For a Texas nurse, the first sign that something was wrong came while brushing her teeth: She couldn't taste the toothpaste. For a Georgia lawyer, it was hitting a wall of fatigue in a normally easy race. When a Wisconsin teacher fell ill in June, he thought a bad meal had turned his stomach.
But eventually all of these people discovered that their multiple symptoms were all signs of COVID-19. Some of the common symptoms (dry cough, headache) can start so mildly that they are at first mistaken for allergies or a cold. In other cases, the symptoms are so unusual (strange leg pain, rash, or dizziness) that patients and even their doctors don't believe COVID-19 could be to blame.
With more than 18 million cases of coronavirus worldwide, one thing is clear: symptoms are varied and rare, they can be mild or debilitating, and the disease can progress, from head to toe, in unpredictable ways.
Despite hundreds of published studies on the symptoms of COVID-19, the frequency of a given symptom depends on the group of patients studied. Patients in hospitals often have more severe symptoms. Older patients are more prone to cognitive problems. Younger patients are more likely to have mild illness and unusual skin rashes.
"The problem is that it depends on who you are and how healthy you are," said Dr. Mark A. Perazella, a kidney specialist and professor of medicine at Yale School of Medicine. “It's so heterogeneous, it's hard to say. If you are healthy, you are likely to have a fever, pain, nasal symptoms, a dry cough, and malaise. But there will be weirdos who will be defiant and have some symptoms and nothing else, and you won't suspect COVID.
The Texas nurse who couldn't taste her toothpaste said the next day she developed a fever, "horrible" body aches and a cough. Her symptoms lasted for five days. (She and many other respondents asked that her names not be used to protect her medical privacy or to protect their families from the stigma of COVID-19.)
Anosmia, the loss of smell that is also often accompanied by loss of taste, is considered a defining symptom. Ina study with 961 health professionalsFor those who were tested for COVID-19, anosmia was the most predictive symptom, but it was not foolproof. Only half of the people who reported losing their sense of smell or taste tested positive, said Dr. Brian Clemency, the study's lead author and an associate professor in the department of emergency medicine at the University of California's College of Medicine and Biomedical Sciences. Buffalo Jacobs University. .
Even a symptom as common as a fever can be tricky when it comes to predicting whether a patient might have COVID-19. Although many companies are doing fever checks to check for COVID-19, many COVID-19 patients never have a fever.In a European study of 2,000 patients with COVID-19with mild to moderate disease, 60% never had a fever. In the University at Buffalo study, fewer than one in three fever patients also tested positive for COVID-19.
Rob Gregson, 52, of South Orange, New Jersey, went to bed feeling unwell and woke up with a tightness in his chest, a "weird" cough, shortness of breath and "crazy fatigue." It was March 11, just before the lockdowns were imposed, and he immediately suspected COVID-19. But since he never had a fever, it took him over a week to find a doctor to help him and do a swab test. He tested positive.
“The fatigue is the most debilitating,” said Gregson, executive director of a faith-based nonprofit, adding that he is still struggling to regain his energy nearly five months later. "I've been on the coronavirus roller coaster, feeling better and thinking I'm going to be okay, but then I came back."
When Erin, a 30-year-old woman who works for a nonprofit organization in Washington, D.C., developed a cough and headache in May, she didn't worry. “I didn't have a fever and I was very diligent about wearing a mask and washing my hands, so I thought it was an allergy or a cold at first,” she said.
About four days after the cough began, Erin suffered from severe fatigue, a sore throat, congestion, chills, body aches, and mild loss of smell, but she did not yet have a fever. She also had an unusual symptom: severe pain in her hip muscles, which she described as "very strange."
While body aches are a common symptom of COVID-19, some patients report severe joint and body pain, particularly large muscles. Although rare, COVID-19 can cause painful joint swelling or lead to rhabdomyolysis, a serious and life-threatening condition that can cause excruciating muscle pain in the shoulders, thighs, or lower back.
