USC Scientists Uncover Likely Order Of COVID-19 Symptoms

More than four months since COVID-19 was declared a pandemic, health officials and scientists are still struggling to define the virus and how some people are affected more than others. According to a new study, USC researchers say they've come a step closer in understanding the coronavirus and have determined the likely order in which symptoms of the virus first appear.

According to the study published this week in the journal, Frontiers in Public Health, COVID-19 symptoms begin with a fever, then cough and muscle pain, followed by nausea, and/or vomiting, and diarrhea. Scientists say knowing the order of symptoms could help patients seek out care faster or self-isolate. This information also allows doctors to rule out other illnesses, and plan how to treat their patients.

The study was lead by doctoral candidate Joseph Larsen and scientists Peter Kuhn and James Hicks at the USC Michelson Center for Convergent Bioscience.

“This order is especially important to know when we have overlapping cycles of illnesses like the flu that coincide with infections of COVID-19,'' said Kuhn, a USC professor of medicine, biomedical engineering, and aerospace and mechanical engineering. “Doctors can determine what steps to take to care for the patient, and they may prevent the patient's condition from worsening.''

Fever and cough are a common symptom of a variety of respiratory illnesses, including the seasonal flu, Middle East Respiratory Syndrome and Severe Acute Respiratory Syndrome. Researchers say the timing and symptoms in a patient's upper and lower gastrointestinal tract is what sets COVID-19 apart from those other viruses.

“Given that there are now better approaches to treatments for COVID-19, identifying patients earlier could reduce hospitalization time,'' Larsen said.

Data for the study was collected from more than 55,000 confirmed cases in China from Feb. 16 to Feb. 24 by the World Health Organization. A second dataset of nearly 1,100 cases collected by the China Medical Treatment Expert Group via the National Health Commission of China.

“The order of the symptoms matter, '' Larsen said. “Knowing that each illness progresses differently means that doctors can identify sooner whether someone likely has COVID-19, or another illness, which can help them make better treatment decisions.''

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