COVID-19: to be or not to be; that is the diagnostic question

Research output: Contribution to journalReview articlepeer-review


Colleges, School and Institutes


Since the first cases in December 2019, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has rapidly spread across the globe, resulting in the COVID-19 pandemic. Early clinical experiences have demonstrated the wide spectrum of SARS-CoV-2 presentations, including various reports of atypical presentations of COVID-19 and possible mimic conditions.This article summarises the current evidence surrounding atypical presentations of COVID-19 including neurological, cardiovascular, gastrointestinal, otorhinolaryngology and geriatric features. A case from our hospital of pneumocystis pneumonia initially suspected to be COVID-19 forms the basis for a discussion surrounding mimic conditions of COVID-19. The dual-process model of clinical reasoning is used to analyse the thought processes used to make a diagnosis of COVID-19, including consideration of the variety of differential diagnoses.While SARS-CoV-2 is likely to remain on the differential diagnostic list for a plethora of presentations for the foreseeable future, clinicians should be cautious of ignoring other potential diagnoses due to availability bias. An awareness of atypical presentations allows SARS-CoV-2 to be a differential so that it can be appropriately investigated. A knowledge of infectious mimics prevents COVID-19 from overshadowing other diagnoses, hence preventing delayed diagnosis or even misdiagnosis and consequent adverse outcomes for patients.


Original languageEnglish
Pages (from-to)392-398
Number of pages7
JournalPostgraduate medical journal
Issue number1137
Publication statusPublished - 10 Jun 2020


  • infectious diseases, respiratory infections, Diarrhea/virology, Olfaction Disorders/virology, Diagnosis, Differential, Pandemics, Humans, Betacoronavirus/immunology, Dysgeusia/virology, Coronavirus Infections/diagnosis, Cytokine Release Syndrome/physiopathology, COVID-19, SARS-CoV-2, Virus Replication, Delayed Diagnosis/prevention & control, Cardiovascular Diseases/virology, Diagnostic Errors/prevention & control, Nervous System Diseases/virology, Pneumonia, Viral/diagnosis

ASJC Scopus subject areas

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