Coronavirus symptoms: what are the less common signs, and how long do they last?

Since Covid-19 emerged at the beginning of this year in China it has caused widespread devastation globally - infecting more than 62.7 million people and killing more than 1.4 million.

There are cases in nearly every country in the world and even the most sophisticated health systems in Europe and the United States have struggled to contain it.

According to the Department of Health and Social Care, there have now been 1,617,327 confirmed cases in the UK, although many more people are thought to be infected, and a total of 58,245 patients have died within 28 days of a positive test. More than 39.8 million coronavirus tests have been processed in the UK.

As the disease has spread around the world our knowledge of it has grown, with a vaccine now being trialled, diagnostic tests being developed and new treatments being tested.

But there is also a lot that individuals can do to stop themselves picking up and spreading this disease. This practical guide will help you keep yourself and your family safe and tell you everything you need to know about this global pandemic.

What is a coronavirus?

Coronaviruses are a family of viruses that cause disease in animals. Seven, including the new virus, have made the jump to humans, but most just cause common cold-like symptoms.

Only two other coronaviruses – Middle East respiratory syndrome (Mers) and severe acute respiratory syndrome (Sars) – have been deadly but did not spread on the same scale as Covid-19. They have killed more than 1,500 people between them since 2002.

So far, around 15 to 20 per cent of Covid-19 cases have been classed as "severe" and the current death rate varies between 0.7 per cent and 3.4 per cent depending on the location and, crucially, access to good hospital care.

Scientists in China believe that Covid-19 has mutated into two strains, one more aggressive than the other, which could make developing a vaccine more complicated.

What are the symptoms of coronavirus?

According to the World Health Organisation (WHO), the main symptoms of coronavirus usually include:

• A dry cough

• A temperature

• Tiredness/lethargy

• Shortness of breath (in more severe cases)

Some patients may have "aches and pains, nasal congestion, runny nose, sore throat or diarrhoea", WHO adds. "These symptoms are usually mild and begin gradually. Some people become infected but don’t develop any symptoms and don't feel unwell".

Loss of the senses of taste and smell has also been defined as one of the key symptoms of coronavirus under new Government guidance.

The chart below identifies some of the most commonly reported symptoms.

• Read more: Coronavirus vs flu and cold symptoms

What are the less common symptoms?

Other symptoms may include:

• Aches or muscle pain

• Loss of taste or smell

• Congestion

• Diarrhoea

• Nausea or vomiting

• Fatigue

• Headache

• Runny nose

• Sore throat

• Confusion or dizziness

• Skin rashes

• Chills

• Conjunctivitis

However, there is disagreement among scientists whether some of these symptoms - such as diarrhoea - are linked to Covid-19.

How long do coronavirus symptoms last?

Because Covid-19 is so new there is a good deal of uncertainty around this. One detailed medical report of a waitress on the Diamond Princess cruise ship - a disease hotspot - who had a mild form of the disease showed that she displayed symptoms for 10 days. And a study of nine German patients who were also only mildly affected showed that they displayed symptoms for between eight and 11 days.

People with more severe forms of the disease will take longer to recover - a study of 138 patients who were hospitalised in China showed that some patients were in hospital for up to two weeks, although the average stay was 10 days.

Some people have been left with psychiatric problems, pain and fatigue for weeks after contracting Covid-19, known as long-Covid.

What is the incubation period?

Symptoms are thought to appear between two and 10 days after contracting the virus, but it may be up to 24 days.

Most people (about 80 per cent) recover from the disease without needing special treatment. However, around one out of every six people (16 per cent) becomes seriously ill and develops difficulty breathing.

Older people, and those with underlying medical problems like high blood pressure, heart problems, lung complaints or diabetes are more likely to develop serious illness.

Is a rash a sign of coronavirus?

A skin rash is not yet recognised by the Government or the NHS as a symptom of coronavirus. Scientists have, however, said that rashes should be included as Covid symptoms after research carried out at King's College London.

Researchers at the university said that characteristic skin rashes and "Covid fingers and toes" can occur in the absence of any other symptoms, and so should be considered when diagnosing Covid-19.

Using data from the Covid Symptom Study app from 336,000 regular UK users, the King's College London research found that 8.8 per cent of people testing positive for the disease had experienced a skin rash as part of their symptoms.

This compared to 5.4 per cent of people with a negative test result, leading the study authors to write: "This study strongly supports the inclusion of skin rashes in the list of suspicious Covid-19 symptoms.

"Although it is less prevalent than fever, it is more specific of Covid-19 and lasts longer."

Is vomiting a coronavirus symptom?

