By now, we all should have memorized the key symptoms of the novel coronavirus that public health officials have hammered home: fever, cough, and trouble breathing. However, that message may have given some who thought they had to have all three symptoms at once a false sense of security. The earliest reports on the disease caused by COVID-19 were based on patients sick enough to see a doctor or go to a hospital. Many had the three symptoms. As we practice social distancing, though, an important question becomes: How does this disease start? Knowing the early symptoms could help people know when to isolate themselves even more and talk to their doctors about testing. While hundreds of thousands of people have contracted COVID-19 over the last few months, information about its earliest stages has been slow to trickle out. Doctors said there are still important gaps in what they know. And, unfortunately, many of the early symptoms of COVID-19 overlap with other common health problems. “There is no clearly defined syndrome at this point," said Nuala Meyer, a pulmonary and critical-care medicine doctor at Penn Medicine. Symptoms can be subtle. It is known that some people infected have no symptoms or ones so mild that they’re not noticed. Daniel Mueller, an infectious diseases doctor at Temple University Hospital, said infected people might feel “just slightly under the weather for a few days.… They might just feel a little tired or a little achy." It’s the sort of feeling you’d have if you thought you were coming down with something, but nothing very worrisome. Then they might start having a dry cough. Later, in some people, shortness of breath comes on. “They don’t always happen together,” Mueller said. It’s not like the flu. Unlike the flu, which announces itself suddenly with fever and muscle aches, the early stages of COVID-19 can go on for a few days. Reynold A. Panettieri Jr., vice chancellor for clinical and translational science at Rutgers University, said some mild cases last just three to four days. Others who are not sick enough for hospitalization still may have symptoms for two weeks. Presentation of the disease is, he said, “very individualistic and very heterogeneous." Some people are barely affected and some have “shaking chills” and muscle aches, he said. Shortness of breath may manifest in two to three days. More severe symptoms may portend a rougher course, but it’s not yet clear if they do. “You just don’t know whether they’re going to progress," he said. In severe cases, patients develop pneumonia and need help breathing. “The susceptibility to progression is unclear.” Fever? Yes and no. Meyer would add sore throat to the list of early symptoms. She said most patients will eventually have a fever, but it “may not be in the first five days.” A report about the outbreak in China published in the New England Journal of Medicine said about 44% of COVID-19 patients had a fever when admitted to a hospital and 88% developed one during their stay. The researchers warned that cases could be missed if doctors considered fever part of the case definition. A rarely mentioned early symptom is gastrointestinal distress. About 10% of cases can start with a couple of days of diarrhea, abdominal pain, nausea, or vomiting and then respiratory symptoms develop, said David A. Johnson, chief of gastroenterology at Eastern Virginia Medical School, who has reviewed studies on the new disease. He said this makes sense because the virus first targets a type of cell that lives both in the lungs and in parts of the digestive tract. There is evidence of viral shedding in feces, he said. That is not proof that virus in the stool is infectious, he said, but is reason to worry that the disease can be transmitted through a fecal-oral route. It’s another argument for good hand hygiene and bathroom cleaning. In a Chinese study, the shedding continued for up to 12 days after people tested negative for the virus, he said. » READ MORE: What to do if you think you have coronavirus Gavin Macgregor-Skinner, an assistant professor in the department of public health at the Penn State University College of Medicine, trains people in hospitals and other organizations in infection prevention and control. He said he is frustrated by the lack of information this many weeks into a pandemic. He said medical journals can be too slow to provide information, and doctors should find quicker ways, such as a clearinghouse, to share data. For now, he is asking the 37 members of his prevention team to take their own temperatures in the morning and evening. That way they’ll know their personal baseline. If the temperature goes up, he wants them to stop working and test every three hours. He said he doesn’t know whether fever is the first symptom, but added that low-grade fever is “definitely present” in the disease. He also wants people to stay away from others if they have any respiratory symptoms. He agreed that breathing difficulty is not an early sign of the disease. He didn’t know about gastrointestinal symptoms, but he had strong words about infection control when fecal-oral transmission is a possibility. Active virus in feces can spray into the room when you flush; so, close the lid when flushing. You shouldn’t have personal items near the toilet, he said: “Don’t have your toothbrush next to your toilet, ever.” Mueller said the three major symptoms — fever, cough, and shortness of breath — warrant a call to the doctor and a discussion about whether to be tested. He would set the threshold lower for transplant patients or those with chronic heart and lung disease. Shortness of breath could be a sign of pneumonia and should get immediate attention, he said. The American Academy of Ophthalmology on March 25 issued a warning to its members that some patients with conjunctivitis, an inflammation of the thin, transparent tissue that lines eyelids and part of the eye also known as pink eye, can be an early sign of coronavirus. It suggested that eye doctors wear full face protection covering eyes, ears and mouth, particularly when patients also have fever and respiratory symptoms. The organization cited two studies from China that involved patients hospitalized for the new disease. One found viral conjunctivitis in 1 of 30 patients. The other found it in 9 of 1,099 (0.8%) lab-confirmed cases. British ear, nose and throat doctors have also raised the alarm that loss of the sense of smell can be a symptom. In a statement, ENTUK said there is “good evidence” from South Korea, China and Italy that pepole with COVID-19 infection can experience total loss of the sense of smell (asnosmia) or a decline. “In Germany it is reported that more than two in three confirmed cases have anosmia,” they wrote. “In South Korea, where testing has been more widespread, 30% of patients testing positive have had anosmia as their major presenting symptom in otherwise mild cases.”
