Are Nosebleeds and COVID-19 Related?

As COVID-19 mutates and produces variants, more and more symptoms of the virus emerge. What began as predominantly a respiratory illness can now affect the body in a range of ways, including gastrointestinally and neurologically. Minor conditions have cropped up alongside the disease too, including problems such as nosebleeds, or epistaxis.

While more common in kids and middle-aged adults than in other populations, about 60% of people will experience a nosebleed at least once. During the pandemic, though, patients have reported them with enough frequency for researchers to take note and investigate. A causal link has not been determined, but the prevalence of nosebleeds in COVID-19 patients suggests that the factors that cause them may also be present in the virus. That said, nosebleeds can have many everyday, more benign causes.

What Causes Nosebleeds?

A nosebleed is the loss of blood from the tissue that lines the inside of your nose, according to the Cleveland Clinic. Your nose has a lot of blood vessels close to the surface in the lining of your nose, making it easy to bleed.

They can be due to a slew of possible causes, including:

• Dry air
• Picking your nose
• Upper respiratory infections and sinusitis, which can cause repeated sneezing, coughing, and nose blowing
• Blowing your nose with force
• Inserting an object into your nose
• An injury to your nose or face
• Allergies
• Blood-thinning drugs
• Cocaine and other drugs inhaled through the nose
• Chemical irritants
• High altitudes
• A deviated septum
• Overuse of nasal sprays and medications to treat an itchy, runny, or stuffy nose

Why Are COVID-19 Patients Experiencing Nosebleeds?

Several studies point to a correlation, indicating that nosebleeds may be a result of what COVID-19 or its treatments do to the mucous membranes, rather than a clear symptom of the disease.

In a 2020 study published in the Journal of International Medical Research, 30 COVID-19 patients developed nosebleeds while they were hospitalized. They required oxygen therapy, which was administered through continuous airway pressure or a nasal cannula, a thin tube. Both methods of treatment are risk factors for nosebleeds. They produce nasal dryness and crust formation, which in turn weaken the mucosa (the moist lining of the nose), increasing the likelihood of bleeding.

Also, the patients in the study were taking anticoagulant (anti-clotting) drugs, another contributing factor for nosebleeds.

Another procedure commonly used in the diagnosis and treatment of COVID-19 is swabbing of the nose. Evidence of nosebleeds following the procedure is documented in a 2021 study in the British Journal of Surgery, indicating a need for careful swabbing, particularly in older, frail patients.

Environmental factors may be at play as well. Dry air, either from air conditioning in the summer or low humidity in the winter, may induce nosebleeds, John Sellick, DO, infectious disease doctor and professor of medicine at the University at Buffalo/SUNY, told Health. There are "times of year where people get nosebleeds anyway, due to allergies and being in the air conditioning."

Ultimately, if you develop a random nosebleed but don't have any other symptoms, you probably don't have COVID-19. But if your nosebleed comes along with other signs of the virus, like a fever and cough, you'll want to distance yourself from others and get tested for COVID-19.

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.