COVID-19 has always been difficult to identify because the symptoms easily overlap with the common cold, flu, and even allergies. Even more confusing? Some people experience no symptoms at all.
To better understand how COVID-19 manifests and progresses, a team of researchers from the University of Southern California sought to determine the most common sequence in which symptoms appear.
Their study, which was recently published in the journal Frontiers in Public Health, analyzed the rates of COVID-19 symptom onset. They used data from the World Health Organization to collect more than 55,000 new cases of coronavirus in China, as well as a dataset of nearly 1,100 cases collected by the National Health Commission of China.
Based on their findings, the researchers determined that this is the most likely sequence in which someone will experience COVID-19 symptoms:
- Fever
- Cough
- Nausea and / or vomiting
- Diarrhea
When she expanded her analysis to include additional symptoms, the sequence still looked the same:
- Fever
- Cough
- Sore throat, muscle aches, or headache
- Nausea and / or vomiting
- Diarrhea
The researchers also compared the likely progression of COVID-19 symptoms against the flu and found that the flu was more likely to start with a cough instead of a fever. People with the flu were also more likely to have body aches, headaches, and a sore throat before developing a fever, she discovered.
In turn, these results support the “idea” that fever should be used to screen people for COVID-19 before they are allowed in buildings. “Furthermore, our findings suggest that good clinical practice should be taken into account in recording the order of symptoms occurring in COVID-19 and other diseases,” the authors wrote.
But infectious disease experts say the order of your COVID-19 symptoms does not paint the whole picture.
William Schaffner, MD, a specialist and infectious disease and professor at Vanderbilt University School of Medicine, says the results of this study are “very interesting”, but stresses that “it will not be universal. We know for a start that some people do not have a fever. “
What’s more, there’s the problem of recurrent bias, which is when patients have a hard time remembering exactly when something happened. “It’s just like this kind of thing,” says Amesh A. Adalja, MD, senior scientist at the Johns Hopkins Center for Health Security. “You will not be able to tell people, ‘You have COVID-19 because you had symptoms in this order versus another order.'”
Instead, experts say it is important to pay attention elk unusual symptoms associated with COVID-19, regardless of when they appear. This includes chills, shortness of breath, fatigue, loss of taste or odor, runny nose, or station next to the list above.
“When someone first presents with cough and fever, I would not assume it is not COVID,” says Thomas Russo, MD, professor and head of infectious disease at the University of Buffalo. “It’s an interesting guide, but you should never let symptoms drive you alone whether you need to do a test or not.” He adds that doctors “now need a low threshold” with all respiratory symptoms at present, regardless of their order.
That said, the data may still be useful in further understanding COVID-19, as it is caused by a newly discovered coronavirus that still requires a great deal of research. “This is a good starting point for people,” says Rajeev Fernando, MD, an infectious disease expert in Southampton, New York. He found that his patients tended to follow a similar path to that in the study, with additional symptoms such as loss of smell and taste after the fever and cough.
Bottom line: Ask about testing as you experience it elk COVID-19 symptoms, but keeping track of when your symptoms started to appear and how they progressed can be helpful information for your doctor.
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