Coronavirus explainer: Is it possible to have diarrhea with no fever?

Coronavirus most commonly presents with respiratory symptoms such as cough, shortness of breath, and sore throat. Fever is also a common symptom. However, digestive symptoms can also occur in patients infected with coronavirus.

In fact, diarrhea can be the first symptom of COVID-19. Some people with COVID-19 experience diarrhea and other gastrointestinal symptoms without having any other flu-like symptoms, like a fever. In some cases, however, flu symptoms can develop after diarrhea.

Because COVID-19 testing has largely focused on respiratory symptoms, it is possible that there is a large cohort of undiagnosed patients with low severity illness but with digestive symptoms and are unknowingly spreading the virus. Therefore, it is imperative to take appropriate care measures if you experience diarrhea and suspect it to be a COVID-19 symptom.

A research published in Wolters Kluwer Public Health Emergency Collection found that out of 206 patients with low severity COVID-19, 48 had digestive symptoms alone, 69 of them were with both digestive and respiratory symptoms, and 89 had respiratory symptoms only.

Between the 2 groups with digestive symptoms, 67 of them had diarrhea, of whom 19.4% experienced diarrhea as the first symptom. The diarrhea lasted from 1 to 14 days. Concurrent fever was found in 62.4% of patients having a digestive symptom. The researchers also found that patients with digestive symptoms had a longer duration between symptom onset and viral clearance.

Research regarding whether gastrointestinal symptoms emerge before or after respiratory symptoms is mixed. In one study conducted in the US, COVID-19 patients exclusively developed diarrhea after developing cough, fever, and shortness of breath.

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The researchers have found that SARS-CoV-2 can enter our digestive system through cell surface receptors for an enzyme called angiotensin converting enzyme 2 (ACE2). The receptors for this enzyme are 100 times more common in our gastrointestinal tract than in the respiratory tract.

In addition, research published in the journal Gastroenterology detected viral nucleic acid in feces in over half of the patients infected with COVID-19 and in nearly one-quarter of the cases, stool samples test positive when respiratory samples are negative.

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Gastrointestinal symptoms such as diarrhea, nausea, stomach pain or loss of appetite may have other causes than COVID-19. Experiencing any of these symptoms doesn’t necessarily mean you have COVID-19, however, they can also be early warning signs of coronavirus.

You can treat COVID-19 digestive symptoms at home by staying hydrated, avoiding foods that upset your stomach, getting rest and consulting your doctor for appropriate medication. It is important to minimize contact with other people. Seek immediate medical attention if you develop more serious symptoms like trouble breathing, pain or pressure in the chest, confusion or an inability to wake and blue lips or face.