Are COVID-19 symptoms changing?
This question has been discussed in the BMJ earlier this year (Looi et al, 2023).
Have COVID symptoms changed since the start of the pandemic?
Yes. In the short space of a few years we have seen surprising changes in the way COVID-19 presents. At the start of the pandemic the first commonly reported symptoms were loss of smell and taste; followed by shortness of breath and a cough, followed by vascular injuries.
This is the view of David Strain, senior clinical lecturer at the University of Exeter Medical School. “That became the standard that we expected,” he says.
Betty Raman, senior clinical research fellow in the Radcliffe Department of Medicine, University of Oxford, says,
People presenting with the earlier variants would have quite severe cardiorespiratory or mostly respiratory symptoms in the acute phase with other symptoms too, like brain fog. Quite a significant proportion were admitted to hospital with the earlier variants.”
Since then there has been an evolution of symptom clusters and manifestations across the variants, she says, affected by the evolution of the virus itself but also by vaccines, the vaccine landscape, the use of other treatments, and people getting recurrent infections. This has led to falling hospital admissions and changes in the frequency of each symptom.
Strain says that the loss of sense of smell and taste is nowhere near as prevalent as it used to be. “That really happened at the time of Omicron,” he says. “Omicron subvariants BA.1 and BA.2 seemed to migrate from [infecting mainly] lungs and nervous tissue to the upper airways. BA.1 for many people was little more than a severe head cold.”
Raman adds that, while some people still experience brain fog, this is less prevalent with newer variants and vaccines.
Strain estimates that at the start of the pandemic infection resulted in vascular damage in around 15-20% of patients – “for some this was simple ‘COVID toes,’ but for others it was pulmonary emboli and acute kidney injury” – while a smaller proportion went on to experience a full cytokine storm and acute respiratory distress syndrome (ARDS).
Thankfully, ARDS has almost completely disappeared now that we’ve got vaccination,” he says. “Very, very few people get onto that final stage.”
With vaccination, immunity from prior infection, and the evolution of Omicron to cause overall less intense acute infection, the presentation of symptoms has evolved. Strain says that we now see mostly upper respiratory symptoms, fever, myalgia, fatigue, sneezing, sore throat, and cough. He notes that many of these are not specific to COVID-19 and could also be a manifestation of other viral illnesses.
World Health Organization (WHO) list of COVID-19 symptoms
Common
Fever
Cough
Tiredness
Loss of taste or smell
Less common
Sore throat
Headache
Aches and pains
Diarrhoea
Rash on skin or discoloration of fingers or toes
Red or irritated eyes.
Most serious
Chest pains
Confusion
Loss of speech or mobility
Difficulty breathing.
Summary
We have discussed whether COVID-19 symptoms are changing. We hope you have found it helpful.
Other resource
MyHSN has a related article.
What does a positive COVID lateral flow test (LFT) look like?
