The presentation of COVID-19 varies, but the most commonly reported signs and symptoms are:1-7,19
- Fever
- Cough
- Shortness of breath or difficulty breathing
- Fatigue
- Anorexia
- Chills (+/– shaking)
- Headache
- Sore throat
- Sputum production
- Myalgias
Atypical presentations have also been reported. Some of the less common signs and symptoms are:2,3,8-13,20
- Confusion
- Rhinorrhea
- Hemoptysis
- Vomiting
- Diarrhea
- Nausea
- Anosmia or ageusia
- Ocular manifestations (including conjunctival hyperemia, chemosis, epiphora, or increased secretions)
Dermatologic Manifestations
- Dermatologic manifestations may be associated with COVID-19 and although the frequency remains unknown, reports have ranged from 0.2%, early in the pandemic, to as high as 20.4%.
- Association with disease severity and timing of skin symptoms among COVID-19 patients is unclear.
- The clinical presentation appears varied, though in a study of 171 persons with laboratory-confirmed COVID-19 (ranging from mild to severe disease), the most common skin manifestations reported were:
- a maculopapular rash (22%),
- discolored lesions of the fingers and toes (18%)
- hives (16%).
- Among all study participants with COVID-19 and any skin manifestations, approximately 60% reported fever and/or cough.
Evaluating skin manifestations in COVID-19 patients remains challenging as symptoms can resemble a variety of other disease conditions. Additionally, COVID-19 treatments also may cause certain skin side-effects. Images of cutaneous findings are available from the American Academy of Dermatology.
According to the CDC’s “Coronavirus Disease 2019 in Children — United States, February 12-April 2, 2020,” signs and symptoms among pediatric and adult patients with laboratory-confirmed COVID-19 include those in Table 6.1.
Table 6.1 Signs and symptoms among 291 pediatric (age <18 years) and 10,944 adult (age 18-64 years) patients* with laboratory-confirmed COVID-19 in the US from February 12, 2020, to April 2, 2020.

* Cases were included in the denominator if they had a known symptom status for fever, cough, shortness of breath, nausea/vomiting, and diarrhea. Total number of patients by age group: <18 years (N = 2,572), 18-64 years (N = 113,985).
a Includes all cases with one or more of these symptoms.
b Patients were included if they had information for either measured or subjective fever variables and were considered to have a fever if “yes” was indicated for either variable.
c Runny nose and abdominal pain were less frequently completed than other symptoms; therefore, percentages with these symptoms are likely underestimates.
Asymptomatic and Pre-Symptomatic Infection
Several studies have documented SARS-CoV-2 infection in patients who never develop symptoms (asymptomatic) and in patients not yet symptomatic (pre-symptomatic).13-18 Since asymptomatic persons are not routinely tested, the prevalence of asymptomatic infection and detection of pre-symptomatic infection is not well understood. One study found that as many as 13% of RT-PCR-confirmed cases of SARS-CoV-2 infection in children were asymptomatic.21 Patients may have abnormalities on chest imaging before the onset of symptoms.13,14 Some data suggest that pre-symptomatic infection tended to be detected in younger individuals and was less likely to be associated with viral pneumonia.13,14
References
- Centers for Disease Control and Prevention. Interim clinical guidance for management of patients with confirmed coronavirus disease (COVID-19). CDC website.
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- Chen N, Zhou M, Dong X, et al. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study. Lancet. 2020;395(10223):507-513. doi:10.1016/S0140-6736(20)30211-7
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- Wang D, Hu B, Hu C, et al. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China [published online ahead of print, 2020 Feb 7]. JAMA. 2020;e201585. doi:10.1001/jama.2020.1585
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- Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China [published online ahead of print, 2020 Mar 13]. JAMA Intern Med. 2020;e200994. doi:10.1001/jamainternmed.2020.0994
- Yang X, Yu Y, Xu J, et al. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study [published online ahead of print, 2020 Feb 24] [published correction appears in Lancet Respir Med. 2020 Feb 28]. Lancet Respir Med. 2020. doi:10.1016/S2213-2600(20)30079-5
- Zhou F, Yu T, Du R, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study [published correction appears in Lancet. 2020 Mar 28;395(10229):1038] Lancet. 2020;395(10229):1054-1062. doi:10.1016/S0140-6736(20)30566-3
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- Wu P, Duan F, Luo C, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China [published online ahead of print, 2020 Mar 31]. JAMA Ophthalmol. 2020;e201291. doi:10.1001/jamaophthalmol.2020.1291
- Hu Z, Song C, Xu C, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China [published online ahead of print, 2020 Mar 4]. Sci China Life Sci. 2020;10.1007/s11427-020-1661-4. doi:10.1007/s11427-020-1661-4
- Wang Y, Liu Y, Liu L, Wang X, Luo N, Ling L. Clinical outcome of 55 asymptomatic cases at the time of hospital admission infected with SARS-Coronavirus-2 in Shenzhen, China [published online ahead of print, 2020 Mar 17]. J Infect Dis. 2020;jiaa119. doi:10.1093/infdis/jiaa119
- Pan X, Chen D, Xia Y, et al. Asymptomatic cases in a family cluster with SARS-CoV-2 infection. Lancet Infect Dis. 2020;20(4):410-411. doi:10.1016/S1473-3099(20)30114-6
- Bai Y, Yao L, Wei T, et al. Presumed asymptomatic carrier transmission of COVID-19 [published online ahead of print, 2020 Feb 21]. JAMA. 2020;e202565. doi:10.1001/jama.2020.2565
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