Signs and symptoms

Symptoms of COVID-19[4]

Symptom Range

Fever 83–99%

Cough 59–82%

Loss of appetite 40–84%

Fatigue 44–70%

Shortness of breath 31–40%

Coughing up sputum 28–33%

Muscle aches and

11–35%
pains

Fever is the most common symptom, although some older people and those with other health
problems experience fever later in the disease.[4][35] In one study, 44% of people had fever when they
presented to the hospital, while 89% went on to develop fever at some point during their
hospitalization.[4][36]
Other common symptoms include cough, loss of appetite, fatigue, shortness of breath, sputum
production, and muscle and joint pains.[4][5][37][38] Symptoms such as nausea, vomiting,
and diarrhoea have been observed in varying percentages.[39][40][41] Less common symptoms include
sneezing, runny nose, or sore throat. [42]
Some cases in China initially presented with only chest tightness and palpitations.[43]
A decreased sense of smell or disturbances in taste may occur.[44][45] Loss of smell was a presenting
symptom in 30% of confirmed cases in South Korea. [12][46]
As is common with infections, there is a delay between the moment a person is first infected and the
time he or she develops symptoms. This is called the incubation period. The incubation period for
COVID-19 is typically five to six days but may range from two to 14 days,[47][48] although 97.5% of
people who develop symptoms will do so within 11.5 days of infection. [49]
A minority of cases do not develop noticeable symptoms at any point in time. [50][51] These
asymptomatic carriers tend not to get tested, and their role in transmission is not yet fully known. [52]
[53]
 However, preliminary evidence suggests they may contribute to the spread of the disease. [54][55] In
March 2020, the Korea Centers for Disease Control and Prevention (KCDC) reported that 20% of
confirmed cases remained asymptomatic during their hospital stay.[55][56]

Complications
In some, the disease may progress to pneumonia, multi-organ failure, and death.[57] Neurological
manifestations include seizures, stroke, encephalitis, and Guillain–Barré syndrome.
[58]
 Cardiovascular-related complications may include heart failure, irregular electrical activity, blood
clots, and heart inflammation.[59]
In some people, COVID-19 may affect the lungs causing pneumonia. In those most severely
affected, COVID-19 may rapidly progress to acute respiratory distress syndrome (ARDS) causing
respiratory failure, septic shock, or multi-organ failure.[60][61] Complications associated with COVID-19
include sepsis, abnormal clotting, and damage to the heart, kidneys, and liver. Clotting
abnormalities, specifically an increase in prothrombin time, have been described in 6% of those
admitted to hospital with COVID-19, while abnormal kidney function is seen in 4% of this group.
[62]
 Approximately 20-30% of people who present with COVID-19 demonstrate elevated liver enzymes
(transaminases).[63] Liver injury as shown by blood markers of liver damage is frequently seen in
severe cases.[64]

Transmission
As COVID-19 is a new disease, many aspects as to how it spreads are being researched. [6][16][18] The
disease is spread during close contact, often by small droplets produced during coughing, sneezing,
or talking.[6][18] The droplets are transmitted, and cause new infection, when inhaled by people in close
contact (1 to 2 metres, 3 to 6 feet). They are produced during breathing out, however as they are
relatively heavy, they usually fall to the ground or surfaces.[6][18]
Loud talking releases more droplets than normal talking. [65] A study in Singapore found that an
uncovered cough can lead to droplets travelling up to 4.5 metres (15 feet). [66] An article published in
March 2020 argued that advice on droplet distance might be based on 1930s research which
ignored the effects of warm moist exhaled air surrounding the droplets and that an uncovered cough
or sneeze can travel up to 8.2 metres (27 feet). [17]
After the droplets fall to floors or surfaces, they still can infect other people, if they touch
contaminated surfaces and then their eyes, nose or mouth with unwashed hands. [6] On surfaces the
amount of active virus decreases over time until it can no longer cause infection. [18] However,
experimentally, the virus can survive on various surfaces for some time, (for example copper or
cardboard for a few hours, and plastic or steel for a few days).[18][20] Surfaces are easily
decontaminated with household disinfectants which kill the virus outside the human body or on the
hands.[6] Notably, however disinfectants or bleach should never be swallowed or injected as a
treatment or preventative measure, as this is harmful or potentially fatal. [67]
Sputum and saliva carry large amounts of virus.[68][6][16][18] Some medical procedures may result in the
virus being transmitted easier than normal for such small droplets, known as airborne transmission.[6]
[18]

