Diana Zuckerman, Ph.D., Thomas Eagen, Ph.D., Meg Seymour, Ph.D., Sophia Phillips, M.S., Avni Patel, Angelica Estrada
Updated October 18, 2022
Everything you need to know on the symptoms, treatments, long term impact of COVID-19.
What are the symptoms of COVID-19?
Symptoms tend to start between 2 and 14 days after coming into contact with the virus. Although some people have compared the symptoms to a cold or flu, not everyone with COVID-19 has those types of symptoms. In fact, some people (especially children, teens, and younger adults) have very mild symptoms or none at all, which is why getting tested is so important before you spend time with others. These symptoms have been reported in people with COVID-19:
| · Fever or chills
· Cough · Shortness of breath or difficulty breathing · Fatigue · Muscle pains · Headache · New loss of taste or smell · Sudden confusion (delirium) · Skin rash, redness on toes/fingers |
· Chest pains
· Sore throat · Congestion or runny nose · Nausea or vomiting · Diarrhea · Skipping meals · Abdominal pains · Sneezing · Changes in the mouth or tongue |
Studies out of the United Kingdom show that the most common symptom associated with COVID-19 is a sore throat, with fever and loss of smell becoming rarer in patients. Tim Spector, a professor of genetic epidemiology at King’s College London, reported that “COVID starts in two-thirds of people with a sore throat,” which is something to keep an eye out for if you think you may have COVID.
Most people who are infected with this coronavirus have mild symptoms and can recover at home in about 2 weeks. However, symptoms can become severe. These are the ones that require immediate medical attention:
- Difficulty breathing or shortness of breath
- Persistent chest pain or pressure
- Confusion or inability to awaken
- Blueish color in the lips or face
As described above, people who are older than 60 or with other medical conditions are more likely to develop severe illness and complications from COVID-19. The most serious complications include pneumonia, stroke, blood clots, organ failure, and death.
What should I do if I develop symptoms?
If you develop more than one of the symptoms listed above, get tested for COVID, using an at-home test. That’s the fastest way to get results, but keep in mind that the rapid tests (whether at home or anywhere else) are not as accurate as the PCR test. If you have symptoms but your rapid test is negative, test yourself again a day or 2 later, because the tests get more accurate after a few days of symptoms.
If you have symptoms that worry you, call your doctor whether or not you test positive. If you have severe symptoms, such as difficulty breathing, persistent chest pain or pressure, confusion or inability to awaken, or blueish color in the lips or face, you need to call 911. Tell the 911 operator that you think you have COVID-19 so the responders can take the necessary precautions to protect themselves.
People who experience mild symptoms can usually stay home and will recover in about 2 weeks. People are discouraged from simply showing up at the doctor’s office with symptoms: Call them first so you have tell them about your symptoms and any other health problems so that they can help decide what to do. If you do become sick, you can take the following steps to protect others:
- Get tested for COVID-19, ideally with a PCR test to confirm the results (positive or negative) of your at-home test
- Wear a face mask
- Stay home, unless you need essential medical care
- Stay away from others in your home as much as possible
- Cover your mouth and nose when you cough or sneeze, properly dispose of tissues, and wash your hands
- Monitor your symptoms and temperature
If you were not tested for COVID-19, you should follow those steps until at least one or two weeks have passed since you first noticed symptoms or your fever or other symptoms go away for 3 full days without medicine. If you have been diagnosed with COVID-19 based on test results, you should follow those same steps until you have 2 negative test results taken 24-hours apart, and your symptoms improve.
What treatments are safe and effective?
In late December 2021, the FDA authorized two prescription treatments in pill form that can be taken at home for mild to moderate COVID-19 infections. The aim of each medication is to prevent these infections from progressing to severe infections that lead to hospitalization and/or death. Each drug was only tested on unvaccinated adults with underlying medical conditions that make severe infection more likely, such as diabetes. The preferable treatment is Pfizer’s medication, Paxlovid. Although the FDA authorized Paxlovid without a public meeting, it was awarded an EUA based on research data which indicated that Paxlovid reduces hospitalization or death by 88% for patients at high risk if taken shortly after COVID symptoms develop.
However, newer research results, based on more recent variants, indicates that the benefits are primarily for older patients. They report that people 65 or older who took Paxlovid had a 73% lower chance of being hospitalized for COVID-19 and around a 79% lower chance of dying of the disease, compared to people in the same age group who did not take Paxlovid, but Paxlovid did not significantly prevent hospitalization or death for adults ages 40-65.
It is important to note that there have been reports of a “rebound” of COVID-19 symptoms in some people within 2 to 8 days after completing the five-day course of Paxlovid, with one study estimating that about 5% experienced a rebound within 30 days. The CDC says a rebound does not mean a person was re-infected with the virus or that the Paxlovid wasn’t beneficial, but they advise isolating for 5 days when the rebound occurs. Rebounds were not affected by whether the patient was vaccinated against COVID or not. New research suggests that rebounds are not unique to Paxlovid because recurring symptoms are common among COVID patients who were not treated with Paxlovid or other medication.
