Update from Dr. David Clark: COVID-19 Symptoms and Time Course

Written By Jen Jewell

Written by: David Clark, PhD, chair of the Coalition for Hemophilia B

NOTE: This article is not intended as medical advice. Readers should seek the advice of their own physician. Because information regarding COVID-19 (novel coronavirus) is ever changing, readers are also asked to check for frequent updates on our website.

In the midst of the pandemic with all varieties of information swirling around, it is important to stop and think about what the disease really looks like. If you feel sick, how do you know whether it might be COVID-19? 

For instance, yesterday I was sure I was infected because I had all kinds of upper respiratory symptoms. Fortunately, it just turned out to be allergies, and I’m fine today. The New York Times article by Tara Parker-Pope (freely available) addresses just that subject. She lists the most common symptoms of COVID-19 and their approximate timing. (Parker-Pope also has a lot of other good advice.) Here’s the list.

DAYS 1 TO 3

Early symptoms of COVID-19 vary widely. It can start with a tickle in your throat, a cough, fever, headache, and feeling winded or just a little pressure in your chest. Sometimes it begins with a bout of diarrhea. Some people just feel tired and lose their sense of taste and smell. Many people have several symptoms but no fever. Some patients with gastrointestinal symptoms go on to develop respiratory symptoms while others don’t.

DAYS 4 TO 6

Some patients never develop more than mild symptoms, or none at all. Others begin to feel terrible, with an ever-present fever, aches, chills, cough, and an inability to get comfortable. 

Some children and younger adults with mild disease may develop rashes, including itchy red patches, swelling, or blistering on the toes or fingers, similar to frostbite. The exact timing is not clear, and the symptom may appear early in the infection or after it has passed. That’s what happened to Dr. Ilan Schwartz, a professor of infectious disease, who developed respiratory symptoms and then blisters on his feet. “It seems that a lot of these individuals, including myself, test negative” on coronavirus swab tests, he said. “I presume it’s a false negative. It could be that what we’re seeing is an immunological phenomenon that occurs after the initial infection is on the mend.”1

Readers should note that these are only typical characteristics that don’t fit everyone. Some people have no symptoms or only very mild symptoms. If you’re in doubt, call your doctor.

DAYS 7 TO 8

For some lucky patients with mild illness, the worst is over after a week. Guidelines from the Centers for Disease Control and Prevention say patients whose symptoms have improved and who haven’t had a fever for three days can leave isolation. But some patients who have felt terrible continue to feel terrible or get worse. And some patients might start to feel better briefly then take a turn for the worse.

Patients should monitor their oxygen levels and check in with a doctor if they start to feel unwell. “We should instruct patients to have a lower threshold for contacting their doctor,” said emergency room physician Dr. Richard Levitan. “I believe they should contact their physicians to have monitoring if they’re feeling worse.” 2

DAYS 8 TO 12

Monitoring should continue for the second week of illness. Patients may feel better sleeping on their stomachs or sides. “Days eight to 12 are when we have a really good idea if someone is going to get better or get worse,” said Dr. Charles A. Powell, director of the Mount Sinai-National Jewish Health Respiratory Institute. “The major thing we worry about is a worsening at eight to 12 days—an increasing shortness of breath, worsening cough.” 3

Dr. Powell said a home oxygen monitor can signal if someone needs to come in. Otherwise, patients should talk to their doctors. “If it’s difficult for the person at home to feel comfortable, and it’s difficult for the family to feel things are manageable, that would lead a physician to suggest the patient come in for evaluation,” said Dr. Powell. “We don’t want to wait too long for blood oxygen levels to get worse.” 

DAYS 13 TO 14

Patients who had mild illness should be well recovered. Patients who had worse symptoms but maintained normal oxygen levels should feel mostly recovered after two weeks. However, patients with severe symptoms and those who needed additional treatment because of low oxygen may still feel unwell and fatigued and take longer to recover. 

The New York Times and the Washington Post have excellent coverage  of the pandemic. You can sign up for free daily updates on their  websites.

CAVEATS

Readers should note that these are only typical characteristics that don’t fit everyone. As stated previously, some people have no symptoms or only very mild symptoms.  Others have gone as long as five or more weeks before they fully recover.  The most important thing is that if you’re in doubt, call your doctor.

MISINFORMATION

A few weeks ago I read a conspiracy theory that coronavirus is caused by the new 5G (fifth-generation technology) cell phone service. That is not true. However, the conspiracy theory is still going around. People in Europe are burning down cell towers. (Just when people are stuck at home and dependent on their cell phones.) I was going to write a little piece on some of these theories, but there has been too much real news. (My favorite is that the president of the Republic of Belarus recommends hockey and vodka as preventative measures.)

Anyway, I recommend this Washington Post article about conspiracy theories and why people tend to believe them. It is also free.

SOURCES:

Jen Jewell
Previous

Update from Dr. David Clark: COVID Symptoms and Inflammation