COVID-19: Signs and Symptoms



source: emcrit.org
signs & symptoms
  • COVID-19 may cause constitutional symptoms, upper respiratory symptoms, lower respiratory symptoms, and, less commonly, gastrointestinal symptoms.  Most patients will present with constitutional symptoms and lower respiratory symptoms (e.g. fever and cough).
    • 👁 Table of symptoms described by various studies.

  • Fever:
    • The frequency of fever is variable between studies (ranging from 43% to 98% as shown in the table above).  This may relate to exact methodology used in various studies, different levels of illness severity between various cohorts, or different strains of the virus present in various locations.  Additionally, some studies defined fever as a temperature >37.3 C (Zhou et al. 3/9/20).
    • Regardless of the exact numbers – absence of a fever does not exclude COVID-19.
  • Gastrointestinal presentations:  up to 10% of patients can present initially with gastrointestinal symptoms (e.g. diarrhea, nausea), which precede the development of fever and dyspnea (Wang et al. 2/7/20).
  • “Silent hypoxemia” – some patients may develop hypoxemia and respiratory failure without dyspnea (especially elderly)(Xie et al. 2020).
  • Physical examination is generally nonspecific.  About 2% of patients may have pharyngitis or tonsil enlargement (Guan et al 2/28).

typical disease course

  • Incubation is a median of ~4 days (interquartile range of 2-7 days), with a range up to 14 days (Carlos del Rio 2/28).
  • Typical evolution of severe disease (based on analysis of multiple studies by Arnold Forest)
    • Dyspnea ~ 6 days post exposure.
    • Admission after ~8 days post exposure.
    • ICU admission/intubation after ~10 days post exposure.  However, this timing may be variable (some patients are stable for several days after admission, but subsequently deteriorate rapidly).

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