The signs and symptoms of COVID-19 present at illness onset vary, but over

the course of the disease, most persons with COVID-19 will experience the
following :
1,4-9

 Fever (83–99%)
 Cough (59–82%)
 Fatigue (44–70%)
 Anorexia (40–84%)
 Shortness of breath (31–40%)
 Sputum production (28–33%)
 Myalgia (11–35%)

Within 5–6 days of symptom onset, SARS-CoV-2 viral load reaches its
peak — significantly earlier than that of the related SARS-CoV, where viral
load peaks at about 10 days after symptom onset https://www.nature.com/articles/s41577-020-0311-8

Also observed are following symptoms

 older adults and persons with medical comorbidities may have delayed
presentation of fever and respiratory symptoms. 10,1

 fever was present in only 44% at hospital admission but later developed
in 89% during hospitalization.  
1

 Headache, confusion, rhinorrhea, sore throat, hemoptysis, vomiting, and

diarrhea have been reported but are less common (<10%). 1,4-6

 Some persons with COVID-19 have experienced gastrointestinal

symptoms such as diarrhea and nausea prior to developing fever and
lower respiratory tract signs and symptoms.  
9

 Anosmia or ageusia preceding the onset of respiratory symptoms has

been anecdotally reported , but more information is needed to
12

understand its role in identifying COVID-19.

 Some data suggest that pre-symptomatic infection tended to be
detected in younger individuals and was less likely to be associated with
viral pneumonia.19,20
Illness Severity

Among all hospitalized patients, a range of 26% to 32% of patients were

admitted to the ICU.   6,8,11

 Mild to moderate (mild symptoms up to mild pneumonia): 81%

 Severe (dyspnea, hypoxia, or >50% lung involvement on imaging): 14%
 Critical (respiratory failure, shock, or multiorgan system dysfunction): 5%

Clinical Progression

 Among patients who developed severe disease, the median time to

dyspnea ranged from 5 to 8 days,
 the median time to acute respiratory distress syndrome (ARDS) ranged
from 8 to 12 days
 , and the median time to ICU admission ranged from 10 to 12 days.   5,6,10,11

 One should be aware of the potential for some patients to rapidly

deteriorate one week after illness onset.
 Among all patients, a range of 3% to 17% developed ARDS compared to
a range of 20% to 42% for hospitalized patients and 67% to 85% for
patients admitted to the ICU.   1,4-6,8,11

 Mortality among patients admitted to the ICU ranges from 39% to 72%
depending on the study.  T 5,8,10,11

 the median length of hospitalization among survivors was 10 to 13

days. 1,6,8

Ahmad et al., A Review of COVID-19 (Coronavirus Disease-2019) Diagnosis, Treatments and Prevention / doi: 10.14744/ejmo.2020.90853

On infection, the median incubation period is approximately 4–5 days before

symptom onset 6,7,8,9, with 97.5% of symptomatic patients developing
symptoms within 11.5 days Latest research The virus incubation
days https://www.nature.com/articles/s41577-020-0311-8.

time shows a wide range (0–24 days) and the virus displays a high
infectivity. https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(20)30120-X/fulltext

Symptoms may appear 2-14 days after exposure. day by https://wmich.edu/sites/default/files/attachments/u5/2020/COVID19-symptoms.pdf

day breakdown of coronavirus symptoms shows how symptoms progress

among typical patients, how the disease, COVID-19, goes from bad to worse.
[16]
Day 1: In the starting day of the symptom, the patient suffers from fever along
with fatigue, muscle pain, and a dry cough. Few of them may experience
nausea and diarrhoea a few days before the arousal of symptoms.

Day 5: Patients may suffer from breathing problem especially if they are
elderly or have some pre-existing health condition.

Day 7: According to the Wuhan University study, these are the symptoms of
the patient that lead the patient to be admitted in the hospital.

Day 8: On the 8th day, patients (15%, according to the Chinese CDC) develop
acute respiratory distress syndrome (ARDS), a condition where the fluid fills up
in the lungs and this is mostly fatal. This usually happens in severe cases.

