As a doctor, I know there's always a difficult balance between looking after yourself and becoming obsessive about possible COVID-19 symptoms. The COVID-19 pandemic has heightened anxiety and increased levels of hypochondriasis. In fact, "cyberchondria" is the new buzz term, as more and more people search the internet for answers. Good quality, well-researched information can help calm anxiety and provide reassurance. Sometimes articles use inflated statistics and can be scaremongering.
In this piece, I have used only authoritative sources, and hope that if you are worried about the virus, you will find some truthful and helpful information here. I'm hoping that once you've read it, it will help answer some of your questions and concerns. Read on, and to ensure your health and the health of others, don't miss these Sure Signs You've Already Had Coronavirus.
You May Have a Fever
Fever is one of the top three COVID-19 symptoms. 87.9% of people with positive laboratory COVID tests, report having a fever. Normal body temperature is 98.6°F. Your temperature is considered raised if it is above that. In COVID infection, the fever is usually 100°C or above.
Fever occurs because your body recognizes there is a foreign organism on board. The temperature rises because your body is making the environment hostile to the virus so it cannot survive and multiply. The temperature rise also helps stimulate your immune system. Even though you feel unwell when your temperature is elevated, so long as it's not too high for too long, this is actually a good thing.
A study published in the journal Critical Care (May 2020) compared body temperature on admission to hospital with COVID-19, during the course of infection, with the number of deaths.
Interestingly, the authors found
Low body temperature (<36°C) on admission was significantly associated with a greater risk of death.
50% had a body temperature >37°C on admission and 78.5% developed a body temperature of >37°C during their illness.
As the illness progressed, for every 0.5°C degree temperature increase, there was an increase in mortality with death rates of 42% in those with a temperature of >40°C.
What can you do? Make sure you have a thermometer at home, and you know how to use it, and how to take a temperature correctly. Stay home and seek help if you notice your temperature is high.
You May Have a Cough
57% of COVID-19 patients report a cough as a COVID-19 symptom report a cough. Although typically the cough is dry, it may sometimes be wet. The WHO report (16-24th February 2020) on 55,924 cases reported 66.7% had a dry cough, but 33.4% were coughing up mucus.
How do you know if this is a COVID cough?
A dry cough is distinctive, and sounds harsh, like barking. It's a frustrating cough because you cough but don't clear your airway or feel any better, and the cough just keeps going. You can cough so badly your ribs hurt, or even break a rib.
The cough is suggestive of COVID if you are having coughing bouts lasting up to an hour, or 3 or more coughing bouts in 24 hours. If you already have a chronic cough, you may notice your cough is worse than usual.
The cough is caused because the virus is multiplying in the upper airways and causing local irritation. As the infection progresses, the virus predominantly affects the lungs, resulting in more mucus production in the lower airways.
A cough may well be caused by something else, such as a common cold, influenza, asthma, or bronchitis. Some medicines can cause cough as a side effect such as angiotensin-converting enzyme inhibitors (ACE) inhibitors, e.g. enalapril, captopril.
The COVID cough may last for around 19 days. Some patients get a post-viral cough after COVID – this is defined as a cough which lasts for more than 3 weeks after the infection was thought to be cleared. Small numbers of patients suffer long term effects of COVID infection which sometimes includes a chronic cough.
You May Feel Tiredness and Fatigue
Data from the COVID symptom study app suggests that around 82% of patients report fatigue as an early symptom of COVID-19. This is usually not the only symptom. 3% of adults aged 18 to 65 who tested positive, said fatigue was their only symptom.
Fatigue is common in many viral infections including influenza, and in the previous coronavirus infections—SARS and MERS.
Once the virus enters the body, the immune system is called to action. A cascade of inflammatory mediators are released, including interleukin 6 (IL-6) and tumor necrosis factor (TNFα ). Often, this process is associated with fever, and muscle and joint pains, however, even if these other symptoms do not occur, fatigue may be present.
We tend to think of COVID a respiratory infection, but in fact, COVID affects just about every organ in the body. It affects the gastrointestinal system, the brain and nervous system, the hear, the kidneys, the blood-clotting system—it's a very long list. No wonder your body feels tired when so many body parts are under stress.
Even after the COVID infection has passed, chronic fatigue is common. In one study (30th July 2020) of 128 infected hospital care workers, only 50% were back at work 10 weeks after the infection because of severe fatigue.
You May Feel a Headache
72% of people report headache as an early symptom of COVID infection, according to data from the COVID symptom study app. Many people experience headaches anyway. From the COVID study app, only 1% of those who reported headache only, went on to test positive for COVID-19.
It is difficult to tell if a headache is related to COVID-19 infection, as headaches are so common anyway. Headaches in COVID-19 patients tend to be moderate to severe in intensity, described as a feeling of pulsing or pressing inside the head, are usually felt on both sides of your head, and may feel worse when bending forwards. There are not usually any other migraine-type symptoms.
You May Lose Your Sense of Taste or Smell
Loss of sense of taste or smell was also reported by 55% of adults aged 18-65 years, as early COVID-19 symptoms. It was less commonly reported in younger (21%) or older (26%) age groups.
ENT specialists are still unsure if the loss of sense of taste or smell occurs because the COVID-19 virus directly damages the olfactory nerve, or whether this is due to nasal inflammation and obstruction.
You May Have a Sore Throat
5 -17.4% of patients have reported a sore throat as early COVID-19 symptoms, in published medical studies. ENT specialists think not enough attention has been paid to a sore throat as a COVID symptom, because most medical papers focus on people with severe and more advanced COVID infections.
You May Have Conjunctivitis
A pink eye—conjunctivitis—has been reported as the only symptom for some who test positive to COVID-19. COVID-19 can enter the body through the eye.