If you have serious symptoms of illness, contact your primary care provider. UC Davis Health patients can use the MyUCDavisHealth symptom tracker to evaluate whether to seek help. Telehealth video visits and Express Care are also available. If you think you've been exposed to COVID-19, please see current testing information. If you have a medical emergency, call 911 and notify them of your COVID-19 symptoms.
COVID-19 is a respiratory condition caused by a coronavirus. Some people are infected but don’t notice any symptoms (doctors call that being asymptomatic). Most people will have mild symptoms and get better on their own. But some will have severe problems, such as trouble breathing. The odds of more serious symptoms are higher if you’re older or have another health condition like diabetes or heart disease. Here’s what to look for if you think you might have COVID-19. The most common things people who become ill with COVID-19 have include: These symptoms can start anywhere from 2 to 14 days after you’re in contact with the virus. Call a doctor or hospital right away if you have any of these issues: If you have any of these, you need medical care as soon as possible, so call your doctor’s office or hospital before you go in. This will help them prepare to treat you and protect medical staff and other people. Strokes have also been reported in some people who have COVID-19. Remember FAST: Researchers are working on several possible treatments for COVID-19, but only the antiviral drug remdesivir (Veklury) has been approved by the FDA, and it is approved only for use in hospitalized people. The FDA has authorized health care providers to use medications that aren’t yet approved for COVID-19, such as monoclonal antibodies, in some special cases. COVID-19 can also cause problems including: Some doctors have reported rashes tied to COVID-19, including purple or blue lesions on children’s toes and feet. Researchers are looking into these reports so they can understand the effect on people who have COVID-19. Researchers say kids have many of the same COVID-19 symptoms as adults, but they tend to be milder. Some children may be asymptomatic, but they can still spread the virus. Common symptoms in children include: Some children and teens who are in the hospital with COVID-19 have an inflammatory syndrome that may be linked to the coronavirus. Doctors call it pediatric multisystem inflammatory syndrome (PMIS). Symptoms include a fever, a rash, belly pain, vomiting, diarrhea, and heart problems. It’s similar to toxic shock or to Kawasaki disease, a condition in children that causes inflammation in blood vessels. Get tested for COVID-19 if: You don’t need to be tested for COVID-19 after exposure if: Your regular body temperature may be higher or lower than someone else’s. It also changes throughout the day. Doctors generally consider a fever in an adult to be anything over 100.4 F on an oral thermometer and over 100.8 F on a rectal thermometer. If you think you’ve come into contact with the virus, or if you have symptoms, isolate yourself and check your temperature every morning and evening for at least 10 days. Keep track of the readings. A fever is the most common symptom of COVID-19, but it’s sometimes below 100 F. In a child, a fever is a temperature above 100 F on an oral thermometer or 100.4 F on a rectal one. Most people with COVID-19 have a dry cough they can feel in their chest. If you have milder symptoms like a fever, shortness of breath, or coughing: Dyspnea is the word doctors use for shortness of breath. It can feel like you: You should monitor your oxygen levels, and if they dip into the 80s, contact your doctor. If your face and/or lips get a bluish tint, call 911 right away. Since they share so many symptoms, it can be hard to know which condition you have. But there are a few guidelines that can help. You may have COVID-19 if you have a fever and trouble breathing, along with the symptoms listed above. If you don’t have problems breathing, it might be the flu. You should still isolate yourself just in case. It’s probably allergies if you don’t have a fever but your eyes are itchy, you’re sneezing, and you have a runny nose. If you don’t have a fever and your eyes aren’t itchy, it’s probably a cold. Call your doctor if you’re concerned about any symptoms.
