- Experts are still learning the symptoms of the infection.
- Loss of smell, dizziness, and rash are among the symptoms of COVID-19 that people may miss.
- Cardiovascular and blood clotting issues are also now becoming a problem for some people with the disease.
COVID-19 has gained international notoriety as a respiratory infection that may cause fever, coughing, and difficulty breathing.
But those aren’t the only symptoms that have been linked to the new coronavirus disease.
Some people with COVID-19 have presented with less typical symptoms, including nausea, diarrhea, delirium, chickenpox-like lesions, and more.
“Respiratory symptoms tend to be the most common, obviously, but we’ve also seen symptoms that involve other organ systems,” Dr. Eric Cioe-Pena, an emergency physician and director of global health at Northwell Health in New Hyde Park, New York, told Healthline.
People with atypical symptoms of the infection may develop more classic symptoms as well, such as fever, muscle aches, sore throat, and trouble breathing. A full list of symptoms from the Centers for Disease Control and Prevention (CDC) is available
However, others may develop only atypical symptoms — and a portion of people who contract the virus don’t develop any noticeable symptoms at all.
“The expression of viral infection has been very, very wide,” Cioe-Pena said.
“There are people that are asymptomatic carriers, and their bodies are doing a really good job containing it. And then there are other people who obviously have very systemic and bad symptoms. And then everyone in between,” he explained.
Learning about some less common symptoms may help you recognize COVID-19 if you or someone close to you develops it.
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Your sense of taste or smell may also be disrupted by other conditions, such as the flu or seasonal allergies. But in some cases, such sensory changes may be a warning sign of COVID-19.
So far, the CDC hasn’t added nausea or other digestive complaints to its list of COVID-19 symptoms. However, early research suggests gastrointestinal distress is relatively common in people with COVID-19.
Recently, the authors of a new study from Stanford Medicine reviewed the medical records of 116 people who had tested positive for COVID-19.
They found that nearly one-third had digestive symptoms, including loss of appetite, nausea, vomiting, or diarrhea.
When dermatologists in Lombardy, Italy, assessed 88 people who had tested positive for COVID-19, they found roughly 20 percent had skin symptoms.
Those skin symptoms consisted of a red rash, widespread hives, or chickenpox-like lesions.
“Patients may present with skin lesions on their feet or toes or red rashes that may resemble a skin infection at first glance,” Dr. Robert Glatter, an emergency physician at Lenox Hill Hospital in New York City, told Healthline.
“Many of these rashes may represent superficial clotting or even bleeding in the skin or extremities,” Glatter said.
Confusion, delirium, and other neurological symptoms have also been observed in some people with COVID-19, report researchers in JAMA Neurology.
Milder neurological symptoms, such as loss of taste or smell, headache, dizziness, or muscle weakness, may appear early in the illness. More severe neurological symptoms may develop later on.
“I have seen patients presenting with confusion and altered mental status,” Glatter told Healthline.
“Some have developed [brain inflammation] requiring admission for close neurologic monitoring,” he added.
COVID-19 may raise the risk of abnormal blood clotting, early reports suggest.
When clots form in small blood vessels in the feet or other extremities, it can cause minor skin symptoms.
When clots occur in the lungs, heart, or brain, it can cause more serious complications, such as pulmonary embolism, heart attack, or stroke.
“Clotting in general seems to be a significant issue,” Dr. Maxine Dexter, a pulmonary and critical care specialist at Kaiser Permanente, told Healthline.
“We are hearing reports from our ER colleagues about patients presenting with stroke and heart attack symptoms that end up being COVID-positive,” she said.
If the virus enters cells in the heart, it can also cause a heart infection known as myocarditis. This infection may cause chest pain, abnormal heart rhythms, and even heart failure.
“Some of the more sick people that we’ve seen have had these kinds of severe cardiac manifestations of coronavirus, and it’s been very tough to manage,” Cioe-Pena told Healthline.
Some people who’ve been treated for COVID-19 have presented with a strange phenomenon that clinicians have dubbed “happy hypoxia.”
Those people have had dangerously low levels of oxygen in their blood, which would typically cause reduced consciousness. However, they’ve been unusually alert and comfortable.
“There is a mismatch [between] what we see on the monitor and what the patient looks like in front of us,” Reuben Strayer, an emergency physician at Maimonides Medical Center in New York City, told Science Magazine.
Some scientists have speculated that this phenomenon might be caused by blood clotting in small vessels in the lungs, but more research is needed to test that hypothesis.
According to Cioe-Pena, the wide variety of symptoms linked to COVID-19 isn’t surprising.
Because this coronavirus is so new, our bodies haven’t built up immunity to it.
As a result, “it gets free rein of the body,” Cioe-Pena said. “Once it’s in the lungs and the bloodstream, it’s able to travel around pretty easily.”
More research is needed to understand how the virus affects different cells in the body. Some symptoms may develop when the virus enters cells in certain organ systems, while other symptoms may be caused by inflammation that results from the body’s immune response to infection.
“Things are evolving so quickly it is hard to keep up,” Dexter told Healthline. “The answers I gave will likely change in a week.”
Given the wide range of effects that the new coronavirus can have, many people may have contracted it without realizing it.
To effectively identify and quarantine cases of confirmed infection, Dexter told Healthline that increased testing for the virus is essential.
“People will need to be routinely screened and then isolated when they or someone in their household are diagnosed with the infection,” she said.
“Until we can test broadly, we won’t be able to get people back to work safely,” she added.
For now, Cioe-Pena emphasizes the importance of continued physical, or social, distancing.
“We can’t relax social distancing yet. We’re getting encouraging news [in New York], like new infections are down, but it’s a direct cause and effect from social distancing,” he said.
“We don’t get a medal for trying really hard in March and April and then slacking off in May,” he added.