When conjunctivitis is present, the eye feels uncomfortable, the conjunctival membrane (the clear membrane which covers the eye) is swollen and red, and there is often a discharge. Sunlight can cause eye pain (photophobia).
COVID-19 can enter the body through the eye. Anyone working in a healthcare environment is recommended to wear goggles or a face shield, as well as wearing a mask and using gloves.
This is another reason why to control the spread of the virus, we need to keep washing our hands, stop touching our faces, follow the rules about self-isolating if there is a chance of being infected, and remain in quarantine if the COVID-19 test is positive.
You May Have Diarrhea
COVID-19 enters the body through ACE-2 receptors, some of which are found in the gut wall. This may explain why diarrhea is sometimes a COVID symptom. A Chinese study (30th April 2020), on a cohort of 1099 patients who had tested positive to COVID-19, reported 3.8% of patients complained of diarrhea.
A further Chinese study reported diarrhea in 29.3% of cases. Diarrhea was typically described as three loose stools a day. The COVID-19 virus has been isolated from feces even when respiratory tract COVID tests are negative. This is another reason why we all need to keep washing our hands, to help control the virus.
You May Develop a Skin Rash
The COVID symptom study collated information from 12,000 people with skin rashes and possible COVID infection.
17% of people who had a positive COVID-19 test, said a skin rash was the first sign of their infection.
In 21% of COVID positive patients, the skin rash was their only symptom.
Three main types of rash were described:
Hives – urticaria – little raised bumps which come and go anywhere on the body and can be very itchy
Prickly heat – little bumps, sometimes itchy, that may have a fluid-filled center
COVID fingers and toes – reddish or purplish discoloration on fingers and toes – not itchy – which look like chilblains
Dermatologists have commented anyone who notices a new skin rash should take it seriously, self-isolate, and have a COVID test.
You May Have Aches and Pains
In February, a WHO study which included data from 55,954 cases of COVID-19, reported muscle aches and pains in 17.8% of cases. Muscle pain is common in viral infections because the virus causes inflammation in the muscle fibers. This may mean muscles feel sore and are tender to touch. Muscle pains are best treated by keeping well hydrated, resting, and taking paracetamol and/or non-steroidal anti-inflammatories (NSAIDS).
There are Also Serious COVID-19 Symptoms
There is unlikely to be any doubt that people who experience serious COVID symptoms need urgent assessment, COVID testing, and treatment.
The most serious symptoms are:
Inability to speak or move
If you are experiencing these symptoms you call 911 immediately.
You May Experience Breathlessness
5% to 60% of COVID patients complain of breathlessness. If you become breathless, this tends to develop between day 4 – day 10. Although not everyone with COVID becomes breathless, for those who do, this is a poor prognostic sign.
Why does COVID-19 make you breathless? This is because the virus causes pneumonia. As the virus spreads down inside your lower respiratory tract, your lung tissues become inflamed. There is a build-up of inflammatory fluid in the tiny air sacs – the alveoli. The presence of this fluid impedes the diffusion of oxygen from the lungs and into the bloodstream, meaning your oxygen saturation starts to fall.
As soon as the brain recognizes these falling oxygen levels, you breathe faster, and more deeply, to draw more air into your lungs. It now seems hard work to breathe. As time passes, if you still haven't developed sufficient antibodies to clear the virus, your respiratory rate can continue to increase. You may notice you feel breathless at rest just sitting in a chair, and any of your usual activities are difficult or impossible. You can't walk far, and you probably can't manage the stairs. If your symptoms are as bad as this, this is an emergency.
In severe acute COVID, admission to ITU is generally advised if oxygen saturation falls below 93%, and/or your respiratory rate is greater than 30/minute (European Respiratory Society).
You May Have Chest Pain
The Oxford COVID Medical Service Team conducted a comprehensive review of the medical literature on COVID-19 (April 2020), which included data from 52 studies. They reported chest pain was a symptom of COVID-19 infection, in 5% – 40% of patients, sometimes accompanied by chest tightness.
Chest pain may be directly related to damage to the heart muscle caused by the virus. The infection is associated with cardiac arrhythmias and heart failure.
However, chest pain can also occur with COVID pneumonia. Pneumonia can cause pleuritic chest pain – this is pain felt in the chest when you breathe in and out.
COVID-19 infection increases the risk of venous thromboembolism (blood clots) and pulmonary embolism also causes pleuritic chest pain.
You May Have an Inability to Speak or Move
Rarely COVID-19 patients can present with an acute neurological condition such as a stroke. The first signs of a stroke are often an inability to speak, and/or an inability to move or walk.
In one Chinese study of hospitalized patients with COVID-19 infection, 2.8% had had a stroke, most of whom had severe or critical COVID infection.
Agitation and altered levels of consciousness have also been reported in severely ill COVID patients. Meningitis, encephalitis, and seizures may also occur, although these are rare.
Final Thoughts From the Doctor About COVID-19 Symptoms
The pandemic is frightening, and we feel helpless right now. However, there are some things you can do:
Read and take note of the CDC information on How to Protect Yourself. There is no quick fix for the pandemic – social distancing, handwashing and the use of face masks are crucial.
If you are interested in helping collate information about COVID-19 symptoms, why not join in the COVID symptom tracker study? – US COVID symptom-tracker – Become a citizen scientist!
To conclude –
Know the symptoms—don't let the virus catch you out! Manage your own COVID infection —don't let the disease manage you! If you have experienced any of the symptoms mentioned above, call a medical professional, and to get through this pandemic at your healthiest, don't miss these 35 Places You're Most Likely to Catch COVID.
Dr. Deborah Lee is a medical writer at Dr Fox Online Pharmacy.