What Does COVID Look Like?

As the pandemic lingers on, and with recent numbers of infections increasing, more and more people are wondering if the symptoms they are having could be related to coronavirus.  While the worst cases are characterized by fever and severe cough and breathing issues, most cases look nothing like that.  So, what exactly does COVID look like?

There is a spectrum of symptoms, from asymptomatic to ICU admission, but most healthy kids and adults will have mild symptoms.  In my experience, the most typical course comes in five phases:

Phase 1: Pre-symptomatic – This is when you’ve been infected, but don’t know it yet.  Perhaps you know of a direct contact, or perhaps not, but during this phase you feel perfectly fine despite being potentially contagious.

Phase 2: Sinus/Allergy symptoms – This is the most common presentation that I’ve seen.  Patients report mild to moderate nasal congestion, sinus pressure, etc., similar to what they’ve experienced before with allergies, URIs or sinus infections.  Headaches, body aches and fatigue are common here.  There is often a slight temperature elevation, but fever is not typically a significant symptom here.  Many people will lose their sense of smell and/or taste in this phase.

Phase 3: Slight Improvement – Many of my patients start to feel better after 2-3 days of mild symptoms and feel that they are out of the woods.  For some, that is true, but for most, there’s a Phase 4.

Phase 4: The Second Wave – After a feeling of slight improvement, most patients experience a re-worsening of symptoms, typically worse than the original symptoms.  This will often involve fever, severe fatigue, painful body aches and cough.  This stage can be of variable length, but for most it lasts for a few days.

Phase 5: Recovery – The recovery phase for most patients is a slow, steady progression of improved energy and gradually resolving cough.  Smell and taste gradually return to normal, and the cough is typically the most bothersome symptom, sometimes lasting several weeks.  Many patients experience extended fatigue or easy fatigability, similar to Mono.

In order to help slow the spread of coronavirus, I recommend that you get tested in Phase 1 (if you’ve had a known contact) or Phase 2.  That allows for early detection and proper isolation and quarantine protocols.  More details on testing can be found here, and advice on what to do if you or someone near you has been infected can be found here.