According to the US Centers for Disease Control and Prevention (CDC), a fever, cough, shortness of breath, fatigue, sore throat, runny nose, muscle pain and body aches and a headache can all be symptoms of coronavirus and the flu.

Some people report vomiting and diarrhea, but this is thought to be more common to flu than the coronavirus - as it has not yet been listed as one of the symptoms of Covid-19 - and more common in children than adults.

Is diarrhoea a Covid symptom?

Diarrhoea is not listed as a symptom of Covid-19, and appears more commonly as a symptom of flu.

A report authored by gastroenterologists from Wuhan’s Tongji Medical College and California’s Cedars-Sinai Medical Centre found that over half of their coronavirus cases presented with some form of digestive issue, and nearly a quarter presented with only gastric symptoms for the entirety of their illness. This has led to the term 'gastric coronavirus' being coined.

What are the symptoms in children and babies?

According to the NHS, the main symptoms of coronavirus in children are:

• A high temperature

• A new, continuous cough – this means coughing a lot, for more than an hour, or 3 or more coughing episodes in 24 hours

• A loss or change to sense of smell or taste – this means they cannot smell or taste anything, or things smell or taste different to normal

The US CDC also suggests that parents watch for fever, runny nose, fatigue, muscle aches, vomiting and diarrhoea.

Read more: Should I send my child to school with a cold?

When should I seek medical help?

If you have difficulty breathing - for example, you are breathing hard and fast, then you should seek medical help. But do not go to a GP - call NHS 111. The NHS 111 website has a symptom checker and specific advice about what you should do in the event that you need to seek medical help.

If you have a fever and a cough - the main early symptoms of coronavirus - the government now advises that you self-isolate for seven days. However, if you live with others you and the people you live with will have to self isolate for 14 days. This will help protect others.

If you live alone, ask neighbours, friends and family to help you to get the things you need.

You do not need to call NHS 111 to go into self-isolation. But if your symptoms worsen during home isolation or are no better after seven days contact the NHS 111 online. If you have no internet access, you should call NHS 111.

For a medical emergency dial 999.

How to 'self-isolate' if you think you might have coronavirus

If you think you may have the virus,  you should try to isolate or quarantine yourself.

This means you should:

• Stay at home

• Do not go to work and other public areas

• Do not use public transport and taxis

• Get friends and family to deliver food, medicines etc. rather than going to the shops

How is coronavirus spread and how can I protect myself?

The most important advice to follow is to stay at home and keep washing your hands.

Like cold and flu bugs, the new virus is spread via droplets when a person coughs or sneezes. The droplets travel for up to three metres, landing on surfaces which are then touched by others and spread further.

People catch the virus when their infected hands touch the mouth, nose or eyes.

It follows that the single most important thing you can do to protect yourself is to keep your hands clean by washing them frequently with soap and water or a hand sanitising gel.

Also try to avoid touching your mouth, nose or eyes with unwashed hands – something we all do unconsciously on average about 15 times an hour.

Other tips include:

• Carry a hand sanitiser with you at all time to make frequent cleaning of your hands easy

• Always wash your hands before you eat or touch your face

• Be especially careful about touching things and then touching your face

• Sneeze or cough into the crook of your elbow to prevent your hands being contaminated

• Carry disposable tissues with you, cover your nose and mouth when you cough or sneeze and dispose of the tissue carefully (catch it, bin it, kill it)

• If you do have to go to work remember social distancing rules and keep away from people

• Wash your hands when you get in after you have been out

• Regularly clean not only your hands but also commonly used surfaces and devices you touch or handle

Is it just droplets from the nose and mouth that spread the new virus?

Probably not, but they are by far the most common risk.

The NHS and WHO are advising doctors that the virus is also likely to be contained in other bodily secretions including blood, faeces and urine.

Here again, hand and surface hygiene is the key.

How can I protect my family, especially children?

Children are a major vector for the spread of droplet-based viruses because they interact physically so much with each other and are not the best at keeping themselves clean.

The virus appears to impact older people more commonly but children can be infected and they can get severe illness, the government warns.

However, you can greatly lower the risk that children pose of spreading or catching viruses by:

• Explaining to them how germs spread and the importance of good hand and face hygiene

• Ensuring that they stick to the rules on social distancing so no meeting up with friends however bored they are getting

• Keeping household surfaces clean, especially kitchens, bathrooms, door handles and light switches

• Using clean or disposable cloths to wipe surfaces so you don't transfer germs from one surface to another

• Giving everyone their own towel and making sure they know not to share toothbrushes etc

• Keep your home dry and airy (bugs thrive in musty environments)

The Government is advising that people stay at home and practice social distancing. Stay at least three metres away from other people.