In contrast, the FDA held an advisory committee meeting in November 2021 to review the data on Molnupiravir, Merck’s antiviral medication because the study results were more controversial for Molnupiravir than for Paxlovid. The potential benefits of the drug appear very small, with only a 3% absolute difference in the rate of hospitalization or death between those taking the drug and those taking a placebo. There are also potential risks of Molnupiravir, especially for pregnant women, but also the risk of creating a “breeding ground” for variants of the virus. To read NCHR’s statement to the committee about Molnupiravir, click here. The Advisory Committee voted 13 in favor and 10 against issuing an EUA for the drug, and on December 23 2021, the FDA officially issued an EUA for Molnupiravir, “For whom alternative COVID-19 treatment options authorized by FDA are not accessible or clinically appropriate,” and specifically cautioning against its use in pregnant patients and for people who engage in sexual activity that may result in conception. For those reasons, NCHR is questioning FDA’s authorization of Molnupiravir.
The FDA approved the antiviral drug remdesivir, which has been found to help very ill adults and children 12 years of age or older reduce the number of days of hospitalization. In one study sponsored by the National Institute of Allergy and Infectious Diseases showed a significantly faster time to recovery in patients taking remdesivir (about 10 days) compared to the placebo group (about 15 days).
The FDA has authorized several monoclonal antibody treatments for individuals with mild to moderate illness due to COVID-19. Bebtelovimab was authorized in March of 2022 as the only monoclonal antibody to cover all mutations of Omicron. This treatment had been shown to reduce the risk of illness progressing to severe illness, including hospitalization or death. However, in November 2022, FDA withdrew its emergency use authorization as it does not seem to be effective at neutralizing the two most dominant omicron subvariants.
Evusheld, another monoclonal antibody, was awarded an EUA by the FDA in December 2021, for individuals 12 years or older who are at risk for severe illness, or those who cannot receive COVID-19 vaccines. In January 2023, FDA withdrew the EUA for this treatment because Evusheld currently works on fewer than 10% of circulating COVID variants.
FDA also authorized combination treatments consisting of 2 monoclonal antibodies, but neither of those combinations has been effective for Omicron variants. For that reason, the EUA for bamlanivimab/etesevimab was revoked by the FDA in April 2021 and the EUA for casirivimab/imdevimab was amended to prevent use in the U.S. while Omicron is the dominant variant.
Another possible treatment is blood plasma from people who recovered from COVID-19. Known as convalescent plasma, this blood product contains antibodies that help fight the virus. In March, 2021, convalescent plasma was given emergency FDA authorization for treating hospitalized COVID-19 patients early in the disease course. However, studies published in the summer of 2021 indicated that this treatment was not effective, and in late 2021, the WHO recommended against the use of convalescent plasma as it is not shown to have any benefit. On December 28, 2021, the FDA revised its EUA to be limited to COVID-19 convalescent plasma with high titers of antiSARS-CoV-2 antibodies only for COVID-19 patients with immunosuppressive disease or receiving immunosuppressive treatment.
Experts now agree that hydroxychloroquine with or without azithromycin is not a good treatment for COVID-19 because it has been found to increase heart problems and has not been shown to prevent or treat COVID-19.
Ivermectin is a drug approved by the FDA for human use to treat infections caused by internal and external parasites, but it has not been approved to treat COVID-19. A 2021 study of 476 patients found that ivermectin is not more effective than placebo to reduce the symptoms of COVID-19 and a 2022 study with over 1,000 COVID-19 patients confirmed that ivermectin was no better than placebo. Although an earlier preprinted study (not peer reviewed) suggested it would drastically reduce deaths from COVID, that preprint was withdrawn in July 2021 because of irregularities in the data. Despite the lack of data showing effectiveness, the drug has been widely promoted as a potential treatment to the virus, with families suing hospitals that refuse to prescribe it. Invermectin has potentially dangerous side-effects, and its use for COVID has resulted in five times as many calls to poison control centers. The National Institutes of Health (NIH), World Health Organization, FDA, the American Medical Association (AMA), and other experts have warned against its use for COVID.
Research is continuing to find out which of these treatments are safe and effective and for which patients.
If I’ve had COVID-19, am I immune in the future?
A large Danish study of almost 4 million individuals (nearly 70% of the Danish population) found that having previously been infected by the COVID-19 virus provides protection against a repeated infection, particularly for people younger than 65 years. However, it is clear that people who previously had COVID-19 can become infected months later, and the strength and duration of immunity remain unclear.
For more information, view our other articles on basic information about the virus how to prevent COVID-19.
Questions?
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