The virus is most contagious during the first three days after onset of symptoms, although spread is
known to occur up to two days before symptoms appear (presymptomatic transmission) and in later
stages of the disease.[16][18][69][70] Some people have been infected and recovered without showing
symptoms, but uncertainties remain in terms of asymptomatic transmission. [18]
Although COVID-19 is not a sexually transmitted infection, kissing, intimate contact, and faecal oral
routes are suspected to transmit the virus.[71][72]

Diagnosis
The WHO has published several testing protocols for the disease. [96] The standard method of testing
is real-time reverse transcription polymerase chain reaction (rRT-PCR).[97] The test is typically done
on respiratory samples obtained by a nasopharyngeal swab; however, a nasal swab
or sputum sample may also be used.[22][98] Results are generally available within a few hours to two
days.[99][100] Blood tests can be used, but these require two blood samples taken two weeks apart, and
the results have little immediate value. [101] Chinese scientists were able to isolate a strain of the
coronavirus and publish the genetic sequence so laboratories across the world could independently
develop polymerase chain reaction (PCR) tests to detect infection by the virus.[9][102][103] As of
4 April 2020, antibody tests (which may detect active infections and whether a person had been
infected in the past) were in development, but not yet widely used. [104][105][106] The Chinese experience
with testing has shown the accuracy is only 60 to 70%.[107] The FDA in the United States approved
the first point-of-care test on 21 March 2020 for use at the end of that month.[108]
Diagnostic guidelines released by Zhongnan Hospital of Wuhan University suggested methods for
detecting infections based upon clinical features and epidemiological risk. These involved identifying
people who had at least two of the following symptoms in addition to a history of travel to Wuhan or
contact with other infected people: fever, imaging features of pneumonia, normal or reduced white
blood cell count, or reduced lymphocyte count.[109]
Low oxygen levels detected using a pulse oximeter are a low cost quick diagnosis method for those
with asymptomatic pneumonia relative to CT scans. Patients display acute or silent hypoxia where
the oxygen level in blood cells and tissue can drop without any initial warning, even though the
individual’s chest x-ray shows diffuse pneumonia with an oxygen level below normal. Doctors report
cases of silent hypoxia with COVID-19 patients who did not experience shortness of breath or
coughing until their oxygen levels had plummeted to such a degree that the patients risked acute
respiratory distress (ARDS) and organ failure. [110] In a New York Times opinion piece (20 April 2020),
emergency room doctor Richard Levitan reports "a vast majority of Covid pneumonia patients I met
had remarkably low oxygen saturations at triage — seemingly incompatible with life — but they were
using their cellphones as we put them on monitors." [110]

A study asked hospitalised COVID-19 patients to cough into a sterile container, thus producing a
saliva sample, and detected the virus in eleven of twelve patients using RT-PCR. This technique has
the potential of being quicker than a swab and involving less risk to health care workers (collection at
home or in the car).[68]

Along with laboratory testing, chest CT scans may be helpful to diagnose COVID-19 in individuals
with a high clinical suspicion of infection but are not recommended for routine screening. [23][24] Bilateral
multilobar ground-glass opacities with a peripheral, asymmetric, and posterior distribution are
common in early infection.[23] Subpleural dominance, crazy paving (lobular septal thickening with
variable alveolar filling), and consolidation may appear as the disease progresses.[23][111]
In late 2019, WHO assigned the emergency ICD-10 disease codes U07.1 for deaths from lab-
confirmed SARS-CoV-2 infection and U07.2 for deaths from clinically or epidemiologically diagnosed
COVID-19 without lab-confirmed SARS-CoV-2 infection.[112]
What is Social Distancing?

Social distancing, also called “physical distancing,” means keeping space

between yourself and other people outside of your home. To practice social
or physical distancing:

 Stay at least 6 feet (about 2 arms’ length) from other people

 Do not gather in groups
 Stay out of crowded places and avoid mass gatherings

In addition to everyday steps to prevent COVID-19, keeping space between

you and others is one of the best tools we have to avoid being exposed to
this virus and slowing its spread locally and across the country and world.

