What are the typical symptoms of COVID-19 (Coronavirus Disease 2019) by day of infection?

COVID-19 Symptoms by Day of Infection

COVID-19 symptoms typically progress through distinct stages, with fever being most common around day 5 after exposure, followed by respiratory symptoms, and potential progression to more severe disease in some patients. 1

Early Stage (Days 0-4)

• Initial symptoms often begin 3-5 days after exposure (incubation period ranges 1-14 days, average 5.2 days) 1, 2
• Common early symptoms:
  • Fever (58.6-77% of cases)
  • Fatigue (20.3-50%)
  • Dry cough (41-67%)
  • Sore throat
  • Headache
  • Muscle pain
  • New loss of taste or smell 3, 1

Progressive Stage (Days 5-8)

• Fever peaks (most common around day 5 after exposure) 3
• Respiratory symptoms may worsen:
  • Persistent cough
  • Increasing breathlessness/dyspnea (37-49.3% of cases)
  • Chest tightness 1
• Gastrointestinal symptoms may appear:
  • Diarrhea (7.7-16.3%)
  • Nausea/vomiting (5.2-14.9%)
  • Decreased appetite
  • Abdominal pain (2-8.8%) 3, 1

Peak Stage (Days 9-13)

• For mild cases (81% of patients): symptoms begin to improve 1
• For severe cases (14% of patients): worsening symptoms 1
  • Increasing shortness of breath
  • Hypoxemia
  • Potential development of pneumonia
• For critical cases (5% of patients): 1
  • Acute respiratory distress syndrome (ARDS)
  • Respiratory failure
  • Multi-organ dysfunction

Absorption Stage (≥14 Days)

• Most mild-moderate cases: resolution of symptoms
• Some patients: persistent symptoms (Long COVID)
• Severe cases: continued hospitalization with potential complications 1

Important Clinical Considerations

Symptom Variations

• Up to 23-41% of patients may not present with fever, particularly in early disease 1
• Elderly patients might develop hypoxemia without fever or respiratory symptoms 1
• Immunocompromised patients may present with atypical symptoms 1
• Children are more likely to be asymptomatic (up to 45%) 1

Positioning for Cough Management

• Avoid lying on back as this makes coughing ineffective 3
• Sitting upright increases peak ventilation and reduces airway obstruction 3
• Leaning forward with arms bracing a chair or knees can improve ventilatory capacity 3

Warning Signs for Severe Disease

• Risk factors for progression to severe disease include:
  • Body temperature >37.5°C
  • Chills
  • Abnormal findings on initial chest X-ray
  • Presence of diabetes 4
  • Older age
  • Multiple comorbidities 3

Breathlessness Management

• Controlled breathing techniques include positioning, pursed-lip breathing, and breathing exercises 3
• In pursed-lip breathing: inhale through nose for several seconds, then exhale slowly through pursed lips for 4-6 seconds 3
• Relaxing and dropping shoulders reduces hunched posture associated with anxiety 3

Remember that asymptomatic carriers can still transmit the virus, with viral loads similar to symptomatic patients 1. The disease is transmitted by inhalation or contact with infected droplets 2.

For fever management, paracetamol is preferred over NSAIDs, and patients should maintain adequate hydration (no more than 2 liters per day) 3.

Early laboratory indicators that may accompany initial symptoms include lymphopenia, elevated inflammatory markers, and elevated liver enzymes 1.