What You Need to Know About Croup and COVID-19
The last few weeks have shown that the Omicron variant of COVID-19 is different from previous strains, and that includes some of the symptoms that can pop up. One that’s getting a lot of attention right now is croup, an upper airway infection that causes a barking cough along with other issues.
Twitter is filled with comments from people who have children who have experienced croup as a symptom of COVID-19 and pediatricians who have witnessed it in patients. “It’s amazing how many of these little kids with COVID are presenting with croup-like symptoms,” one doctor wrote. “Whoever said this was a ‘mild strain’ was not a pediatrician.”
There have also been several case reports detailing the link between croup and COVID-19 cases in kids. As Omicron continues to spread rapidly across the country, it’s understandable to have questions about what croup is and whether it can impact adults as well. Here’s what you need to know.
What is croup, exactly?
Croup is a condition that causes swelling in the airways and problems breathing, according to Johns Hopkins Medicine. Specifically, croup causes swelling around the voice box or larynx, windpipe (trachea), and bronchial tubes (bronchi), the Mayo Clinic explains. When someone with croup coughs, the air goes through a narrower-than-usual passageway and the swollen vocal cords create a sound similar to a seal barking.
People with croup also usually have a high-pitched “creaking” or whistling sound when they breathe called stridor, Johns Hopkins Medicine says.
What are the symptoms of croup?
These are the main symptoms of croup, according to the Mayo Clinic:
A loud barking cough that gets worse with coughing, crying, anxiety, and agitation
Fever
Hoarse voice
Breathing that may be noisy or labored
Symptoms of croup are usually worse at night and last for three to five days, per the Mayo Clinic.
Can you catch croup?
While you can’t catch croup from someone, you can catch a viral infection that causes croup. Croup can also be caused by bacteria, allergies, or acid reflux, per Cedars-Sinai. However, the most common cause of croup is viruses, including the ones listed below:
Parainfluenza virus
Respiratory syncytial virus (RSV)
Influenza (aka the flu)
Adenovirus
Enteroviruses
People can catch a virus that causes croup by breathing in infected respiratory droplets that are coughed or sneezed into the air, or by touching a contaminated surface and then touching their eyes, nose, or mouth, the Mayo Clinic says.
What is the age range for croup?
Technically, anyone can develop croup, Thomas Russo, M.D., professor and chief of infectious disease at the University at Buffalo in New York says. But children are the most at risk of contracting croup, especially those between the ages of six months and three years because they have small airways, he says. “As you get older, that space in your airway gets larger so you have a greater margin of error with swelling,” Dr. Russo explains. “It’s unusual in adults.” William Schaffner, M.D., an infectious disease specialist and professor at the Vanderbilt University School of Medicine, agrees. “Adults kind of age out of that symptom presentation,” he adds.
But Liam Sullivan, D.O., an infectious disease specialist with Spectrum Health, says that “it would not be surprising if the Omicron variant of SARS CoV-2 was capable of causing croup-like illness in adults.”
What is croup like in adults?
While croup isn’t common in adults, there is a chance you could develop a barking cough from COVID, Dr. Russo says. In those situations, though, it’s typically much less severe than it would be in children. “Adults may have a cough that mimics croup but it would be much less likely that they would need support for upper airway inflammation,” Dr. Russo says. “You’re unlikely to get into trouble as an adult.”
Still, “croup symptoms in adults is very similar to that of children,” Dr. Sullivan says.
How to treat croup
Croup can usually be treated at home by using a cool-mist humidifier, drinking lots of fluids, and treating your fever with acetaminophen or ibuprofen, Johns Hopkins Medicine says.
If you suspect or know that your croup is caused by COVID-19, you’ll want to focus on treatment for that. “It’s more about treating the underlying illness in adults,” Dr. Schaffner says. If you’re considered high risk for COVID-19, you may qualify to receive monoclonal antibody treatment or to get an anti-viral pill designed to treat COVID-19, Dr. Schaffner points out. (The National Institutes of Health (NIH) has information online about who qualifies, and you should also ask your doctor for guidance.)
If your symptoms last past three to five days or get worse, your doctor may recommend that you take medication like a glucocorticoid, including dexamethasone, to reduce inflammation in your airway, the Mayo Clinic says. The hormone epinephrine may also be given via an inhaler to help reduce your airway inflammation and decrease swelling.
Again, it's not common for adults to develop croup, whether it's caused by COVID-19 or not. But, if you are having trouble breathing, or feel like your throat or airways are closing, Dr. Sullivan recommends seeking emergency medical attention ASAP.
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