When COVID-19 is spreading in your area, everyone should limit close

contact with individuals outside your household in indoor and outdoor
spaces. Since people can spread the virus before they know they are sick, it is
important to stay away from others when possible, even if you have no
symptoms. Social distancing is especially important for people who are at
higher risk of getting very sick.

Why practice social distancing?

COVID-19 spreads mainly among people who are in close contact (within
about 6 feet) for a prolonged period. Spread happens when an infected
person coughs, sneezes, or talks, and droplets from their mouth or nose are
launched into the air and land in the mouths or noses of people nearby. The
droplets can also be inhaled into the lungs. Recent studies indicate that
people who are infected but do not have symptoms likely also play a role in
the spread of COVID-19.

It may be possible that a person can get COVID-19 by touching a surface or

object that has the virus on it and then touching their own mouth, nose, or
eyes. However, this is not thought to be the main way the virus spreads.
COVID-19 can live for hours or days on a surface, depending on factors such
as sun light and humidity. Social distancing helps limit contact with infected
people and contaminated surfaces.
Although the risk of severe illness may be different for everyone, anyone can
get and spread COVID-19. Everyone has a role to play in slowing the spread
and protecting themselves, their family, and their community.

Tips for social distancing

 Follow guidance from authorities where you live.
 If you need to shop for food or medicine at the grocery store or
pharmacy, stay at least 6 feet away from others.
o Use mail-order for medications, if possible.
o Consider a grocery delivery service.
o Cover your mouth and nose with a cloth face cover when around
others, including when you have to go out in public, for example
to the grocery store.
 Stay at least 6 feet between yourself and others, even
when you wear a face covering.

 Avoid large and small gatherings in private places and public spaces,
such a friend’s house, parks, restaurants, shops, or any other place.
This advice applies to people of any age, including teens and younger
adults. Children should not have in-person playdates while school is
out. To help maintain social connections while social distancing,
learn tips to keep children healthy while school’s out.
 Work from home when possible.
 If possible, avoid using any kind of public transportation, ridesharing,
or taxis.
 If you are a student or parent, talk to your school about options for
digital/distance learning.

Stay connected while staying away. It is very important to stay in touch

with friends and family that don’t live in your home. Call, video chat, or stay
connected using social media. Everyone reacts differently to stressful
situations and having to socially distance yourself from someone you love
can be difficult. Read tips for stress and coping.

What is the difference between quarantine and isolation?

Quarantine
Quarantine is used to keep someone who might have been exposed to
COVID-19 away from others. Someone in self-quarantine stays separated
from others, and they limit movement outside of their home or current
place. A person may have been exposed to the virus without knowing it (for
example, when traveling or out in the community), or they could have the
virus without feeling symptoms. Quarantine helps limit further spread of
COVID-19.

Isolation
Isolation is used to separate sick people from healthy people. People who
are in isolation should stay home. In the home, anyone sick should separate
themselves from others by staying in a specific “sick” bedroom or space and
using a different bathroom (if possible).

What should I do if I might have been exposed? If I feel sick?

Or have confirmed COVID-19?
If you think you have been exposed to COVID-19, read about symptoms.

If you…

Steps to take…

If you or someone in your home might have been exposed

Self-Monitor

Be alert for symptoms. Watch for fever,* cough, or shortness of breath.

 Take your temperature if symptoms develop.

 Practice social distancing. Maintain 6 feet of distance from others, and
stay out of crowded places.
 Follow CDC guidance if symptoms develop.

If you feel healthy but:

 Recently had close contact with a person with COVID-19, or

  Recently traveled from somewhere outside the U.S. or on a cruise ship
or river boat

Self-Quarantine

 Check your temperature twice a day and watch for symptoms.

 Stay home for 14 days and self-monitor.
 If possible, stay away from people who are high-risk for getting very
sick from COVID-19.

If you:

 Have been diagnosed with COVID-19, or

 Are waiting for test results, or
 Have symptoms such as cough, fever, or shortness of breath

Self-Isolate

 Stay in a specific “sick room” or area and away from other people or

animals, including pets. If possible, use a separate bathroom.
 Read important information about caring for yourself or someone else
who is sick.