How long does Covid diarrhea typically last?

Duration of COVID-19 Diarrhea

COVID-19 diarrhea typically lasts 5 days (median duration), with a range of 2-9 days in most patients. 1, 2

Characteristics of COVID-19 Diarrhea

• Prevalence: Approximately 10-20% of COVID-19 patients experience diarrhea 3
• Onset: Usually begins around 3 days (median) from illness onset 2
• Presentation:
  • Most common stool characteristics: watery (64%) or mushy (28%) 2
  • Frequency: 37% of patients defecate more than 3 times per day 2
  • Usually mild-to-moderate and non-bloody 3
  • Can occasionally be the presenting and only COVID-19 symptom 1, 3

Associated Gastrointestinal Symptoms

COVID-19 patients with diarrhea may also experience:

• Nausea (24% of cases) 2
• Vomiting (17% of cases) 2
• Poor appetite (24% of cases) 2
• Abdominal pain (less common) 1

Clinical Course and Outcomes

• Diarrhea-only presentation:

  • Generally milder illness 4
  • Longer time from onset to seeking medical care (14.5 days vs. 11.0 days) 4
  • Higher rates of viral RNA in stool (80.0% vs. 52.4%) 4

• Diarrhea with respiratory symptoms:

  • Higher levels of inflammatory activity 4
  • Longer hospital stays (27.5 days vs. 23.0 days for diarrhea-only) 4
  • Higher mortality risk (3.2 times higher than diarrhea-only cases) 4

Management Considerations

1. Hydration and electrolyte replacement are essential, especially for patients with frequent watery diarrhea 3

2. Symptomatic treatment may include:

   • Loperamide
   • Kaolin-pectin preparations 3

3. Monitor for complications:

   • Secondary infections, especially Clostridioides difficile 3
   • Nutritional deficiencies during prolonged diarrhea 2

4. Testing considerations:

   • In outpatients with new-onset diarrhea, obtain history of COVID-19 exposure and monitor for development of other COVID-19 symptoms 1
   • In high COVID-19 prevalence settings, consider COVID-19 testing for patients with new-onset diarrhea 1

Important Caveats

• Diarrhea may precede respiratory symptoms by several days 1
• Patients with GI symptoms are more likely to have illness duration of 1 week or longer (33%) compared to patients without GI symptoms (22%) 1
• Stool may remain positive for viral RNA even after respiratory samples become negative, suggesting potential for fecal-oral transmission 5
• Treatment medications for COVID-19 can also cause diarrhea, which should be distinguished from direct viral effects 3

For most patients, COVID-19 diarrhea is self-limiting and resolves within a week, but clinicians should monitor for dehydration and electrolyte abnormalities, especially in elderly or vulnerable populations.