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By now, most of us know to look out for the respiratory symptoms of coronavirus – the unrelenting cough, the breathlessness. But a growing body of evidence suggests that digestive issues can also be a sign of Covid-19.
It’s led some people to believe they have ‘gastrointestinal coronavirus’ or ‘gastrointestinal Covid-19’, but that’s not quite right. It’s not a separate virus or illness. Rather, they have gastrointestinal symptoms caused by coronavirus.
“Covid-19 is the name given to the disease that the SARS-CoV-2 virus causes,” Professor Andrew Goddard, president of the Royal College of Physicians, tells HuffPost UK. “The virus causes both respiratory and other symptoms and ‘Covid-19’ covers these. Symptoms from parts of the body outside the chest are common. Most people say the fatigue, joint pains and headache can be worse than the cough when the disease is in its milder forms.”
So, what are the digestive symptoms?
Scientists in China have found evidence that while Covid-19 most commonly presents with respiratory symptoms, such as cough and shortness of breath, the illness can also present with non-respiratory symptoms, most notably digestive symptoms such as diarrhoea, diminished appetite and nausea.
Of 206 patients with “mild” symptoms at the Union Hospital, Tongji Medical College, in Wuhan, 67 of them had diarrhoea, one study found. One in five of these people (19.4%) experienced diarrhoea as the first symptom of their illness.
In total, 48 presented with a digestive symptom alone, 69 had both digestive and respiratory symptoms, and 89 had respiratory symptoms alone.
The study found patients with digestive symptoms had the virus in their bodies for a longer time, compared to those with respiratory symptoms. The virus was also far more likely to be found in their poo. “We know that patients with Covid-19 can have nausea and diarrhoea and estimates have ranged from 4% to 57% in different studies,” says Prof Goddard.
In milder cases, the digestive problems may be a more noticeable feature, but people are rarely hospitalised because of these symptoms in the UK – most admissions are due to the respiratory problems the virus creates, he says. So we don’t necessarily hear about the digestive symptoms as much.
British historian Dr Fern Riddell recently shed some light on her own experience of coronavirus, which caused digestive problems rather than respiratory ones. “I am on day 33 of Covid-19 and for the last 26 [days] I’ve been the sickest I’ve ever been in my life,” she tweeted.
For the first 10 days of the virus, her symptoms were mild, said Riddell, like a summer cold. On day nine, she started to lose her sense of smell and then on days 10 and 11 she went “down hill really fast”. She likens how she felt to being poisoned. She had full body shakes and aches, nausea, diarrhoea, extreme fatigue and serious dehydration. “You feel so, so ill. And it’s terrifying. I don’t remember much of the next 14 days,” she wrote.
How do you develop – and prevent – them?
Dr Brennan Spiegel, director of health services research at the Cedars-Sinai Health System in Los Angeles, told Today.com that if the virus gets into a person’s saliva and they swallow it, it can then enter the intestinal system.
It’s thought digestive symptoms occur because the virus enters target cells through a receptor found in both the upper and lower gastrointestinal tract. The receptors to which the virus binds are expressed at almost 100-fold higher levels in the gastrointestinal organs compared to the respiratory organs.
Scientists said because Covid-19 testing has been largely focused on patients with respiratory symptoms rather than digestive ones, it’s possible there are a large number of undiagnosed patients with low severity illness who are unknowingly spreading the virus.
At this stage, we don’t know how infectious the virus is once it comes out in a person’s stools, which means hand washing is – as always – imperative.
“The bottom line is that washing hands remains the best defence we all have against the virus,” says Prof Goddard. “Washing hands not only stops it spreading from the respiratory route but also the potential faeco-oral route.”
While acknowledging the debate about whether masks should be worn, Prof Goddard said that “we know hand washing works and works really well”.
Treating digestive symptoms of Covid-19
If you think you might have digestive issues as a result of coronavirus, the message is clear: keep hydrated. You might want to try oral rehydration solutions such as Dioralyte, suggests Dr Philip Smith, a consultant gastroenterologist at The Royal Liverpool University Hospital.
Make sure you’re washing hands regularly and are isolating yourself from others in your household. If you find you can’t keep hydrated and are becoming more unwell, seek medical help – call your GP, try NHS 111 and, if it gets really bad, phone for an ambulance.