Tl;dr COVID-19 might start with a cough, or a fever, or both, or occasionally maybe neither. It might start suddenly or slowly. It might remit and then come back worse.
This was hard to figure out. Most academic/medical papers start with the person’s first contact with the medical system, which is too late, so I looked at social media and news reports. These are obviously going to be biased towards people with symptoms severe enough to be interesting, but not so severe as to die. I also restricted myself to test-confirmed cases, which because I was also looking at mostly American sources biases things towards severe cases. And I’m counting on people to represent themselves honestly. So there’s a lot going against this sample.
In total I found 11 cases, plus two notes from doctors doing front line work. You can see my and Eli Tyre’s notes on every case here and the symptom tracking spreadsheet here. Both are messy and no work has been spent making them comprehensible to others.
From this very small and biased sample:
36% of people started with a cough on their first day (55% if you count two people who had very mild symptoms on day 1 and developed a cough on day 2)
64% started with a fever.
18% of people started with both on the same day.
18% started with neither symptom (but developed a cough on day 2)
78% eventually developed a cough
91% eventually developed a fever. The only person who didn’t eventually develop a fever I think might be a false positive, because his symptoms were very weird.
27% had digestive symptoms (mostly nausea)
⅓ of recovered people had been hospitalized.
On the other hand, this pre-print found that only 44% of patients had a fever on admission to the hospital, and 88% ever had one. The fevers can be intermittent. Both that paper and the doctor I just linked to report very high occurrence (85%+) of lymphocytopenia (low white blood cell count), but that is not very useful to diagnosing yourself, and it’s not clear when it starts.
Known scientific source Business Insider says that most cases start with fever. They do not mention their source.
Commonly Repeated Things I Don’t Believe
You may have heard that 80% of cases are mild. Keep in mind that that paper defined mild to include mild pneumonia, which I would classify as at least moderately severe.
Similarly, the paper reporting 50% of patients appeared at the hospital with digestive symptoms counted “loss of appetite” as a digestive symptom. Only 19% presented with a more definitely gastroenteric complaint like nausea or vomiting.
Early Appearance of Symptoms
Tl;dr COVID-19 might start with a cough, or a fever, or both, or occasionally maybe neither. It might start suddenly or slowly. It might remit and then come back worse.
This was hard to figure out. Most academic/medical papers start with the person’s first contact with the medical system, which is too late, so I looked at social media and news reports. These are obviously going to be biased towards people with symptoms severe enough to be interesting, but not so severe as to die. I also restricted myself to test-confirmed cases, which because I was also looking at mostly American sources biases things towards severe cases. And I’m counting on people to represent themselves honestly. So there’s a lot going against this sample.
In total I found 11 cases, plus two notes from doctors doing front line work. You can see my and Eli Tyre’s notes on every case here and the symptom tracking spreadsheet here. Both are messy and no work has been spent making them comprehensible to others.
From this very small and biased sample:
36% of people started with a cough on their first day (55% if you count two people who had very mild symptoms on day 1 and developed a cough on day 2)
64% started with a fever.
18% of people started with both on the same day.
18% started with neither symptom (but developed a cough on day 2)
78% eventually developed a cough
91% eventually developed a fever. The only person who didn’t eventually develop a fever I think might be a false positive, because his symptoms were very weird.
27% had digestive symptoms (mostly nausea)
⅓ of recovered people had been hospitalized.
On the other hand, this pre-print found that only 44% of patients had a fever on admission to the hospital, and 88% ever had one. The fevers can be intermittent. Both that paper and the doctor I just linked to report very high occurrence (85%+) of lymphocytopenia (low white blood cell count), but that is not very useful to diagnosing yourself, and it’s not clear when it starts.
Known scientific source Business Insider says that most cases start with fever. They do not mention their source.
Commonly Repeated Things I Don’t Believe
You may have heard that 80% of cases are mild. Keep in mind that that paper defined mild to include mild pneumonia, which I would classify as at least moderately severe.
Similarly, the paper reporting 50% of patients appeared at the hospital with digestive symptoms counted “loss of appetite” as a digestive symptom. Only 19% presented with a more definitely gastroenteric complaint like nausea or vomiting.