When Brooklyn, New York-based writer Sara Radin started having neck, shoulder and back pain, she assumed it was just because of working at home from her bed. Then came a migraine, and the day after that, she woke up with red eyes. Radin hasn’t had a fever and the cough wasn’t her primary symptom, but her doctor said it was COVID-19.
“I developed a chest cough but it was pretty minimal,” Radin told The Mighty. “The day after that I woke up with terrible body pain, extreme fatigue, weakness, and a general awful feeling. The following day was the same but I started to feel very nauseous.”
COVID-19, the coronavirus responsible for the current pandemic, causes a respiratory infection that can cause severe breathing issues. Now, however, as research papers are published at a record rate and we hear first-hand accounts of those who have COVID-19, it’s become clear that this virus causes more symptoms than initially recognized and recovery doesn’t necessarily follow a linear pattern.
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What Are the Symptoms of COVID-19?
From the beginning, the Centers for Disease Control and Prevention (CDC) listed three major COVID-19 symptoms that could appear anywhere from two to 14 days after exposure to COVID-19:
- Fever
- Cough
- Shortness of breath
Later, the CDC added additional symptoms that are associated with severe cases of COVID-19 and warrant emergency medical attention. These symptoms included:
- Persistent difficulty breathing
- Chest pain or pressure
- Bluish lips or face
- Confusion or lethargy
A World Health Organization (WHO) report from February based on more than 55,000 confirmed COVID-19 cases in China found that 88% of patients had a fever, 68% experienced a dry cough and nearly 19% had shortness of breath. A fever (and chills) help heat up your body so your immune system can fight off the virus, while the other recognized symptoms point to respiratory distress.
What Are the Atypical Symptoms of COVID-19?
New research and patient reports, especially in milder cases of the virus, highlight that COVID-19 causes a lot more than those initial symptoms and respiratory distress. When mild or in the beginning stages, COVID-19 may initially look like a sinus infection or the symptoms mirror the common cold or flu.
“Initial symptoms should be similar to flu,” Richard Kuhn, Ph.D., Krenicki family director of the Purdue Institute of Inflammation, Immunology and Infectious Disease, told The Mighty. “Scratchy/sore throat, coughing, headaches, possibly body aches, and a feeling of tiredness.”
COVID-19 can cause at least eight other symptoms it’s important to recognize:
1. Fatigue
According to WHO, approximately 38% of people who get COVID-19 will experience fatigue. Fatigue typically includes not just physical tiredness — it might wipe you out to get from the bed to the shower, for example — but can also make you feel run down, “hit by a truck,” exhausted, listless or have a general lack of energy and motivation.
2. Body Aches and Headaches
A number of people with COVID-19 have reported feeling aches and pains throughout their body. In its report, the WHO found nearly 14% of COVID-19 patients experienced a headache and 15% had either muscle or joint pain throughout their body, in addition to fever-related chills. Patients have reported that the headache can be severe.
3. Sore Throat
For many people who get COVID-19, the infection can start at the back of your throat and lead to a sore (and inflamed) throat. The WHO found 14% of COVID-19 patients had a sore throat, and, as Dr. Kuhn mentioned, it is often an early sign of the virus.
4. Digestive Issues and Lack of Appetite
Digestive issues and lack of appetite can be a symptom of COVID-19 in a percentage of patients. Two studies published in The American Journal of Gastroenterology suggested that about 20% of COVID-19 patients may experience digestive problems including nausea, diarrhea and vomiting. Notably, a third of those with digestive symptoms never developed a fever.
5. Sudden Loss of Smell or Taste
Other coronaviruses, including those that cause the common cold, can lead to a sudden loss of smell or taste. COVID-19, which is caused by the SARS-CoV2 virus, seems to be no different. A sudden loss of smell or taste was brought to the attention of the public by ENT UK and the British Rhinological Society as a potential sign of COVID-19.
