When Are Coronavirus Symptoms Bad Enough to Warrant Going to the Hospital?

If you have a dry cough and fever, and it’s getting harder to breathe, this is not a time to delay seeking treatment. Shortness of breath is a hallmark COVID-19 symptom. Although most patients infected with the coronavirus will have milder symptoms and not experience difficulty breathing, those who struggle for air require immediate attention.


The highly effective COVID-19 vaccine reduces illness severity and further avoids the need for hospitalization, data shows. However, people who are immunocompromised may not respond to vaccination as strongly. Children are vulnerable to COVID-19 as well, particularly those who haven’t been vaccinated because they’re too young or other reasons.

People with COVID-19 experience a variety of symptoms that are similar to having the flu, says Dr. Eric Howell, CEO of the Society of Hospital Medicine. “The distinguishing factor is that most people with influenza don’t get short of breath,” he says. “And fortunately, most people with COVID-19 don’t get short of breath.” However, if someone does experience shortness of breath, this is a risk factor for more severe impact of the disease, he adds. “That’s at least one of the indicators where you should consider going to the emergency department or the hospital.”

Sudden changes in your mental status — which family members or friends may notice first — should also trigger an emergency room visit, Howell says.

If you’re experiencing multiple serious symptoms you need to seek medical attention. “If you’re starting to feel really short of breath, coughing a lot and developing fever — especially if you’ve had exposure to somebody who either has had COVID-19 or if you’ve been in a place or situation where you might have been exposed — then it’s a good idea to go to the emergency department,” says Dr. Darlene Tad-y, vice president of clinical affairs for the Colorado Hospital Association and a hospital medicine physician at UCHealth University of Colorado Hospital.

[Read: Is It COVID-19, Allergies, Flu or a Cold?]

Signs of Distress

These COVID-19 signs and symptoms require evaluation in the emergency department for possible hospitalization:

Difficulty breathing. If you’re short of breath even while resting, you should seek an evaluation to prevent the situation from getting worse. If your breathing is labored from routine activities like walking from one room to another, for example, or you can’t recover from being winded after going up the stairs, that’s a serious concern.

Low oxygen levels. In the ER, your vital signs will be checked and you’ll have a physical exam. You’ll also undergo noninvasive testing called pulse oximetry, which measures the level of oxygen circulating in your blood. If your oxygen saturation is too low, that’s a concern with any medical condition. If you have a pulse oximeter at home, a reading of under 95% oxygen saturation should prompt a call to your doctor. However, the Food and Drug Administration cautions that home pulse oximeters have limitations, and to pay attention to any signs or symptoms you have rather than just relying on the pulse oximeter reading.

Chest pain. People with COVID-19 can experience what’s called substernal chest pain, or aching under their breastbone. Any chest pain should be evaluated, so clinicians can determine the specific source of pain or discomfort.

Changes in mental status. Marked confusion, extreme sleepiness and inability to waken are emergency symptoms that can occur with reduced circulating oxygen in the body.

Blue face or lips. If your face or lips are turning blue, that’s a sign of hypoxia, or a lack of adequate oxygen. “Anything that indicates your lungs are being affected, instead of your throat, is an important difference for going to the hospital versus staying home,” Howell says.

Neurological changes. Seizures, stroke, dizziness, confusion and numbness or tingling in the hands or feet can be COVID-19 symptoms in a small subset of patients.

COVID Symptoms to Closely Watch

If you’re not experiencing shortness of breath, but you’re feeling progressively sicker, you should let your doctor know, and you may be advised to go to the ER to be evaluated if these symptoms continue:

Diminished sense of smell or taste. Anosmia, the loss of the sense of smell, and closely related loss of taste appear to be more or less common depending on the specific COVID-19 variant in circulation.

Gastric problems. Gastrointestinal symptoms, in particular severe diarrhea, are more common with COVID-19 than the flu, Howell says. Nausea or vomiting can also occur. To clarify, you don’t need to go to the ER if you lose sense of taste and smell as this is not an acute serious problem. Similarly, you don’t need to go to the ER if you have diarrhea unless you can’t stay hydrated, which is rare. However, you should go to the ER if you are short of breath.

Increasing cough. A persistent dry cough is a COVID-19 hallmark. If that keeps worsening along with other COVID-related symptoms, you should be evaluated. It’s also important to protect those around you as you cough. That includes coughing into your inner elbow, disposing of tissues right away and wearing a mask around others in close quarters. Even though you may not be producing much mucus or phlegm, you could still infect others as you send respiratory droplets into the air. You should get checked out if your cough is associated with chest pain, shortness of breath, low oxygen or your cough isn’t improving.

ER Evaluation and Monitoring

You may have a chest X-ray done if pneumonia — a complication of respiratory infectious diseases including COVID-19 that cause inflammation in the lungs — is suspected.

With hospital resources strained as the pandemic continues, people with confirmed or suspected COVID-19 who are medically stable most likely won’t be admitted as inpatients. However, if you’re in a higher-risk group for severe COVID-19 complications, the emergency department staff may monitor your condition for a longer period before sending you home.

People whose immune systems are weakened by cancer or its treatment, or who have HIV, lung conditions such as chronic obstructive pulmonary disease or asthma, and autoimmune diseases like lupus or heart disease may not respond to vaccination as well as other people and are at higher risk for severe COVID-19. Older adults are also more vulnerable to complications like severe shortness of breath.

Patients who are in higher-risk groups for the coronavirus, but who do not have shortness of breath or other signs of distress, would likely be discharged from the ER rather than being admitted as hospital inpatients. However, they and their family members should keep their vulnerability in mind and watch for worsening signs of illness.

