COVID-19 Coronavirus / Symptoms

Coronavirus Symptoms (COVID-19)

Reported illnesses have ranged from people with mild symptoms to people being severely ill and dying.Symptoms can include:

Fever

Cough

Shortness of breath

Symptoms of Novel Coronavirus (COVID-19) - United States Centers for Disease Control and Prevention (CDC) ^[1]

Content:

Typical Symptoms
80% of cases are mild
Pre-existing conditions
Examples of possible development of symptoms
How long do symptoms last? (duration from onset to recovery)
Symptoms observed in hospitalized patients
Information on Coronavirus Symptoms from Government Health Officials

Typical Symptoms

COVID-19 typically causes flu-like symptoms including a fever and cough.
In some patients - particularly the elderly and others with other chronic health conditions - these symptoms can develop into pneumonia, with chest tightness, chest pain, and shortness of breath.
It seems to start with a fever, followed by a dry cough.
After a week, it can lead to shortness of breath, with about 20% of patients requiring hospital treatment.

Notably, the COVID-19 infection rarely seems to cause a runny nose, sneezing, or sore throat (these symptoms have been observed in only about 5% of patients). Sore throat, sneezing, and stuffy nose are most often signs of a cold.

80% of cases are mild

Based on all 72,314 cases of COVID-19 confirmed, suspected, and asymptomatic cases in China as of February 11, a paper by the Chinese CCDC released on February 17 and published in the Chinese Journal of Epidemiology has found that:

80.9% of infections are mild (with flu-like symptoms) and can recover at home.
13.8% are severe, developing severe diseases including pneumonia and shortness of breath.
4.7% as critical and can include: respiratory failure, septic shock, and multi-organ failure.
in about 2% of reported cases the virus is fatal.
Risk of death increases the older you are.
Relatively few cases are seen among children.

Pre-existing conditions

See also: Death Rates by Existing Conditions
Pre-existing illnesses that put patients at higher risk:

cardiovascular disease
diabetes
chronic respiratory disease
hypertension

That said, some otherwise healthy people do seem to develop a severe form of pneumonia after being infected by the virus. The reason for this is being investigated as we try to learn more about this new virus.

Examples of possible development of symptoms (from actual cases)

A man in his 40s in Japan:

Day #1: malaise and muscle pain
later diagnosed with pneumonia

A man in his 60s in Japan:

Day #1: initial symptoms of low-grade fever and sore throat.

A man in his 40s in Japan:

Day #1: chills, sweating and malaise
Day #4: fever, muscle pain and cough

A woman in her 70s, in Japan:

Day #1: 38° fever for a few minutes
Day #2-3: went on a bus tour
Day #5: visited a medical institution
Day #6: showed symptoms of pneumonia.

A woman in her 40s, in Japan:

Day #1: low-grade fever
Day #2: 38° fever
Day #6: being treated at home.

A man in his 60s, in Japan:

Day #1: Cold
Day #6: Fever of 39° C. (102.2 F)
Day #8: Pneumonia

Another patient, in China with a history of type 2 diabetes and hypertension:

Jan. 22: Fever and cough
Feb. 5: Died

First death in the Philippines (a 44-year-old Chinese thought to have had other pre-existing health conditions):

Jan. 25: Fever, cough, and sore throat (hospitalized)
Developed severe pneumonia
Feb. 2: Died

How long do symptoms last?

Using available preliminary data, the Report of the WHO-China Joint Mission published on Feb. 28 by WHO, ^[5] which is based on 55,924 laboratory confirmed cases, observed the following median time from symptoms onset to clinical recovery:

mild cases: approximately 2 weeks
severe or critical disease: 3 - 6 weeks
time from onset to the development of severe disease (including hypoxia): 1 week

Among patients who have died, the time from symptom onset to outcome ranges from 2 - 8 weeks.

Symptoms observed in hospitalized patients with COVID-19

Below we list the symptoms, with percentages representing the proportion of patients displaying that symptom, as observed in hospitalized patients tested and identified as having laboratory-confirmed COVID-19 infection. These findings refer to hospitalized patients, therefore generally representing serious or critical cases. The majority of cases of COVID-19 (about 80%) is mild.

Findings from the Wang et al study published on JAMA and based on 138 hospitalized patients ^[]

Common symptoms included: (Wang et al study) ^[]
Fever	98.6%
Fatigue	69.6%
Dry cough	59.4%

The median time observed:

from first symptom to → Dyspnea (Shortness of breath) = 5.0 days
from first symptom to → Hospital admission = 7.0 days
from first symptom to → ARDS (Acute Respiratory Distress Syndrome) = 8.0 days (when occurring)

Full list of symptoms from the Wang study:

From: Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China - JAMA, Wang et al., February 7, 2020

Findings from the Huang et al study published on The Lancet and based on 41 hospitalized patients

COMMON SYMPTOMS AT ONSET OF ILLNESS (Huang et al study)
Fever	98%
Cough	76%
Myalgia (muscle pain) or Fatigue	44%
LESS COMMON SYMPTOMS:
Sputum production (coughing up material)	28%
Headache	8%
Haemoptysis (coughing up blood)	5%
Diarrhea	3%

Findings from the Chen et al study published on The Lancet and based on 99 hospitalized patients

Signs and symptoms at admission (Chen et al study)
Fever		83%
Cough		82%
Shortness of breath		31%
Muscle ache		11%
Confusion		9%
Headache		8%
Sore throat		5%
Rhinorrhoea (runny nose)		4%
Chest pain		2%
Diarrhea		2%
Nausea and vomiting		1%
More than one sign or symptom		90%
	Fever, cough, and shortness of breath	15%

Information on Coronavirus Symptoms from Government Health Officials

Canada Public Health Agency

The Canadian PHAC section dedicated to the 2019 novel coronavirus states that:

You may have little to no symptoms.
You may not know you have symptoms of COVID-19 because they are similar to a cold or flu.
Symptoms may take up to 14 days to appear after exposure to the virus. This is the longest known infectious period for this virus.

Symptoms have included:

fever
cough
difficulty breathing
pneumonia in both lungs

In severe cases, infection can lead to death.

UK Government and NHS

The UK National Health Service (NHS) section dedicated to Coronavirus (2019-nCoV) lists the following as the main symptoms of coronavirus:

a cough
a high temperature
shortness of breath

The GOV.UK novel coronavirus guidance for the public page says:

Typical symptoms of coronavirus include fever and a cough that may progress to a severe pneumonia causing shortness of breath and breathing difficulties.

The GOV.UK clinical guidance on Novel coronavirus (2019-nCoV): epidemiology, virology and clinical features notes that:

Fever, cough or chest tightness, and dyspnoea are the main symptoms reported. While most cases report a mild illness, severe are also being reported, some of whom require intensive care.

Australian Government

The Australian Government Department of Health informs that symptoms can range from mild illness to pneumonia, adding that some people will recover easily, while others may get very sick very quickly. According to their list of novel coronavirus symptoms, people may experience:

fever
flu-like symptoms such as coughing, sore throat and fatigue
shortness of breath

United States Centers for Disease Control and Prevention

The CDC has published the following infographic on its Symptoms of Novel Coronavirus (2019-nCoV):

World Health Organization

The WHO has issued an interim guidance on the clinical management of suspected cases in which it says that

"nCoV may present with mild, moderate, or severe illness; the latter includes severe pneumonia, ARDS, sepsis and septic shock."

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