Do not go to work unless it's essential.

Are some groups of people more at risk than others?

Data from China suggests that people of all ages are at risk of contracting the virus, although older people are more likely to develop serious illness.

People with a reduced chance of surviving pneumonia include:

• Those over age 65

• Children under the age of two

• People with underlying health conditions or a weakened immune system

Of the first 425 confirmed deaths across mainland China, 80 per cent were in people over the age of 60, and 75 per cent had some form of underlying disease.

However, young people are not "invincible" as the WHO has warned and they must follow official advice.

Is there a vaccine for coronavirus?

There are almost 200 coronavirus vaccine candidates in development, and at least 15 of these are in human trials.

The most promising developments currently come from Pfizer and Moderna, the latter of which has proven nearly 95 per cent effective in trials.

In comparison to the Moderna vaccine, the Pfizer is more than 90 per cent effective in preventing Covid-19 among those without evidence of prior infection.

The founder of the firm behind the coronavirus vaccine breakthrough has said that the jab has “no serious side effects”.

The comments by immunologist Professor Uğur Şahin, the founder of the BioNTech firm which has developed a vaccine alongside Pfizer, came after promising clinical results earlier this week.

“Key side effects” included a mild to moderate pain in the injection site for a few days, and a “mild to moderate fever” for one or two days, he told the BBC on November 15.

In an announcement from Downing Street on November 16, the Health Secretary, Matt Hancock, shared that the UK has now ordered 100 million doses of coronavirus vaccination when combining the Pfizer and Moderna vaccines and the Astrazeneca (Moderna) agreements.

Both vaccinations will be injected in two does, with the Pfizer likely to arrive in the country before Christmas, and the Moderna expected in the UK around spring 2021.

Intrim data shared on November 23 suggests that the Oxford and AstraZenca vaccine has 70 percent protection but can be as high as 90 percent by altering the dosage.

In an unexpected turn of events, Moscow also claimed its own Sputnik-V candidate had reached 92 per cent efficacy, less than 48 hours after Pfizer's announcement.

Any potential vaccine would be most likely to be given to health workers and vulnerable group most at risk of contracting the virus first.

In his discussion of the latest promising developments on November 16, Professor Van-Tam shared that the Moderna was "the biggest and most important thing the NHS has done for quite a while." He then went on to suggest the vaccination will "dramatically change what the late Spring and Summer will look like. That's how big the prize is, therefore it's really important that everyone works really hard on this."

However, researchers in China believe that the virus may have mutated into two strains, one of which is highly aggressive, and there has also been a mutation of coronavirus in Denmark linked to mink. Both of these factors may impact the effectiveness of a vaccine.

Professor Sahin admitted that he expects the antibody response in patients "will decline over time", but mooted the idea of combining vaccines for people who no longer had an immune response.

What is 'long Covid' and what are the long-term symptoms?

Many people who have been infected with the virus and recovered from its acute phase have had other lingering complaints, or what has become known as 'long Covid'. Symptoms of this often include tiredness and muscle aches.

Guidance issued by the NHS and seen by The Telegraph warns that lung disease is also likely to be an important consequence of Covid-19, in addition to an array of other long-term complications.

Anecdotal evidence suggests that weakness on being discharged from intensive care units is prevalent among more than half of Covid patients, with mild brain damage also persisting in approximately a quarter of the patients who suffer acute respiratory distress syndrome.

Whilst anyone who is critically ill is likely to suffer fatigue as they recover, the NHS guidance warns “patients who have had Covid-19 are reporting extreme fatigue beyond the usual reported levels”, and one in 10 patients could develop chronic fatigue.

The first parliamentary inquiry into the coronavirus pandemic heard from witnesses who spoke of lasting coronavirus symptoms, and found themselves being wiped out months after being first diagnosed with the virus.

An app developed at King's College London traces progress of more than 4 million Covid-19 patients in the United Kingdom, Sweden and the US. As well as the common symptoms are other effects, such as rash, fatigue, abdominal pain, headache and diarrhoea. Some people also report confusion, muscle pain, shortness of breath and a cough.

What is the difference between a coronavirus and a flu virus?

Coronaviruses and flu viruses might cause similar symptoms but genetically they are very different. Coronaviruses begin in animals so humans have no natural immunity.

"Flu viruses incubate very rapidly – you tend to get symptoms two to three days after being infected, but coronaviruses take much longer," says Professor Neil Ferguson, a disease outbreak scientist at Imperial College London.

“[With the] flu virus you become immune, but there are lots of different viruses circulating. Coronaviruses don't evolve in the same way as flu, with lots of different strains, but equally our body doesn't generate very good immunity."

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