Day 10: The progression of the disease leads to worsening of the symptom
and at this point the patient is shifted to ICU. Patients with milder symptoms
probably have more abdominal pain and loss of appetite. Only a small
fractiondie. The current mortality rate is around 2%.

Day 17: On average, after two-and-a-half weeks patients who recover are
discharged from the hospital.

However, it's difficult to find out the symptoms in the earlier days of the
infection. This is usually seen after 5-6 days. [16] Reported symptoms have
ranged from mild to severe illness and death for confirmed coronavirus
disease 2019 cases

Data suggest that infants (<12 months of age) may be at higher risk for severe
illness from COVID-19 compared with older children; 12

The majority of term infants (≥37 weeks gestational age) in these case reports
had asymptomatic or mild disease and recovered without complication 12

Symptoms in neonates with SARS-CoV-2 infection include

 fever,
 lethargy,
 rhinorrhea,
 cough,
 tachypnea,
 increased work of breathing,
 vomiting,
  diarrhea,
 feeding intolerance or decreased intake. 

When to Seek Emergency Medical Attention https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html

Look for emergency warning signs* for COVID-19. If someone is showing

any of these signs, seek emergency medical care immediately

 Trouble breathing
 Persistent pain or pressure in the chest
 New confusion
 Inability to wake or stay awake
 Bluish lips or face

Risk Factors for Severe Illness

 Age is a strong risk factor for severe illness, complications, and
death.  
1,6,8,10,11,38-41

 the case fatality rate was highest among older persons

: ≥80 years: 14.8%,
70–79 years: 8.0%,
60–69 years: 3.6%,
50–59 years: 1.3%,
40–49 years: 0.4%,
<40 years: 0.2%. 38,42

 Early U.S. epidemiologic data suggests that the case fatality was highest
in persons 39

aged ≥85 years (range 10%–27%),

aged 65–84 years, 3%–11%
ages 55–64 years, 1%–3%
for ages 0–54 years. <1%

 Patients in China with no reported underlying medical conditions had an

overall case fatality of 0.9%,
 but case fatality was higher for patients with comorbidities:
10.5% for those with cardiovascular disease,
 7.3% for diabetes,
6% each approximately for chronic respiratory disease, hypertension,
and cancer.  Heart disease, hypertension, prior stroke, diabetes, chronic
42

lung disease, and chronic kidney disease have all been associated with
increased illness severity and adverse outcomes.  Accounting for
1,6,10,11,38,42,43

differences in age and prevalence of underlying condition, mortality

associated with COVID-19 in the United States was similar to China. 24,39,40

1. Guan WJ, Ni ZY, Hu Y, et al. Clinical Characteristics of Coronavirus Disease 2019 in China. N
Engl J Med 2020;382:1708-20.
2. Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-
Infected Pneumonia. N Engl J Med 2020;382:1199-207.
3. Lauer SA, Grantz KH, Bi Q, et al. The Incubation Period of Coronavirus Disease 2019 (COVID-
19) From Publicly Reported Confirmed Cases: Estimation and Application. Ann Intern
Med 2020Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99
cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive
study. Lancet 2020;395:507-13.
4. Huang C, Wang Y, Li X, et al. Clinical features of patients infected with 2019 novel coronavirus
in Wuhan, China. Lancet 2020;395:497-506.
5. Wang D, Hu B, Hu C, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019
Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA 2020.
6. Xu XW, Wu XX, Jiang XG, et al. Clinical findings in a group of patients infected with the 2019
novel coronavirus (SARS-Cov-2) outside of Wuhan, China: retrospective case
series. BMJ 2020;368:m606.
7. Wu C, Chen X, Cai Y, et al. Risk Factors Associated With Acute Respiratory Distress Syndrome
and Death in Patients With Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA
Intern Med 2020.
8. Pan L, Mu M, Yang P, et al. Clinical Characteristics of COVID-19 Patients With Digestive
Symptoms in Hubei, China: A Descriptive, Cross-Sectional, Multicenter Study. Am J
Gastroenterol 2020.

12.https://www.cdc.gov/coronavirus/2019-ncov/hcp/caring-for-newborns.html

https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-guidance-
management-patients.html
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