A day-by-day breakdown of coronavirus symptoms shows how COVID-19 goes from bad to worse

Coronavirus symptoms: How COVID-19 progresses day by day – Business Insider

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As doctors observe a growing number of coronavirus patients, they’ve identified a few patterns in how typical symptoms progress.

The majority of coronavirus cases are mild or moderate, but about 20% become either severe or critical, according to data from the Chinese Center for Disease Control. 

Most patients develop fever, a dry cough, and shortness of breath — the three most common symptoms of COVID-19. But they can also experience fatigue, muscle or body aches, loss of taste or smell, sore throat, congestion, and diarrhea.

These symptoms generally don’t arrive right after a person has been infected. The virus’ average incubation period is about five days, according to the US Centers for Disease Control and Prevention.

Though the virus attacks the lungs first, it can infect the heart, kidneys, liver, brain, and intestines as well. Some research has suggested that COVID-19 is a vascular disease instead of a respiratory one, meaning it can travel through the blood vessels. This could lead to additional complications like heart damage or stroke.

After observing thousands of patients during China’s outbreak earlier this year, hospitals there identified a pattern of symptoms among COVID-19 patients:

  • Day 1: Symptoms start off mild. Patients usually experience a fever, followed by a cough. A minority may have had diarrhea or nausea one or two days before this, which could be a sign of a more severe infection
  • Day 3: This is how long it took, on average, before patients in Wenzhou were admitted to the hospital after their symptoms started. A study of more than 550 hospitals across China also found that hospitalized patients developed pneumonia on the third day of their illness. 
  • Day 5: In severe cases, symptoms could start to worsen. Patients may have difficulty breathing, especially if they are older or have a preexisting health condition.
  • Day 7: This is how long it took, on average, for some patients in Wuhan to be admitted to the hospital after their symptoms started. Other Wuhan patients developed shortness of breath on this day.
  • Day 8: By this point, patients with severe cases will have most likely developed shortness of breath, pneumonia, or acute respiratory distress syndrome, an illness that may require intubation. ARDS is often fatal.
  • Day 9: Some Wuhan patients developed sepsis, an infection caused by an aggressive immune response, on this day.
  • Days 10-11: If patients have worsening symptoms, this is the time in the disease’s progression when they’re likely to be admitted to the ICU. These patients probably have more abdominal pain and appetite loss than patients with milder cases. 
  • Day 12: In some cases, patients don’t develop ARDS until nearly two weeks after their illness started. One Wuhan study found that it took 12 days, on average, before patients were admitted to the ICU. Recovered patients may see their fevers resolve after 12 days.
  • Day 16: Patients may see their coughs resolve on this day, according to a Wuhan study.
  • Day 17-21: On average, people in Wuhan either recovered from the virus and were discharged from the hospital or passed away after 2.5 to 3 weeks.
  • Day 19: Patients may see their shortness of breath resolve on this day, according to a Wuhan study.
  • Day 27: Some patients stay in the hospital for longer. The average stay for Wenzhou patients was 27 days.

Just because patients leave the hospital doesn’t mean their symptoms are fully gone. Some coronavirus patients report having symptoms for months, including chest pain, shortness of breath, nausea, heart palpitations, and loss of taste and smell. 

Those who were never hospitalized can have lingering symptoms, too. A July report from CDC researchers found that among nearly 300 symptomatic patients, 35% had not returned to their usual state of health two to three weeks after testing positive. Patients who felt better after a few weeks said their symptoms typically resolved four to eight days after getting tested. Loss of taste and smell usually took the longest to get back to normal, they said: around eight days, on average. 

Once symptoms appear, some early signs should be treated with more caution than others.

“Body aches wouldn’t be the first thing that I would ask about,” Megan Coffee, an infectious-disease clinician who analyzed the Wenzhou data, told Business Insider. “I would of course always ask about shortness of breath before anything, because that’s somebody who has to be immediately helped.”

Coffee said shortness of breath typically presented itself eight to 10 days into the course of the illness, but not all shortness of breath constitutes a severe case.

“It’s really important to have a primary-care doctor or someone you can talk to about your case so that you can decide whether you need to go to the emergency room or not,” she said. 

This story was originally published February 21, 2020. It has been updated with additional research findings.

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