As news of a strange new pneumonia caused by a novel coronavirus emerged from Wuhan, China, in December 2019, people were told to be on the lookout for symptoms of a fever, cough and shortness of breath. Since then, we’ve learnt more about the symptoms of this new disease we now call COVID-19, which is caused by SARS-CoV-2.
The World Health Organization (WHO) has reported on the cases of 55,924 people with laboratory confirmed COVID-19, giving us an indication of how common certain symptoms are and the types of symptoms people are experiencing. Here’s a roundup of the symptoms linked to COVID-19, many of which are typical of other viral respiratory infections.
Well-known COVID-19 symptoms
Fever, cough, tiredness and shortness of breath are the hallmarks of COVID-19.
Fever: Fever is one of the most common symptoms. The WHO report found that 87.9% of patients with COVID-19 developed a fever. Interestingly, a separate review of 1099 COVID-19 patients, found a similar number (88.7%) had a fever while in hospital, but only 43.8% of them had a fever when they first arrived.
Cough: A new continuous dry cough is another of the most common symptoms of COVID-19. The WHO report noted that 67.7% of patients experienced this symptom. However, sputum production was also noted in 33.4% of cases. Sputum is a thick mucus or phlegm that people may cough up (wet cough).
Fatigue: Fatigue, or a feeling of extreme tiredness or weakness, was reported in 38.1% of the cases, making it another common symptom.
Shortness of breath: Shortness of breath (dyspnea) is a symptom which can cause particular distress or worry. Of the 55,924 cases reviewed by the WHO, 18.6% were found to have had shortness of breath. This can feel like you aren’t able to get enough air or you have a tightness in your chest.
If you have COVID-19, shortness of breath could be a sign of developing pneumonia. Pneumonia can cause the lungs to become inflamed, and as they fill up with pus or mucus it becomes difficult for the oxygen you breathe in to transfer into your bloodstream, which causes breathlessness. Pneumonia has been observed in some patients with mild to moderate COVID-19, as well as in those with severe disease. Infections can also cause acid to build up in the blood, which causes us to breathe faster and makes us feel breathless. Anxiety can also cause feelings of breathlessness.
Headline-making COVID-19 symptoms
Digestive symptoms: Initial reports suggested that diarrhea only occurred in 3.7% of patients and wasn’t that common in COVID-19 patients. However, results from a study conducted in 204 patients with COVID-19 in China reported that 50.5% of patients experienced some digestive symptoms, which included 34% who experienced diarrhea. The researchers noted the fact that further research is required, but concluded that digestive symptoms were common and diarrhea could be one of the first symptoms of COVID-19.
Loss of sense of smell or altered taste: A loss of sense of smell, known as anosmia, appears to be a common symptom of COVID-19. More than 2 in 3 people with confirmed COVID-19 in Germany lost their sense of smell. In addition, in 30% of confirmed cases in South Korea, a loss of sense of smell was their major presenting symptom. Many patients have found their sense of smell returns within 7-14 days. An altered sense of taste (dysgeusia) has also been reported by some people with COVID-19.
Conjunctivitis: Conjunctivitis, or pink eye as it is also known because it causes the eyes to look red or pink, was observed in 0.8% of the cases included in the WHO review. One of the first cases of COVID-19-related conjunctivitis reported was in Dr Guangfa Wang, who wore an N95 mask when he examined some of the first COVID-19 patients in China, but did not wear anything to protect his eye. It shouldn’t really come as a surprise that COVID-19 can cause conjunctivitis, because viral conjunctivitis is the most common cause of infectious conjunctivitis. Viral conjunctivitis is found in people with a range of viral infections including the flu, measles and common colds.
Other COVID-19 symptoms
Muscle and joint aches or pains: Muscle and joint aches or pains (myalgia and arthralgia) affected 14.8% of patients according to the WHO report. Some patients describe the body aches and pain as unbearable, while others appear to find it more like those that accompany a bout of regular flu.
Sore throat: A sore throat developed in 13.9% of cases.
Headache: 13.6% of patients developed a headache.
Chills: 11.4% of patients experienced chills.
Nausea and vomiting: Nausea and vomiting are less common symptoms, with only 5% of patients in the WHO report experiencing these.
Nasal congestion and sneezing: Only 4.8% of the cases reviewed experienced nasal congestion, which covers a blocked and sometimes runny nose. Sneezing was not highlighted as a symptom of COVID-19 in the WHO review covering 55,924 cases.
Coughing up blood: Hemoptysis, or coughing up blood or blood-stained mucus, was only noted in 0.9% of cases.