A New York cyclist who developed severe leg pain in May was initially diagnosed via telemedicine with a bulging disc. He sought a second telemedicine opinion from Dr. Jordan Metzl, a sports medicine specialist at the Hospital for Special Surgery in New York, who asked her to move, twist and press her legs while he watched her on video.
“In her calf, she said, 'Oh, that hurts so much,'” said Metzl, who was concerned. “I am by no means an alarming doctor, but I did look up the closest ER to her, which was 10 miles away. I said, 'I want you to get in her car and drive to the emergency room right away.'
An ultrasound showed that she had no pulse in her legs and severe clotting in both legs, putting her at risk of amputation. She was transferred to another hospital and she underwent nine hours of emergency surgery. Ella Metzl said she was lucky to have had a conference call with colleagues about blood clots and COVID.
"It's a scary story, which is why we need awareness about these strange performances," Metzl said. “COVID infection can affect different parts of the body differently. Some people get this hypercoagulable state and end up with blood clots. We don't always know who these people are."
In June, John, a 55-year-old teacher from Oshkosh, Wisconsin, woke up one morning feeling like something he had eaten wasn't bothering him. The next day, he suffered debilitating fatigue and nausea, cramps, and other gastrointestinal symptoms. He did not suspect COVID-19 because he was wearing a mask and social distancing.
“The second day, I just wanted to sleep the whole time. I was sleeping probably 20 hours a day,” she said. “I even remember that during that time my mentality changed. I couldn't imagine how my wife and son managed to stay up all day. I thought: 'How can someone do this?' I'd get out of bed and go to the kitchen for a glass of water, and when I got there, all I could think about was wanting to go back to bed."
Doctors tested him for COVID-19 and Lyme disease. Both tested negative. An ultrasound showed no problems, but the blood work suggested that he had some sort of infection. A doctor prescribed heartburn medication for two weeks and she lost 10 pounds. After two weeks, she began to feel better. Two months later, he tested positive for COVID-19 antibodies, suggesting that his original COVID test had been a false negative.
Doctors say that COVID patients who only have gastrointestinal symptoms often test negative when tested with a nasopharyngeal swab. The virus is more likely to show up in fecal tests, which are common in other countries but not widely used in the United States. The gastrointestinal tract and the respiratory tract are rich in a receptor called ACE2, which the virus uses to enter our cells. But it's not clear why the virus sometimes seems to skip the respiratory tract and only infect the digestive tract.
“This is a very complicated and confusing virus and disease, and we are discovering amazing things about it every day,” said Dr. asaf bitton,CEO of Ariadne Labsat Brigham and Women's Hospital and Harvard T.H. Chan School of Public Health.
dr Ilan Schwartz,assistant professor of infectious diseases at the University of Alberta, said he was tested for COVID-19 after developing respiratory symptoms. The test came back negative, but he developed COVID toes: painful red or purple lesions on the tips of his fingers and toes that are thought to be a telltale symptom of the coronavirus, particularly in younger patients. It can occur as a result of small blood clots orcuando el virus invade los vasos sanguíneos.
"I started getting sores on my feet and couldn't figure out what was happening," said Schwartz, 37. "They hurt alot. I thought maybe I stabbed them, like all of them, which would be unusual. So I thought maybe there was something wrong with my shoes. I've heard many people with similar stories buy new shoes because they don't know what's going on. It is such an unusual symptom that it is not natural to think that a respiratory virus is responsible for the pain in the fingers.
Thomas Ryan, 36, an Atlanta attorney, said the first sign that something was wrong hit him during the drill.
“I went for a run on a Thursday afternoon after work and I felt terrible,” she said. "I hit the wall like you do in a marathon in a race too short for me."
The next morning, he woke up with a mild cough, sore throat, and a feeling of heartburn in his chest, and then developed fatigue, pain in his lungs, and shortness of breath. Although her COVID test came back negative, her doctor told her it was a false negative and based on her symptoms, she clearly had COVID-19.
“That's not good,” said Ryan, who was still coughing weeks after falling ill. “The amount of energy I have, I feel like I'm at height. It was two weeks without being able to do anything. If this is a mild case, it makes me think that people are taking a lot of risks that they probably shouldn't."
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