% to 37%]). The aim of this study is to provide clinicians concise information of the various extra-pulmonary clinical symptoms of COVID-19 and promote the understanding of administrators who set appropriate quarantine policies.