Fever may not be the initial symptom of COVID-19 illness

Fever may not be the initial symptom of COVID-19 illness

Last Reviewed : 12/14/2020
Fever may not be the initial symptom of COVID-19 illness

There have been multiple studies published regarding the clinical characteristics of COVID-19 illness. Symptoms are relatively similar to flu-like illness. Fever, body aches, headache, cough, sore throat, fatigue and chills are seen. In about 5% of the cases, nausea and vomiting are also seen. Fever, cough and shortness of breath are the symptoms used in most of the screening criteria all across the globe. Based on the study published in New England Journal of Medicine, 1099 patients were studied for their clinical characteristics. It is interesting to note that only 44% of the patients had fever at the time of admission. 45% of the patients developed fever during the course of hospitalization, resulting in total of 89% patients having fever as the most common symptom of COVID-19 illness. Initial symptoms are variable. Common initial symptoms include cough, sore throat, headache, nausea or vomiting. Fever usually develops on day 2 or day 3. Fatigue, chills, body aches and joint pains usually follow fever.

If fever is used as the screening criteria for those 1099 patients in the study, only 44% of the patients would meet the screening criteria at the time of admission. Based on the current screening criteria, there is a possibility that some truly infected COVID-19 patients may be missed for the first few days. Although fever is one of the screening criteria, there should be a high suspicion for COVID-19 if the patient has other symptoms and laboratory findings that are consistent with COVID-19.




  1. Clinical Characteristics of Coronavirus Disease 2019 in China. Wei-jie Guan et al. New England Journal of Medicine. February 28, 2020. DOI: 10.1056/NEJMoa2002032

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