Changing COVID-19 picture
Shortness of breath, dry cough, fatigue, and fever and chills — by now, most people are familiar with the hallmark symptoms of COVID-19. But since the pandemic first hit the U.S. in early 2020, symptoms have evolved with subtle shifts in importance. Cold-like symptoms are gaining significance while changes in taste and smell might be somewhat less common. Long-haul COVID-19 is creating disruptions in thinking ability and other lingering health issues.
Vaccination — the big game-changer — is reducing symptom severity even when breakthrough cases occur. Unfortunately, virus variants are also making their mark, and younger populations are experiencing increased infection rates.
“COVID symptoms, broadly speaking, are the same, because it’s still the same virus that’s infecting people,” says Dr. Darlene Tad-y, an associate professor of medicine at the University of Colorado, vice president of clinical affairs for the Colorado Hospital Association and a hospital medicine physician at UCHealth University of Colorado Hospital. “However, with the new strains — the Delta variant, the Lambda variant — we’re seeing that the prominence of some of the symptoms is a little bit different.”
Here are virus trends and symptoms to keep in mind.
Shortness of breath is a key COVID-19 symptom, and dry cough is another early warning sign.
Patients can experience persistent chest pain or pressure as the virus leads to lung inflammation and COVID-19 pneumonia. In acute respiratory distress syndrome, an advanced COVID-19 complication, it becomes extremely difficult to breathe as fluid-filled lungs begin to fail.
If you or someone around you develops difficulty breathing, particularly at rest, don’t wait — seek medical help.
Early in the pandemic, fever was considered a key COVID-19 symptom. But that may have been overstated. Although medical and other facilities used touchless thermometers to check all who entered, that sort of screening couldn’t possibly detect everyone who indeed was infected.
Eventually, “It became quite clear that fever was not a sensitive indicator of COVID-19, because many people who were developing COVID-19 didn’t have fever but had different symptoms,” says Dr. Andrew Chan, a physician, researcher and chief of the clinical and translational epidemiology unit at Massachusetts General Hospital.
So if you have other possible COVID-19 indicators but your temperature is normal, “It’s still critical that you get tested because there isn’t any one symptom that’s enough to rule in or rule out the diagnosis,” says Chan, who is both a professor of medicine at Harvard Medical School and a professor of immunology and infectious diseases at Harvard T.H. Chan School of Public Health.
Now, fever is back on the upswing. “What we have noticed, more recently — particularly with the surge we’re seeing with the Delta variant — is there may be a greater number of people presenting with symptoms like runny nose, sore throat, fever and cough,” Chan says.
Fatigue can be an early symptom of COVID-19. More than simply feeling tired or sleepy, COVID-19-related fatigue leaves you drained and exhausted. Normal activities like walking up a flight of stairs become challenging and your concentration can be affected. Taking a nap or having a full night’s sleep don’t relieve this fatigue, and just getting out of bed is difficult.
Persistent fatigue is a long-COVID symptom. For example, three young adults who developed fatigue early in their COVID-19 illness still suffered from chronic fatigue syndrome six months later, according to a case study review from Johns Hopkins Medicine published April 29 in the journal Frontiers in Medicine.
Those more likely to become seriously ill with COVID-19 include people over age 65 and those with underlying medical problems such as high blood pressure, heart disease or diabetes. For that reason, these groups were prioritized when the COVID-19 vaccine first became available and supplies were limited. More recently, there’s been a rise in cases among adolescents and young adults.
“There are differences in the demographic and risk factors of individuals who are getting infected,” Chan says. “Very early on in the pandemic, there were disproportionate numbers of older adults who were getting the infection. Now, we’re seeing that it’s really increasingly younger people who are getting the infection.”
Weekly rates of COVID-19-associated hospitalizations have increased “significantly” for adults ages 18 to 49, according to tracking data from the Centers for Disease Control and Prevention, posted on August 6. For the week ending July 10, 2021, hospitalization rates increased by nearly 40% compared with June 26, 2021, in this age group.
Hospitalizations are up for children 4 years old and younger, as well. Children younger than 12 are not currently eligible for any of the available COVID-19 vaccines, the CDC points out.
Nasal congestion, runny nose and sore throat
“One of the challenges right now is people are thinking: ‘This is my seasonal allergies’ or ‘Maybe this is the flu coming on,’ because the symptoms of COVID are very similar to those,” Tad-y says.
Before brushing symptoms off as allergies, flu or a cold, think them through, Tad-y suggests. As in, “I don’t feel so good and I kind of have the sniffles again — because we’re past the time when our plants are pollinating.” And consider: “Maybe this is COVID because I was at a weekend barbecue two days ago.” The next step: getting tested or talking to your primary care provider.