6. Pink Eye
Pink eye, which causes redness, watery discharge and a burning sensation in your eyes, is often caused by viruses. According to a statement from the American Academy of Ophthalmology based on several small studies, pink eye seems to be a symptom in a small percentage of COVID-19 patients.
7. Heart Issues
A recent study published in JAMA Cardiology suggested that some patients can experience heart symptoms due to COVID-19 that may mimic a heart attack. The small study of 187 COVID-19 patients in China found that about 20% of those hospitalized showed signs of heart damage, likely related to SARS-CoV2 infection. Many of these patients did not have any underlying heart disease, and those who presented with heart problems had a more severe course of illness.
8. Neurological Problems
The CDC highlighted that confusion, disorientation or lethargy can be signs of a severe SARS-CoV2 infection. A New York Times report indicated that neurologists are finding that in rare cases, the virus can impact the brain in other ways as well. Some COVID-19 patients are admitted to the hospital with an altered mental status, which can include loss of speech, seizures, inability to recall basic information and staring off into space. The cause of these issues isn’t clear, but it could be due to inflammation in the brain or a lack of oxygen in the bloodstream.
How Do COVID-19 Symptoms Progress?
It’s also become apparent that the progress of COVID-19 — and how you might experience symptoms — isn’t always linear. Often with a cold or the flu, your symptoms start mild, worsen and then you gradually recover. Like other COVID-19 patients, Radin found her symptoms didn’t progress in such a straight line and they evolved over the course of illness.
“Yesterday the cough was the only symptom so I thought I might be in the clear but woke up today feeling awful all over again — body pain (not as bad as last week), fatigue, minimal cough, very nauseous,” Radin said. “I have yet to have a fever. The body pain has probably been the most severe/uncomfortable symptom.”
Rishi Desai, M.D. chief medical officer at Osmosis, told Business Insider the reason COVID-19 may be affecting people in a variable manner is how the virus travels through the body. It may start in the back of the throat or the nose and then can travel to the lungs and then the bloodstream (the potential cause of fatigue or fever).
“Each person has a unique immune system, and as a result, some people will react very aggressively to COVID-19, and others won’t,” Dr. Desai said. “Symptoms generally correspond to where the virus is located in the body.”
Radin highlighted that it’s important for people to realize how COVID-19 can show up differently, especially in mild cases. While doctors are screening for fever or respiratory symptoms, many people who likely have the virus aren’t getting tested and may not realize they have COVID-19 and are at risk of spreading the infection.
“It’s incredibly frustrating because I feel like there’s a lot of doubt and sickness shaming going on,” Radin said, adding:
I wasn’t able to get a test because my situation is luckily mild but when I started to tell people I was pretty sure I had it they’d always ask if I had a fever as if that was a requirement for this virus. I know my body. I’ve had the flu. I have chronic allergies and sinus problems. This is not the same. So many people I’ve spoken to who have similar symptoms to me haven’t had a fever either.
The Takeaway
Hearing about new or different COVID-19 symptoms can be scary, and that’s normal — you’re not alone if you were wondering if that was one of your typical migraines or something more. It’s important to know all the potential COVID-19 symptoms to protect yourself, your loved ones and to reduce the spread of the virus.
“I’m super grateful my case isn’t serious and of course, staying home is the best thing I can do right now,” Radin said. “People need to realize that mild and even minor cases are real and what they look like so they are better educated and can take better precautions, also so they don’t spread it around more.”
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Header image via Natalie_/Getty Images
Renée Fabian was the features editor at The Mighty. She has also written for The Washington Post, VICE, Healthline, Talkspace, The Fix, The Establishment, The Culture Trip, and GRAMMY.com, among others. Renée was named a 2019 AHCJ Comparative Effectiveness Research fellow, a 2020 USC Center for Health Journalism California fellow, and holds a master's degree in journalism from the University of Southern California and a master's degree in psychology from Antioch University Los Angeles. You can follow her on Twitter @ryfabian.
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