This post was updated on 4/29/20 to reflect new information.
If there is any good news about COVID-19, it is perhaps that the illness is not always severe or fatal. From what we know so far, the CDC reports that close to 80% appear to be mild to moderate.
But, since patients’ experiences of COVID-19 vary widely – from no symptoms at all to life-threatening – it can be hard to know what experts mean when they say “mild.”
It’s also important to know that people can have sudden shifts from mild symptoms to more severe ones, requiring medical attention, and we have no way of knowing who will have a sudden deterioration. That’s why it’s so important to monitor your symptoms if you are isolating at home.
So, what does “mild” disease look like?
While we first thought that symptoms of COVID-19 were limited primarily to fever, dry cough, and shortness of breath, the list of symptoms has grown as we’ve learned more about the virus.
Based on the best available data, the CDC recently added chills, repeated shaking with chills, muscle pain, headache, sore throat and new loss of taste or smell to the list of COVID-19 symptoms.
Some COVID-19 patients and doctors have reported other potential symptoms as well, including: runny nose, weakness, fatigue, nausea, stomach upset, vomiting, diarrhea, rashes (and other skin presentations), and red eyes. Researchers will need to further investigate these symptoms to confirm their association with COVID-19, but for now, suffice it to say that COVID-19 symptoms vary widely.
Like everything with COVID-19, this is causing a lot of confusion. Is it possible to have just a runny nose and have COVID-19? Is it possible just to have an upset stomach and diarrhea and have COVID-19? How about a mild fever, sore throat, and muscle aches that go away after a week or two? Could you have already had COVID-19 and not even known?
These are all great questions.
The answer is: It’s possible. It seems that mild disease really can look like anything. The likelihood of having COVID-19, depends in part on if there is an outbreak in your community and if you’ve had exposure to someone who has COVID-19. If you are in parts of New York City, it’s more of a possibility right now than if you are in a part of the country that isn’t seeing much COVID-19 yet.
This biggest unknown though is whether there actually is a lot of COVID-19 in your community right now. Because we have such poor testing rates throughout the U.S., we really just don’t know where it is silently spreading until there’s a surge of more moderate to severe cases.
Until the testing situation is fixed, we are not going to be able to know if people suffering with mild symptoms have COVID-19 or not.
What do I do if I am having mild viral symptoms?
Practically speaking, if you feel unwell, you should isolate (find tips here). This means staying home, staying away from family members (stay at least 6 feet away, in a separate room and use a separate bathroom, if possible, don’t share household items, clean and disinfect surfaces) and monitoring your symptoms to make sure you are getting better. Check your temperature daily, watch for worsening cough or shortness of breath. If your breathing worsens, call right away for medical attention. We’ve seen many cases where people are feeling ok, and then suddenly worsen.
Keep in mind that there are many other reasons for people to have respiratory symptoms, besides COVID-19 – cold and flu viruses can cause similar symptoms, and allergy season is just beginning in many places.
Also, understand that as we still have a very limited capability to test, it is very likely that you will not qualify for testing in your community for mild symptoms at this time.
So, again, if you start experiencing any symptoms, the best thing to do is isolate and watch. And if you live with someone who is sick, stay home and away from others for 14 days, to make sure you don’t develop symptoms during that time as well.
How do I know if I’m out of the woods?
In most cases, it can take anywhere from 1-14 days to develop symptoms from COVID-19 (sometimes even longer), but most people with mild disease develop symptoms around day 3- 5 and start to show recovery in about a week. Some data suggest that people who go on to have more severe disease (requiring hospitalization) develop worsening symptoms after day 5 or over the course of the second week, from day 7-10 days (but again this is based on limited data).
There is also some data that people with severe fatigue, headache, abdominal pain, and shortness of breath seem to progress past mild disease, especially if their age is over 60 and they have other health problems (like heart or lung disease, obesity, and depressed immune system). But remember, ANYONE can get severely ill from COVID-19, we are seeing people in their 20s, 30s, and 40s, without any medical problems get so sick that they need a breathing tube.
Another finding that suggests you may have more severe disease is if your breathing rate (the number of breathes in a minute) starts moving up past more than 24 breathes/minute when you are resting. If you are breathing at less than 20 breaths/minute that seems to be more reassuring. So, if you have any of these symptoms, watch yourself very closely and let your doctor know quickly if your condition worsens
When can I stop isolating?
For people with mild symptoms, it’s also not quite clear when you should stop the safeguards and come out of isolation.
The CDC recommends that you can stop home isolation is you haven’t had a fever for at least 72 hours (without fever reducing medicines), any other symptoms you had have improved (runny nose, fatigue, cough, abdominal pain) and at least 7 days have gone by since the start of your symptoms.
At the end of the day, there is A LOT we don’t know about this virus. Until testing capability improves in the US, many of us who experience mild symptoms may never know if our illness is COVID-19, the flu, or a cold. But the most important thing to do if you don’t feel well, is to LISTEN to your body, and rest. This can be a HUGE challenge in many homes, especially if you are the primary care taker in your family. But, this is what we should be doing anyway. When we aren’t feeling well, our body is telling us to pause, rest, pay attention, and take time away from others.
This is not just important advice during the COVID-19 outbreak, it’s good advice at any time.
For more COVID-19 information and other public health updates, follow Dr. Pathak on Twitter @NehaPathakMD.