Gastrointestinal issues could signal a coronavirus infection—even if nausea and vomiting are your only symptoms.

By Claire Gillespie
July 10, 2020
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The most common symptoms of COVID-19 are pretty much what you’d expect from a respiratory disease: fever, persistent cough, fatigue, and muscle pain. But according to the Centers for Disease Control and Prevention (CDC), many people with COVID-19 experience gastrointestinal symptoms such as nausea, vomiting, or diarrhea—sometimes even before developing the respiratory tract symptoms. 

"COVID-19 can present in many ways. I have seen patients who only have symptoms of vomiting and diarrhea, but they usually also have a fever," Jorge Vournas, MD, medical director of the Emergency Department at Providence Little Company of Mary Medical Centerin Torrance, California, tells Health.

Anecdotally, vomiting has been linked to COVID-19. In March, 22-year-old Amy Shircel from Madison, Wisconsin, began detailing her COVID-19 symptoms in a series of tweets. "I'm 22 and I tested positive for COVID-19. Take it from me - you do NOT want to catch this," she wrote. Shircel shared that the first few days of her illness were manageable, with a mild cough, headache, chills, and a runny nose. Because she had just visited Europe recently, her state allowed her to get tested for COVID-19 with minor symptoms. But things progressed on the third day. "I couldn't keep anything down. I was vomiting constantly. I couldn't sleep, I obviously couldn't eat," she wrote. The next day, she received a positive COVID-19 diagnosis. She detailed her symptoms through day 12 of her illness—after being hospitalized for dehydration—and still had "all the major symptoms" even then, but is apparently recovered now.

Shircel's not the only one: In an opinion piece for The New York Times, writer Abigail Tarttelin detailed her experience with what she thinks was the coronavirus and the symptoms that accompanied it. "Here's what happened to me," she wrote. "On the morning of Friday, March 6, I woke up with a mild sore throat and, to put it delicately, digestive issues." Just four days later, she came down with what seemed like norovirus. "Profuse vomiting. I spent the day alternating between the couch and the bathroom, feeling sorry for myself," she wrote. Days after that, she developed a cough, muscle aches, and lung pain—and though she never got tested for COVID-19, she believes it's what caused her symptoms.

Research, too, has found gastrointestinal issues, including nausea and vomiting, to be symptoms of COVID-19, in addition to other respiratory symptoms. Some of the earliest research on gastrointestinal issues as related to COVID-19 came from China, and was published in the BMJ's Gut in March. Study authors from Zhejiang University found that, among 651 patients admitted to hospitals in China's Zhejiang province between January 17 and February 8, 74 patients—or 11.4%—presented with at least one gastrointestinal symptom of nausea, vomiting, or diarrhea. 

Other research from Beijing, published in the journal Alimentary Pharmacology & Therapeutics in May, analyzed all COVID-19 clinical studies and case reports relating to digestive issues published between December 2019 and February 2020. Researchers found that 3.6% to 15.9% of adults with COVID-19 experienced vomiting, along with other gastrointestinal issues like loss of appetite, nausea, abdominal pain, and even gastrointestinal bleeding. The study also uncovered that vomiting was more common in children with COVID-19 than adults, with 6.5% to 66.7% of infected children presenting with the symptom.

And sometimes, vomiting and other gastrointestinal issue were the only sign of a COVID-19 infection, or a precursor to the infection. According to research published in The American Journal of Gastroenterology in April, more than 50% of 204 COVID-19 patients hospitalized in China's Hubei province between January 18 and February 28 reported digestive symptoms like lack of appetite, diarrhea, vomiting, or abdominal pain. Six of those patients had no respiratory symptoms whatsoever. Research published in the Journal of the American Medical Association, too, identified 14 coronavirus patients who had diarrhea and nausea before they showed any signs of fever or respiratory symptoms—that was equal to about 10% of the study's 138-person sample size.

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While experts aren't entirely sure why or how COVID-19 may cause vomiting or other gastrointestinal symptoms, researchers have a theory: Because the molecule that the coronavirus attacks in the body—angiotensin-converting enzyme 2, or ACE2—exists not only in the lungs, but in the gastrointestinal tract as well, that may explain why some people experience stomach issues. Another study published The American Journal of Gastroenterology suggests that the virus can enter the digestive system through cell surface receptors for ACE2. Receptors for this enzyme are 100 times more common in the gastrointestinal tract than the respiratory tract. Still, more research needs to be done to identify the exact mechanism. 

All of this research and anecdotal evidence suggests that vomiting and other gastrointestinal issues shouldn't be ignored during the COVID-19 pandemic, and that the symptoms may warrant a test to see if you have the virus. "It would be wise to consider that you may have COVID-19 if you develop vomiting and diarrhea and have no other obvious cause," says Dr. Vournas. "In which case, getting tested would be the next best step."

If you experience vomiting, and have been tested for COVID-19, the best thing you can do is self-isolate while you wait for your results and treat yourself at home. The CDC advises staying hydrated, getting as much rest as possible, avoiding foods that upset your stomach, and keeping an eye on your symptoms. But "if you have vomiting, you should seek medical attention if your symptoms are lasting for more than 24 hours, or if you are experiencing high fevers, abdominal pain or have blood or a dark 'coffee-ground’ appearance of your vomiting," says Dr. Vournas, as that can be a sign of a more serious issue that needs immediate care. 

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 CDCWHO, and their local public health department as resources.

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