Being sent home from the ER doesn’t mean your condition can’t change for the worse. “For COVID, and generally for any medical condition, when you’ve come to the emergency department, that’s only a snapshot of your illness,” Tad-y says. “Things can get better but sometimes they don’t. It’s really important to stay in contact with your medical team and your primary doc to monitor (your ongoing condition). You can’t always predict how people are going to recover from this, so keeping an eye on patients is really important.”

[Read: Immunocompromised and Getting the COVID-19 Vaccine.]

Children and COVID-19

Parents should be aware of when to call their pediatrician or seek emergency care for their kids.

“Most children and adolescents with COVID-19 will have mild symptoms like fever, cough, congestion and sore throat,” says Dr. Carlos Oliveira, a Yale Medicine pediatric infectious diseases doctor and an assistant professor at Yale School of Medicine. “Some can also have mild non-respiratory symptoms like abdominal pain, vomiting and diarrhea. Most children with mild symptoms can safely be managed at home and won’t require a visit to the emergency room — assuming they do not have a preexisting condition that places them at high risk for severe COVID-19.”

Severe COVID-19 in Kids

Worse COVID-19 cases require immediate attention. “A subset of children and adolescents can develop more severe symptoms, and these should be managed by an experienced pediatrician in an emergency room,” Oliveira says. “These symptoms can vary by age.”

Serious respiratory-related signs include:

— “Teenagers who have severe COVID-19 often report feeling short of breath or having chest pain,” Oliveira says.

— In infants or young children, COVID-19 pneumonia causes rapid, shallow breathing, grunting or bluish discoloration of the lips.

— “Some children cannot keep any fluids down and may need to go to the emergency room for dehydration,” he says.

Less common effects may occur in kids, as well. “On rare occasions, the virus can also cause problems outside the respiratory system, like damage to the kidneys, the heart and the brain,” Oliveira notes. Beyond pulmonary symptoms, those may include:

— Urine output decreases.

— Cold, clammy skin.

— Confusion.

— Seizures.

“Children who have these symptoms should also be evaluated at an ER,” Oliveira says.

[SEE: How to Describe Medical Symptoms to Your Doctor.]

Kids Who Need Hospitalization due to COVID

Once evaluated for such symptoms in the emergency room, kids are likely to be admitted as inpatients. “Children are generally hospitalized if they have severe pneumonia or require respiratory support to maintain their oxygen levels,” Oliveira says. “Children may also be hospitalized if they are rapidly deteriorating, need medications to maintain their blood pressure at normal levels, have injuries to multiple organs or have a medical condition that puts them at high risk for severe disease.”

Multisystem inflammatory syndrome, or MIS-C, is a rare but severe complication of COVID-19 infection that primarily affects school-age children. The heart, blood vessels and other organs can be affected by this strong inflammatory reaction to the virus.

MIS-C often leads to hospitalization, Oliveira says: “It usually occurs one to two weeks after infection with COVID-19 and manifests with persistent fevers, rash, red eyes, abdominal pain and low blood pressure.”

Kids could possibly have more than one viral infection, such as COVID-19 and flu. “Co-infections with other respiratory viruses, like influenza and RSV, can also lead to more severe disease and higher hospitalization rates, particularly in infants,” Oliveira says.

As the pandemic progressed, virus variants such as delta or omicron may have led to subtle shifts in symptom trends. “It is uncertain if the different variants of SARS-CoV-2 cause distinct manifestations in children,” Oliveira says. “Some data suggest that compared to the delta variant, omicron is more likely to cause upper respiratory symptoms, like a barky, croup-like cough, and less likely to cause loss of smell and taste or lower-respiratory manifestations like pneumonia.”

Now, long-COVID is causing different, more chronic health concerns. “Long-COVID symptoms in children can vary considerably, but common symptoms are fatigue, headache, insomnia, joint pain and loss of taste and smell,” Oliveira notes. “These symptoms can cause quite a bit of grief and lead to numerous doctor visits, but they rarely require hospitalization.”

In general, Oliveira emphasizes, “Because of the possible cardiac and neurologic complications of SARS-CoV-2, acute symptoms like chest pain, palpitations, confusion, loss of consciousness or shortness of breath should always trigger a call to your pediatrician or a visit to a nearby emergency room.”

COVID-19 Hospitalization Alternatives

Although hospitals are places of healing, they’re also environments for potential exposure to infectious organisms including the new coronavirus. That’s why hospitals and other health care facilities have been restricting visitors. It’s also the reason that patients with COVID-19 symptoms who don’t have respiratory difficulties are being encouraged to consult with their primary care providers before heading to the ER and to recover at home if possible.

“We want people to avoid the hospital if they can,” Howell says. “So, if they have the typical viral-like illness — they have a fever and muscle aches and they’re not feeling well — then they probably should contact their doctor.” Reasons for staying away from the hospital, if possible, are twofold, he adds: “No. 1, because we don’t want them to get exposed if they don’t have coronavirus or coronavirus symptoms. But, No. 2 — just in case — we don’t want them exposing others, either.”

Telehealth has stepped up as a source of patient care during the coronavirus pandemic. Virtual office visits, including telemedicine and teletherapy, allow people to receive treatment for other conditions when it can’t be provided in person. Telemedicine is also providing an alternate venue for patients who aren’t urgently ill to be evaluated for possible coronavirus symptoms.

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When Are Coronavirus Symptoms Bad Enough to Warrant Going to the Hospital? originally appeared on usnews.com

Update 05/11/22: This story was previously published at an earlier date and has been updated with new information.

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