Coronavirus: How COVID-19 progresses; a day-by-day breakdown of symptoms

Studies of coronavirus around the world - including the U.S. and China - point to a common disease progression in coronavirus patients that generally begins with a fever, a dry cough and breathing difficulties.

Two studies from China and doctors in the U.S. report seeing very similar disease progression: Those who have a milder form of the virus begin recovery from fever, cough and shortness of breath about two weeks after the onset of symptoms. More severe cases at that point are moved to intensive care units and sometimes placed on a ventillator.

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Here are some takeaways from the studies in the U.S. and China:

• The first symptom of COVID-19 is usually a fever. The fever is often followed a few days later by a dry cough, one in which you do not cough up any phlegm, and shortness of breath.
• The first symptoms begin from two to 14 days after you have been exposed to the virus. A new study from Johns Hopkins Bloomberg School of Public Health suggests a median time of about five days.
• The average duration of fever was 12 days. Ninety-nine percent of the patients studied had a fever. About 50% felt fatigued and had a dry cough, with 33% having difficulty breathing and complaining of muscle pain.
• The study showed that 85% of those with the virus only experience “phase one” of the virus’s course. Phase one encompasses the first seven days of symptoms (see below). Those with more critical cases of COVID-19 went on to suffer more severe symptoms that last for two more weeks, on average.
• Age is a strong risk factor for severe illness, complications and death
• The second Wuhan study also said it observed that the average hospital stay was 10 days.

Here is what having COVID-19 looks like day-by-day according to the studies:

Day 1 (the first day symptoms begin): Most of those infected – 88% – will have a fever and feel tired. Many also have muscle pain and a dry cough.

Some people, around 10% according to the study from China, experience nausea or have diarrhea in the days just before the fever begins.

Day 2-4: The fever persists as does the cough.

Day 5: Breathing difficulty begins on day 5. It is especially likely to happen if the person has a preexisting condition or is older.

Day 6: Breathing difficulty, cough and fever persist. Some people describe chest tightening or having a feeling that a “band” is around their chest.

Day 7: It is on this day that people who have been experiencing persistent chest pain or pressure, shortness of breath and bluish lips or face are admitted to the hospital.

People who are suffering less severe symptoms will likely see those symptoms begin to get better.

Day 8: According to the Chinese Center for Disease Control and Prevention, about 15% of people with COVID-19 will develop symptoms of ARDs, or acute respiratory distress syndrome.

According to the Mayo Clinic, ARDs “happens when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. The fluid keeps your lungs from filling with enough air, which means less oxygen reaches your bloodstream. This deprives your organs of the oxygen they need to function.”

Day 10: If breathing difficulties worsen, it is on this day that patients who are in the hospital will tend to enter the intensive care unit.

Day 12: In the Wuhan study, fever ended for most people on Day 12. Many still had a cough.

Days 13-14: For those who will survive the virus, breathing difficulties are generally ending on these days.

Day 18: For those who do not survive the virus, the average number of days from onset of symptoms until death is 18 1/2 days.

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