Particularly with the Delta variant taking hold as the dominant cause of new COVID-19 cases, those include people who are fully vaccinated. Following multiple large public gatherings in Barnstable County, Massachusetts, in July, of the roughly 470 cases identified, about three-quarters occurred in fully vaccinated individuals.
Fortunately, milder symptoms and fewer hospitalizations are typically seen in people who are vaccinated against the virus.
Lost sense of taste and smell
Earlier in the pandemic, many people who came down with COVID-19 reported a loss of the sense of smell, known as anosmia, and of taste, which is highly dependent on smell.
“One of the more common causes of smell loss is a virus, including other coronaviruses that cause the common cold,” Steven Munger, director of the University of Florida Center for Smell and Taste, told U.S. News last year. In some people who have tested positive for the virus, in fact, loss of smell was the only symptom.
However, these sensory symptoms appear to be somewhat less common as COVID-19 indicators with the Delta variant on the rise, with fewer infected people reporting a loss of taste or smell, Chan says.
Gastrointestinal symptoms such as diarrhea, nausea or vomiting can occur with COVID-19. Although GI symptoms usually show up along with upper respiratory symptoms, they sometimes appear first.
In an April 2020 study of patients with mild COVID-19, more than half experienced diarrhea or other digestive symptoms. Of those, nearly 20% of those who had diarrhea experienced it as their first or only symptom. Bottom line: If you suddenly develop diarrhea, you and your doctor should consider the possibility of COVID-19 infection.
In a small subset of patients with active COVID-19, serious neurological symptoms experienced include seizures, stroke, dizziness, confusion and numbness or tingling in their hands or feet. With neurological symptoms such as rare cases of COVID-related seizures and stroke, it’s believed that virus enters the nervous system and causes a series of brain disruptions, according to a November 2020 study.
No symptoms at all
In some cases, COVID-19 testing is the only reason people realize they were ever infected. About 25% to 30% of people infected with COVID-19 never develop symptoms, according to various estimates.
Although people infected with COVID-19 may never get sick themselves, they can still spread the virus to others — some of whom unfortunately will get quite sick. At least 50% of transmissions were estimated to have happened from people without symptoms in a Jan. 7, 2021, analysis published in JAMA Network Open.
“There are still a lot of people out there thinking that if they’re feeling healthy and well then they’re not harboring the virus or are at risk of spreading it,” Chan says. “Because of the highly contagious nature of the virus, and the fact that a significant number of people are not symptomatic, it means we still have to be vigilant about getting vaccinated.”
Wearing a mask in certain situations is another way to stay vigilant. The CDC, which continues to update mask recommendations, advises keeping up with COVID-19 transmission rates in your area and local regulations and guidance.
Although rare, a severe condition known as multisystem inflammatory syndrome is a troubling COVID-19 complication. Organs including the gut brain, kidney, heart and skin can be affected.
The condition is classified by whether it occurs in adults or kids. Multisystem inflammatory syndrome in children, or MIS-C, resembles a rare childhood illness called Kawasaki disease. Prolonged fever, body rash, red eyes, cracked lips, swollen glands, gastrointestinal symptoms and swelling of the hands or feet are some signs.
Multisystem inflammatory syndrome in adults, or MIS-A, may have somewhat different symptoms. Low blood pressure, chest pain and tightness, blood clots, rash, headaches and extreme fatigue can occur, among other signs. Research on MIS related to COVID-19 is ongoing.
You can participate in an widespread effort to pinpoint new COVID-19 cases and trends via the free, downloadable COVID Symptom Study app. The study, led by Chan, is an initiative to locate COVID-19 hot spots, identify new symptoms to watch for and as a possible planning tool for future outbreaks. Nearly 5 million people have downloaded the app across the U.K., U.S. and Sweden, he says.
The effort “gives us a rapid picture of the kinds of symptoms that people are experiencing in the general community,” Chan says. “We encourage people to report if they’re feeling well so we can track that. But if they start to develop symptoms, they report those and we then track if those symptoms are associated with being diagnosed with COVID-19.”
Symptoms of COVID-19 infection fall into these categories:
— Shortness of breath.
— Dry cough.
— Nasal congestion, runny nose and sore throat.
— Loss sense of taste or smell.
— Neurological — seizure, stroke, confusion.
— No symptoms at all.
— Rare multisystem effects.
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Update 08/11/21: This story was previously published at an earlier date and has been updated with new information.