COVID-19 Symptoms & Course

Roughly 81% of people infected with COVID-19 will experience symptoms considered to be mild to moderate that fully resolve at home. With that said, you may feel truly awful during this time which generally lasts up to 14 days with fluctuating symptoms. Many describe an overwhelming feeling of being rundown, whole body aches and pains, gastrointestinal symptoms like diarrhea or nausea, and fevers that can go up and down, but tend to climb quite high. Others say they feel “beat up” with “weird” symptoms that may include loss of taste and smell and lack of appetite. Some additional COVID-19 symptoms include headache, cough and sore throat. It’s important to note that while fever is considered a hallmark of the virus, it is not present in everyone infected. 

Cough, too, happens in most (roughly 2 out of 3) but not all people with COVID-19. Shortness of breath is often an indicator that the condition is progressing from mild or moderate to severe; you should be seen and tested.

Jill shares her story and explains how she felt.

Once infected, the riskiest time tends to be roughly one week after the start of symptoms – more specifically, between days 5 and 8 after getting sick. At that point, shortness of breath can set in and rapidly worsen. If you are gasping for air, coughing up blood, or experiencing chest pain, you must seek medical care emergently.
Symptom
Likelihood
Fever and/ or chills
83%-99%
Cough
67% (range 59%-82%)
Shortness of Breath
31%-40%
Muscle aches and pains
15% (11%-35%)
Fatigue
70%
Loss of smell and/or taste; loss of appetite
70%; 40%-84%
Stomach symptoms like diarrhea, nausea, vomiting
10%

Clusters

Interestingly, symptoms tend to cluster. For example, fatigue and loss of smell often go hand in hand, and that combination can herald a milder illness. Similarly, headache, stomach symptoms, and confusion are frequently seen grouped together in older, frailer patients or those who have comorbid risk factors like diabetes. With that said, nothing about COVID-19 is yet fully predictable because there is so much left to learn. The more data and info that we gather, from testing, tracing, and tracking, the more we understand and can help protect everyone.

COVID-19 Risks

About 14% of people who contract COVID-19 develop serious symptoms that require hospitalization and for the remaining 5%, COVID-19 becomes life threatening. We (i.e. the medical community) are still learning much about the symptoms and risks for COVID-19 and its complications that can include severe shortness of breath, heart inflammation, and the potential need for a respiratory machine (called mechanical ventilator) to support breathing.

There does appear to be greater risk to catch the virus and to develop complications if you:

Lingering Syndromes

While COVID-19 symptoms typically last up to 14 days, there are post-viral syndromes that can continue for weeks or even months, particularly for those who have experienced a prolonged course or required hospitalization. Some individuals describe a sensation of pins and needles, ringing in their ears (called tinnitus), lingering breathlessness, dizziness, joint pain and swelling (especially of one’s hands), confusion, and emotional lability. If you’ve “recovered” from COVID-19 (meaning that you’re past the most acute phase and you’ve even now tested negative for the virus), but have persistent symptoms, you are not “crazy” and you are definitely not alone. The data suggests that roughly 5% of those recovering from COVID-19 experience these ongoing symptoms that can ebb and flow for a prolonged period. Loss of taste or smell, emerging as hallmark symptoms of COVID-19, tend to last for 2 to 4 weeks, for example. But, as some patients share, there are even stranger symptoms that can appear well past the infectious stage:

For example, Jonny never knew that he had COVID-19 until unusual bruises appeared on his toes.

Known now as COVID-toes, this happens from inflammation of the small blood vessels in the skin, called chilblains or pernio. Jonny says he feels no pain but has had some mild itching. Because this unexpected finding is fairly common — in conjunction with other COVID symptoms, as part of a post-viral syndrome, or the one and only manifestation of the virus – an international registry has been set up by a dermatologist at Massachusetts General Hospital in Boston. To date, patients from 21 countries have reported COVID-toes specifically. Dr. Esther Freeman reports that there are many other skin manifestations being reported including hives and measle-like rashes.

*Most data to date have suggested that males are at higher risk for complications from COVID-19 than females; however, recent data from Massachusetts specifically suggests the opposite in that state. More needs to be understood before drawing definitive conclusions either way.

COVID-19 Surface Survival

Like many details related to COVID-19, the length of time that the virus lives on various surfaces is not clear-cut. One early study from the New England Journal of Medicine (NEJM) suggested slightly different amounts of time than more recent research published in The Lancet. The table below illustrates the values tested and reported by scientists for each of these esteemed journals. It’s important to note, though, that living on surfaces does NOT mean that it can be easily transferred to infect people.  Contracting the virus from objects is extremely rare. 

Surface
NEJM
Lancet
Glass
5 Days
4 Days
Wood
4 Days
2 Days
Plastic
3 Days
7 Days
Stainless Steel
3 Days
7 Days
Copper
4 Hours
Not tested
Money
Not tested
4 Days
Clothing
Not detected
2 Days

While COVID-19 can live up to several days to a week on a variety of surfaces, especially those that are smooth, like doorknobs and countertops, the likelihood that you will contract the virus from that surface is extremely slim. The virus cannot seep into your skin; you would need to transfer it through your nose, mouth, or eyes. That is why we emphasize disinfecting often, washing your hands frequently, and avoiding touching your face (which may be more easily remembered with a mask in place).

Of note, COVID-19 doesn’t like cardboard, paper (with the exception of money), or fabric as much as other surfaces because of the presence of microscopic holes. So, clothes, couches, pillows, sheets, mail, and the many boxes arriving lately are much less likely to carry COVID-19 than other surfaces. Unlike other forms of paper, however, Lancet found COVID-19 still living on money at Day 4, as indicated in the table above. Again, wash your hands often and use hand sanitizer with at least 60% alcohol, especially after doing errands, emptying groceries, or handling money.

Given the mixed info about clothes and how much we still are learning about COVID-19, it seems like a good idea to be cautious. If you’ve been working in a hospital, long term care facility, meat packing plant, or prison, for example, it makes sense to wash your clothes right away; or, store them somewhere inaccessible for a couple of days and then put them through a machine wash cycle.

It is interesting to note, however, that often the soles of shoes are more impacted than clothes. Try wiping them down with disinfectant. Also, the total amount of virus (called inoculum) on any surface diminishes over time; so, the amount on a given surface on day 4 will be less than on day 1.

Frontline “Heroes” Don’t Always Want to Be Heroes

Nick, a nurse (RN) on a general medical ward of an urban academic teaching hospital in a Northeast city, takes much of the experience of treating COVID-19 patients in stride. His refreshing approach is inspiring and reinforces that nurses are the heart and backbone of our healthcare institutions, under both normal and pandemic circumstances.

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Mass. General Vaccine Chief Warns Coronavirus Still ‘Highly Infectious’

Dr. Poznansky discusses the risk of COVID-19 transmission during crowded Memorial Day celebrations, as well as the current status of vaccine development.

“From a crowded pool party at Lake of the Ozarks in Missouri to a street party in Daytona Beach, Florida, Memorial Day festivities brought hundreds close together in several U.S. cities Monday ⁠— largely without masks or other such precautions…”