Is Diarrhea a Symptom of COVID-19? New Study Says Digestive Issues May Be Common With Coronavirus
You've likely heard the most common symptoms of COVID-19
by now: dry cough, fever, shortness of breath. But now, researchers are
warning that another less-common symptom may be more prominent than
doctors once thought: diarrhea.
A new study published Wednesday in The American Journal of Gastroenterology
claims that digestive issues—like diarrhea, vomiting, and abdominal
pain—may be more common in those with COVID-19 than was once thought,
with up to half of patients diagnosed with the disease in the study
issuing complaints of those issues. Also important: Compared to study
patients without gastrointestinal issues, those who had GI complaints
had a higher risk of mortality.
The research, a cross-sectional multicenter study
from China by investigators from the Wuhan Medical Treatment Expert
Group for COVID-19, examined 204 early cases of novel coronavirus in
Wuhan, China from three separate hospitals. The average age of the
patients was 54.9 years, and included 107 men and 97 women.
The study authors noted that while respiratory
issues remain the most common symptom of novel coronavirus, many
patients—99 of the 204, or 48.5%—experienced digestive symptoms as their
chief complaint that generally worsened with time. Some patients also
never presented with respiratory symptoms at all. “Clinicians must bear
in mind that digestive symptoms, such as diarrhea, may be a presenting
feature of COVID-19, and that the index of suspicion may need to be
raised earlier in these cases rather than waiting for respiratory
symptoms to emerge,” write the authors.
Those with digestive symptoms—which included
anorexia or loss of appetite (83.8% cases), diarrhea (29.3%), vomiting
(0.8%), and abdominal pain (0.4%)—also had “a worse clinical outcome and
higher risk of mortality compared to those without digestive symptoms,”
Brennan M.R. Spiegel, MD, MSHS, FACG, Co-Editor-in-Chief of The American Journal of Gastroenterology,
explained in a press release. And, due to the fact that patients
without digestive symptoms were more likely to be cured and discharged
than patients with digestive symptoms, (60% of those without digestive
symptoms were discharged, versus only 34.3% of patients with digestive
symptoms), Dr. Spiegel emphasized “the importance of including symptoms
like diarrhea to suspect COVID-19 early in the disease course before
respiratory symptoms develop.” That in itself could lead to an earlier
diagnosis of COVID-19, "which can lead to earlier treatment and more
expeditious quarantine to minimize transmission," he said.
It should also be noted that those with digestive
symptoms took much longer seek medical care. While the average time from
symptom onset to hospital admission for those without digestive
symptoms was 7.3 days, those with them took 9 days to be admitted.
Researchers believe this may be an indicator that those with digestive
symptoms sought care later because they did not yet suspect they were
infected with the virus since they weren’t experiencing the most
commonly discussed respiratory symptoms like cough or shortness of
breath.
Niket Sonpal, MD, Board Certified NYC Internist and Gastroenterologist, who was not involved with the study, explains to Health
that this is a “significant” finding, due to the fact that, “in the
earlier stages of the outbreaks in China, Iran, and later Italy, we
mostly saw the lower respiratory symptoms—dry cough, fatigue,
accompanied by fevers.” Diarrhea was seen in some cases, “but not an
overwhelming amount in the reported cases, as we see with the dry cough
and the fever,” he explains. The significance here “has more to do with
testing and hospital admission, as reports out of China state that many
patients who presented, first, with digestive symptoms were made to wait
longer until they had the respiratory issues as well before they could
get tested or receive medical attention,” says Dr. Sonpal. According to
the study, these people too should have been a priority.
At the community level, these findings should be
used to promote social distancing and isolation to flatten the curve,
says Dr. Sonpal. "There is so much we do not know about this virus, and
while we are moving as fast as possible, it is up to the community to
stay home to control the spread," he says. He also urges that if you do
experience diarrhea during the coronavirus pandemic, you should exert
extra caution to protect those around you.
“With many viruses, the fecal matter needs to be
taken into consideration,” he explains. “This is part of the reason why,
when possible, a sick person should be using a different bathroom from
others inside their home. If this is not possible, while it may be
tedious, the CDC says it is in everyone’s best interest for the sick
person to disinfect the bathroom after using it to avoid other members
of the family becoming infected through bodily fluids.” That's, of
course, in conjunction with the other preventive tips from the CDC,
which include washing your hands frequently, avoiding large crowds or
groups of over 10 people, keeping a safe distance from those who are
sick, and disinfecting commonly touched surfaces.
The information in this story is accurate as of
press time. However, as the situation surrounding COVID-19 continues to
evolve, it's possible that some data have changed since publication.
While Health is trying to keep our stories as up-to-date as possible, we
also encourage readers to stay informed on news and recommendations for
their own communities by using the CDC, WHO, and their local public health department as resources.