What about the asymptomatic COVID-19 patients? Those who are infected, but don’t have any symptoms
Asymptomatic COVID-19 infection was initially thought to be relatively rare. However, on March 22, 2020, it was reported that by the end of February more than 43,000 people in China had tested positive for COVID-19, despite having no immediate symptoms. Recently the director of the US Centers for Disease Control and Prevention (CDC), also reported that as many as 25% of those with COVID-19 may not show any symptoms.
It’s unclear how many people with COVID-19 are truly asymptomatic throughout the course of their infection. News reports about Iceland suggested that as many as 50% of those who tested positive were asymptomatic. However, Dr. Kári Stefánsson, the CEO of deCODE genetics which has been carrying out some of the screening in Iceland, has confirmed that many of the people who didn’t have symptoms at the time of diagnosis actually went on to develop them later. Unlike many other COVID-19 testing programs, people in Iceland can volunteer to be tested by deCODE and do not have to have symptoms or contact with a confirmed COVID-19 case to be eligible.
COVID-19 symptom table
|Aches and pains||♦|
|Coughing up blood||♦|
|Digestive symptoms (incl. diarrhea)||♦*|
|Loss of sense of smell||♦|
|Nasal congestion and sneezing||♦|
|Nausea and vomiting||♦|
|Shortness of breath||♦|
* Researcher note more studies are required to confirm results
- Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. January 24, 2020. Lancet. 2020 Feb 15;395(10223):497-506. DOI:https://doi.org/10.1016/S0140-6736(20)30183-5. Epub 2020 Jan 24.
- World Health Organization (WHO). Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19). February 16-24, 2020. Available at: https://www.who.int/docs/default-source/coronaviruse/who-china-joint-mission-on-covid-19-final-report.pdf.
- Guan W-J, Ni Z-Y, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. NEJM. February 28, 2020. DOI: 10.1056/NEJMoa2002032.
- Chest Foundation. Shortness of Breath. Available at: https://foundation.chestnet.org/patient-education-resources/shortness-of-breath-2/. [Accessed April 9, 2020].
- American Lung Association. Learn About Pneumonia. Available at: https://www.lung.org/lung-health-diseases/lung-disease-lookup/pneumonia/learn-about-pneumonia. [Accessed April 9, 2020].
- Pan L, Mu M, Yang P, et al. Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: a descriptive, cross-sectional, multicenter study. American Journal of Gastroenterology. Available at: https://journals.lww.com/ajg/Documents/COVID_Digestive_Symptoms_AJG_Preproof.pdf. [Accessed April 9, 2020].
- ENT UK. Loss of sense of smell as marker of COVID-19 infection. Available at: https://www.entuk.org/sites/default/files/files/Loss%20of%20sense%20of%20smell%20as%20marker%20of%20COVID.pdf. [Accessed April 9, 2020].
- ENT UK. Advice for patients with new-onset anosmia during COVID-19 pandemic. March 22, 2020. Available at: https://mcusercontent.com/e386d81be4a76bada89909666/files/2b18c56d-a34b-47a2-8b56-1bb21e225eb9/Advice_for_patients_with_new_onset_anosmia_during_COVID_19_pandemic.pdf?utm_source=All+ENT+UK+Members+NO+EVENTS+COMMS+12.02.20&utm_campaign=e13b37d047-EMAIL_CAMPAIGN_2020_03_23_05_26_COPY_01&utm_medium=email&utm_term=0_6774fc77e2-e13b37d047-.
- Azari A, Barney NP. Conjunctivitis. A Systematic Review of Diagnosis and Treatment. JAMA. 2013 Oct 23; 310(16): 1721-1729. DOI: 10.1001/jama.2013.280318.
- Lu C-W, Liu X-F, Jia Z-F. 2019-nCoV transmission through the ocular surface must not be ignored. Lancet. https://doi.org/10.1016/S0140-6736(20)30313-5.
- New York Times. Infected but Feeling Fine: The Unwitting Coronavirus Spreaders. March 31, 2020. Available at: https://www.nytimes.com/2020/03/31/health/coronavirus-asymptomatic-transmission.html. [Accessed April 9, 2020].
- South China Morning Post. A third of coronavirus cases may be ‘silent carriers’, classified Chinese data suggests. March 22, 2020. Available at: https://www.scmp.com/news/china/society/article/3076323/third-coronavirus-cases-may-be-silent-carriers-classified. [Accessed April 9, 2020].
- Iceland Review. Is Iceland’s coronavirus testing showing that 50% of cases have no symptoms? April 2, 2020. Available at: https://www.icelandreview.com/sci-tech/is-icelands-coronavirus-testing-showing-that-50-of-cases-have-no-symptoms/. [Accessed April 9, 2020].
- Iceland Review. Iceland’s Coronavirus Testing Could Help Global Pandemic Response. April 2, 2020. Available at: https://www.icelandreview.com/sci-tech/icelands-coronavirus-testing-global-pandemic-response/. [Accessed April 9, 2020].