Is Diarrhea a Symptom of COVID-19?

Respiratory symptoms are the top complaint, but don't ignore a case of diarrhea.

According to the Centers for Disease Control and Prevention (CDC), if you experience diarrhea with COVID-19, you are not alone. It is one of the most common symptoms of the disease.

A multicenter study published in Digestive Diseases and Sciences in February 2022 looked at 1672 hospitalized COVID-19 positive cases. The researchers found that 41% of patients had gastrointestinal (GI) symptoms, including diarrhea, nausea, vomiting, abdominal pain, or a combination of these.

In addition, a study from researchers in Iran published in BMC Infectious Diseases in November of 2021 found that the typical respiratory symptoms of COVID-19 are quite commonly accompanied by GI symptoms, with nearly 50% of COVID-19 patients experiencing at least one GI symptom.

An Early Respiratory Virus

However, when it first appeared in 2019, COVID-19 was not thought of as a GI virus. It was most commonly associated with symptoms such as cough, fever, and shortness of breath. With time, researchers noted an increased prevalence of GI issues in COVID-19 patients.

One of the earliest studies on the topic, published in Clinical Gastroenterology and Hepatology in March of 2020, looked at the occurrence of diarrhea and other gastrointestinal symptoms in over 1,100 COVID-19 patients hospitalized in Wuhan, China. The researchers found diarrhea was a symptom in 37% of patients. Since then, researchers have noted the involvement of the gastrointestinal system in COVID-19 patients in numerous studies. In some cases, GI issues such as diarrhea have been the only symptoms of the virus. One retrospective study published in the Indian Journal of Gastroenterology in October 2021 involved 344 patients admitted to the hospital between March to July 2020. The researchers found that the most common presenting symptoms of COVID-19 in patients that were admitted to the hospital were cough (38.4%), shortness of breath (37.5%), and fever (34.3%), followed by GI symptoms in 25.9% of patients.

Why Diarrhea?

​​Although the specific reasons why COVID-19 leads to GI symptoms such as diarrhea are not entirely known, researchers have proposed some explanations. In a review published in the Journal of Microbiology, Immunology and Infection in August 2021, researchers noted that an inflammatory response of the body to SARS-CoV-2 (the virus that causes COVID-19), side effects from drugs, and psychological distress may all contribute to GI symptoms.

Diarrhea and Transmission of COVID-19

According to the CDC, aerosol and droplet-based routes are the main means of transmission of COVID-19. The agency highlights that ​​COVID-19 can be spread by touching eyes, nose, or mouth with hands that have the virus on them.

​​Researchers have called for more in-depth studies in order to understand whether feces genuinely contributes to virus transmission. It is well established that SARS-CoV-2 RNA can be traced in the feces of those with the virus and has been found in untreated wastewater (also referred to as "sewage"). It is important to follow the CDC's guidelines for proper disinfection of your home if you have any symptoms of COVID-19, including diarrhea.

"With many viruses, the fecal matter needs to be taken into consideration," explained Niket Sonpal, MD, Board Certified NYC Internist, and Gastroenterologist. "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 getting vaccinated and boosted, wearing a mask, washing your hands frequently, keeping a safe distance from those who are sick, and disinfecting commonly touched surfaces.

Not Usually a Cause for Concern

While diarrhea is an uncomfortable symptom of the virus, according to the NIH, in the absence of shortness of breath, dyspnea, or abnormal chest imaging, it is considered a symptom of a mild illness on the clinical spectrum.

Research published in Digestive Diseases and Sciences in February 2022 found no increase in mortality with the presence of GI symptoms in COVID-19 in its study of 1672 patients. In fact, researchers observed that patients presenting with GI symptoms (with or without non-GI symptoms) had a lower mortality rate compared to patients presenting with only non-GI symptoms, as well as a reduced hospitalization discharge time for only GI symptom patients.

A person experiencing mild symptoms of diarrhea can stay at home and manage the symptoms at home by watching what they eat and drink. Many people find relief following the bland BRAT (bananas, white rice, applesauce, and white-bread toast) and staying away from caffeine, alcohol, greasy, fatty or fried foods, dairy products, and spicy food.

However, diarrhea, especially if it lasts longer than one or two days, can become dangerous if it leads to dehydration. The symptoms of dehydration include feeling thirsty all the time, urinating less than usual or producing dark urine, a dry mouth, skin that doesn't bounce back when you pinch it, sunken eyes or cheeks, fainting or feeling lightheaded, nausea and vomiting, and not producing tears when you cry. You may also have a rapid heartbeat and headaches.

If you do get diarrhea, prevent dehydration by drinking plenty of fluids, especially ones with electrolytes, such as fruit juice, sports drinks, soup broths, and soft drinks without caffeine. People at higher risk for dehydration should look for or make rehydration solutions that contain glucose and electrolytes.

If an adult or child experiences any of the following symptoms, they should see a doctor as soon as possible according to the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK):

  • Diarrhea lasting more than two days
  • A fever of 102 Fahrenheit or higher
  • Frequent vomiting
  • Severe pain in the abdomen or rectum
  • Stools that are black and tarry or contain blood or pus
  • Symptoms of dehydration

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.

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