Health

Coronavirus symptoms: Which symptom of COVID-19 appears first? Latest study reveals order

In a latest study, the most common pattern of COVID-19 symptoms was revealed. This discovery could be integral in the build up to the autumn/winter flu season beginning - which could bring a potential second wave.

A new study by scientists at the University of Southern California offers valuable guidance when it comes to onset of coronavirus symptoms.

The study, which was published in Frontiers in Public Health, finds that a distinguishing feature of COVID-19 is the order in which symptoms first appear.

Typically, patients will experience fever, cough, muscle pain and then nausea and diarrhoea.

Joseph Larsen who led the study said: "Given that there are now better approaches to treatments for COVID-19, identifying patients earlier could reduce hospitalization time."

The study found that a patient infected with the coronavirus is most likely to experience symptoms in the order of fever, cough, nausea/vomiting, then diarrhoea.

A backward path of symptoms that starts with diarrhoea and nausea/vomiting and is followed by cough, and finally fever is also possible, though less likely.

What the experts said

"The importance of knowing first symptoms is rooted in the need to stop the spread of COVID-19, a disease that is two to three times more transmissible than influenza and results in outbreaks of clusters," the authors of the study wrote.

"There is a heightened risk in COVID-19 being passed on, so faster testing and social distancing are important, especially when social distancing and quarantine measures are relaxed.

"Our results assert that fever is the most likely symptom to occur first in symptomatic adult patients with COVID-19."

The order by which the symptoms appear "are identical in severe and non-severe cases and to our original findings above," the study found.


The study finds that fever and cough are frequently associated with all four diseases studied. For influenza, the first symptom is more likely to be cough.

In the three coronavirus infections, the most common initial symptom is fever.

Scientists report that it is the timing of gastrointestinal symptoms that sets COVID-19 patients apart from MERS and SARS patients.

In COVID-19 patients, upper tract GI symptoms like nausea and vomiting seem to appear before lower GI tract symptoms like diarrhoea.

According to the authors, early identification of whether someone likely has COVID-19, or another illness is also important. 

That's because of the great need to stop the spread of coronavirus, as compared to influenza, COVID-19 is two to three times more transmissible.

However, the authors caution that the identification of symptom order should not be used in place of testing. Instead, it should be taken as a possible sign to get tested.

"Given that there are now better approaches to treatments for COVID-19, identifying patients earlier could reduce hospitalization time," concludes Larsen.



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