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 Table of Contents 
Year : 2020  |  Volume : 11  |  Issue : 4  |  Page : 199  

COVID-19: The vital sign

1 Pulmonary and Critical Care, Apollo Hospitals, Apollo Health City, Hyderabad, Telangana, India
2 Obstetrics and Gynaecology, Tanvir Hospital, Hyderabad, Telangana, India

Date of Submission16-Dec-2020
Date of Decision19-Dec-2020
Date of Acceptance23-Dec-2020
Date of Web Publication21-Jan-2021

Correspondence Address:
Sai Praveen Haranath
Apollo Hospitals, Apollo Health City, Hyderabad, Telangana - 500 096
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jmh.jmh_286_20

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How to cite this article:
Haranath SP, Meeta M. COVID-19: The vital sign. J Mid-life Health 2020;11:199

How to cite this URL:
Haranath SP, Meeta M. COVID-19: The vital sign. J Mid-life Health [serial online] 2020 [cited 2023 Jan 26];11:199. Available from:

COVID-19 has been the single-most transformational event in our lifetime. Is this the tuberculosis or perhaps the syphilis of this generation? The multisystem impact of the disease and the need for physical isolation are remarkable. Despair has set in with adverse mental health impact when the COVID-positive status for someone has been notified. Knowledge of the current health status has always been helpful in evaluating patients. Diabetes affects cardiovascular outcomes, hypertension when uncontrolled portends future strokes, and the presence of eosinophilia may suggest asthma. Today, every patient needs to have a workup to ensure that he/she is not currently infected with COVID. Just as in the not-too-distant past HIV and hepatitis B status was essential knowledge before admitting in hospitals, COVID has added itself as the next new marker of infectious disease. I call it the vital sign. Perhaps, it is The Vital Sign of our times. After initially calling it the sixth vital sign, I quickly realized that every system of care has an assigned vital sign beyond the basic physiologic measures of heart rate, blood pressure, temperature, respiratory rate, and oxygen saturation. Some have added pain, activity limitation, urine output, or level of consciousness.[1] Trending vital signs has been a basic tenet of care.[2] In practice, it may be the unconscious gestalt of experience that is relevant rather than the actual measurement of perhaps oxygen saturation to determine the acuity of illness. However, intuition builds up with time and can be unreliable when the health-care team is composed of novice providers.[3] In this circumstance, measurement matters and perhaps the respiratory rate may be crucial in a COVID-infected patient with respiratory involvement. The rate of breathing may unconsciously increase with lung involvement and acidosis can also trigger tachypnea. Likewise, oxygen saturation needs to be measured, but may not always change at rest and a walk test may be needed to bring out hypoxia. Many pulse oximeters are sensitive to ambient light, and there are quality differences to be kept in mind.

COVID has protean manifestations. It can alter heart rate, oxygen saturation, temperature, respiratory rate, or blood pressure. Being COVID positive immediately conjures up images of permutations and combinations of severe distress. The reality as we now know is fairly bland. Most infected patients do well. Those that did not were unfortunately predisposed to a similar outcome with any infection. It is evident that while we have challenges ahead, knowing the COVID status will assist in triaging safely. We must remember that this needs physical distancing and not social isolation. The arrival of vaccines is perhaps to be celebrated, but just as there were insufficient lifeboats on the Titanic, we must remember to avoid colliding with COVID for as long as possible. Despite the challenges with managing COVID from a medical and societal perspective, treatment and evaluation is not to be denied or delayed. We have to remind ourselves that it remains vital to protect and to care: COVID positive or negative.

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Conflicts of interest

There are no conflicts of interest.

   References Top

Malcolm E, Alysia C. Critical care: The eight vital signs of patient monitoring. Br J Nurs 2012;21:621-5.  Back to cited text no. 1
Brekke IJ, Puntervoll LH, Pedersen PB, Kellett J, Brabrand M. The value of vital sign trends in predicting and monitoring clinical deterioration: A systematic review. PLoS One 2019;14:e0210875.  Back to cited text no. 2
Price A, Zulkosky K, White K, Pretz J. Accuracy of intuition in clinical decision-making among novice clinicians. J Adv Nurs 2017;73:1147-57.  Back to cited text no. 3


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