Signs & Symptoms: Could it be COVID-19?

Last Updated 4 May 2020

The signs and symptoms of a COVID-19 infection can vary widely, from having mild or no symptoms to a severe viral pneumonia causing severe breathing difficulty and respiratory failure.

There is growing concern from European and American data that Black, Asian and Minority Ethnic Groups (BAME) have more severe infections or worse prognosis [1]. However this has not yet been confirmed by published data, and there may by other confounding factors such as pre-existing co-morbidities, socioeconomic differences and occupation/work-exposure to the coronavirus

Key Points:

  • The average incubation period is 5 days, but can be up to 14 days [2,3]

  • Asymptomatic infection is now recognised as having a role in transmission, previously based on analysis of contact traced case series this is now supported by positive tests in symptomatic individuals and disease modelling evidence [4,5]

  • The clinical course and progress over 1-3 weeks from onset of symptoms and deteriorations can be rapid [2,6,7,8]
    Common signs and symptoms summarised below

  • Majority of patients with a COVID-19 infection will experience symptoms within 12.5 days (95%) [2]

  • The most common radiological findings are ground glass opacification and patchy consolidation of lung fields. CT lung field changes may be present even in the asymptomatic and mild cases [3,6,7,9]

  • Patients who required intensive care unit (ITU) admission were older, more likely to have comorbidities [3,10]; median age for patients in ITU was 56 years [3]


Common Symptoms:

  • Fever

  • Dry cough

  • Fatigue

  • Myalgia (muscle ache)

  • Dyspnea (breathing difficulty)

  • Anorexia (loss of appetite)

Uncommon symptoms: 

  • Diarrhoea

  • Headache

  • Haemoptysis (blood stained sputum)

  • Productive cough/sputum

  • Pleuritic chest pain (pain from chest movement on breathing)

  • Anosmia/Smell and taste disturbance (emerging evidence)


Infographic tweeted on COVID-19 by Nick Mark MD, now also available in multiple languages. Helpful one-page summaries available on his website.



Useful Resources:  

WHO: Coronavirus – Signs and Symptoms

How does SARS-CoV-2 spread?

Rational use of personal protective equipment (PPE) for coronavirus disease (COVID-19)

Asymptomatic infection of COVID-19 (coming soon)

Loss of smell and taste as a presenting symptom in COVID-19 (coming soon)


References:

  1. Nuffield Trust, Are more black, Asian and minority ethnic people dying with Covid-19 than might be expected?, URL: https://www.nuffieldtrust.org.uk/news-item/are-more-black-asian-and-minority-ethnic-people-dying-with-covid-19-than-might-be-expected(Accessed 1 May 2020)

  2. He F, Deng Y, Li W. Coronavirus Disease 2019 (COVID-19): What we know? [published online ahead of print, 2020 Mar 14]. J Med Virol. 2020;10.1002/jmv.25766. doi:10.1002/jmv.25766

  3. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–1069. doi:10.1001/jama.2020.1585

  4. Bai Y, Yao L, Wei T, et al. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA. Published online February 21, 2020. doi:10.1001/jama.2020.2565

  5. Chan JF, Yuan S, Kok KH, et al.  A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster.  Lancet. 2020;3 95(10223):514-523. doi:10.1016/S0140-6736(20)30154-9

  6. Pan F, Ye T, Sun P, Gui S, Liang B, Li L, Zheng D, Wang J, Hesketh RL, Yang L, Zheng C. Time Course of Lung Changes On Chest CT During Recovery From 2019 Novel Coronavirus (COVID-19) Pneumonia. Radiology. 2020 Feb 13;200370. doi: 10.1148/radiol.2020200370. [Epub ahead of print] PubMed PMID: 32053470

  7. Pan Y, Guan H, Zhou S, Wang Y, Li Q, Zhu T, Hu Q, Xia L. Initial CT findings and temporal changes in patients with the novel coronavirus pneumonia (2019-nCoV): a study of 63 patients in Wuhan, China. Eur Radiol. 2020 Feb 13;. doi: 10.1007/s00330-020-06731-x. [Epub ahead of print] PubMed PMID: 32055945

  8. Shi H, Han X, Jiang N, et al. Radiological findings from 81 patients with COVID-19 pneumonia in Wuhan, China: a descriptive study. Lancet Infect Dis. 2020

  9. Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020

  10. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020; published online Jan 24. https://doi.org/10.1016/S0140-6736(20)30183-5

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