Several COVID-19 vaccines are available, and they’re the best way to protect yourself and those around you unless your doctor advises otherwise. Full vaccination lowers your chances of getting COVID-19 by 91%. The most accessible vaccines in the U.S. are:
Talk with your doctor before getting the vaccine if you have immune system issues. The CDC recently said there’s a clinical preference for people to get an mRNA COVID-19 vaccine (either the Pfizer or Moderna one) over the Johnson & Johnson COVID-19 vaccine. This recommendation came after the Advisory Committee on Immunization Practices (ACIP) discussed the latest data on vaccine effectiveness, vaccine safety, rare adverse side effects, and U.S. vaccine supply. But the ACIP also said that any vaccine is better than no vaccine. If you can’t get an mRNA vaccine, the Johnson & Johnson COVID-19 vaccine is still an option. Until you’re vaccinated, be sure to take these steps to prevent COVID-19: If you’re taking care of someone who’s sick, follow these steps to protect yourself:
SOURCES: UpToDate: “Coronavirus disease 2019 (COVID-19): Epidemiology, virology, clinical features, diagnosis and prevention,” “Coronavirus disease 2019 (COVID-19).” Medscape: “Kidney Complications in COVID-19 Send Hospitals Scrambling.” Global Radiology CME: “COVID-19 Presenting with Syncope.” Iranian Red Crescent Medical Journal: “Frequent Convulsive Seizures in an Adult Patient With COVID-19: A Case Report.” Consul General of the Official Colleges of Podiatrists, Spain: “COVID-19 Compatible Case Register.” World Health Organization: “Q&A on coronaviruses (COVID-19),” “Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19).” CDC: “Coronavirus disease 2019 (COVID-19) and you,” “Symptoms of coronavirus disease 2019,” “Symptoms,” “Coronavirus Disease 2019 (COVID-19).” “Symptoms of COVID-19,” “Treatments Your Healthcare Provider Might Recommend If You Are Sick,” “COVID-19 In Children and Teens,” “Test For Current Infection,” “What To Do If You Are Sick,” “Pfizer-BioNTech COVID-19 Vaccine: Vaccine Preparation and Administration Summary,” “Moderna COVID-19 Vaccine: Vaccine Preparation and Administration Summary,” “Janssen COVID-19 Vaccine (Johnson & Johnson): Vaccine Preparation and Administration Summary,” “Interim Clinical Considerations for Use of COVID-19 Vaccines Currently Authorized in the United States,” “CDC Endorses ACIP’s Updated COVID-19 Vaccine Recommendations,” “Most Children and All Teens Can Get COVID-19 Vaccines,” “Quarantine and Isolation,” “Types of Masks and Respirators.” University of Alabama at Birmingham: “Sorting out symptoms of COVID-19, influenza, colds and allergies.” Merck Manual Consumer Version: “Fever in Adults,” “Shortness of Breath.” Loma Linda University Health: “Coronavirus 2019 (COVID-19).” American Society of Clinical Oncology: “Shortness of Breath or Dyspnea.” American Academy of Family Physicians: “Shortness of Breath.” American Academy of Ophthalmology: “Coronavirus Eye Safety.” The Lancet Gastroenterology and Hepatology: “Liver injury in COVID-19: management and challenges.” National Institute of Allergy and Infectious Diseases” “Cold, Flu, or Allergy?” The New England Journal of Medicine: “Large-Vessel Stroke as Presenting Feature of Covid-19 in the Young.” American Stroke Association: “Stroke Symptoms." Boston Children’s Hospital: “COVID-19 and a serious inflammatory syndrome in children: Unpacking recent warnings.” Nemours/KidsHealth: “Kawasaki Disease,” “Fevers.” Morbidity and Mortality Weekly Report: “Coronavirus Disease 2019 in Children – United States, February 12-April 2, 2020.” Hartford Health Care: “30 Percent of People With COVID-19 Show No Symptoms: Here’s Where They Carry It.” MANA Medical Associates: “What Are The Symptoms of COVID-19?” © 2022 WebMD, LLC. All rights reserved. |
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