COVID-19: Nausea, vomiting, diarrhea could be first symptoms - Business Insider Page 1 of 5

Almost half of coronavirus patients experience

nausea, vomiting, or diarrhea before they get a fever.
It could be one of the first signs of COVID-19
infection.

An exhibition center has been converted into a hospital in Wuhan, February 5, 2020.
STR/AFP/Getty Images

• Almost half of patients with the new coronavirus experience nausea, vomiting, or
diarrhea.
• Though the virus primarily causes fever or difficulty breathing, these symptoms
sometimes appear first.
• In one case, a coronavirus patient was placed in the wrong ward because they only showed
abdominal symptoms. They spread the virus to 14 other people there.
• Like SARS, the new coronavirus could spread through poop.
• For the latest case total, death toll, and travel information, see Business Insider's live
updates here.
• Visit Business Insider's homepage for more stories.

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Symptoms from the coronavirus is giving almost half of coronavirus patients nausea, vomiting, and
diarrhea, CBS News reported, citing Chinese researchers.

Data from 204 coronavirus patients in their mid-50s who were hospitalized in the Hubei province in
China between between Jan. 18 and Feb. 28, according to the CBS News report.

"Clinicians must bear in mind that digestive symptoms, such as diarrhea, may be a presenting fea-
ture of COVID-19, and that the index of suspicion may need to be raised earlier in these cases rather
than waiting for respiratory symptoms to emerge," investigators from the Wuhan Medical Treat-
ment Expert Group for COVID-19 wrote, according to CBS News.

Gastrointestinal symptoms like nausea and diarrhea could be early clues of coronavirus infection,
according to a study by The American Journal of Gastroenterology.

The deadly new coronavirus, which causes a disease known as COVID-19, has spread from the city
of Wuhan, China, to more than 156 countries. As of Thursday, the disease has infected more than
242,700 worldwide, and the global death toll has surpassed 9,800.

The coronavirus is part of a family of respiratory illnesses that includes the common cold, severe
acute respiratory syndrome (SARS), and Middle East respiratory syndrome (MERS). Patients often
show pneumonia-like symptoms, especially fever, cough, and difficulty breathing.

A peer-reviewed study published in the Journal of the American Medical Association identified 14
coronavirus patients who had diarrhea and nausea before they showed any signs of fever or respira-
tory symptoms. That was 10% of the study's 138-person sample size.

One of those patients was placed in a surgical ward because they only showed abdominal symptoms,
so doctors didn't suspect the new coronavirus. That patient then transmitted the virus to at least 10
healthcare workers and four other patients in the ward. (If you think you might have the corona-
virus, call your doctor before leaving the house.)

Researchers found the virus in poop

A staff member moves bio-waste containers past the entrance of the Wuhan Medical
Treatment Center in Wuhan, China, where some people infected with the new virus are
being treated on January 22, 2020.
Dake Kang/AP

The first US patient with the new coronavirus had diarrhea and reported abdominal discomfort the
day after he arrived at the hospital, according to a report published in the New England Journal of
Medicine. Researchers later detected the coronavirus' RNA in his poop.

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Another study, shared in the pre-publication repository biorXiv, detected an enzyme signature of the
virus in cells from the small intestine and colon.

Patients in China and Vietnam have also had diarrhea, vomited, or reported nausea.

These symptoms could be relatively rare, though: A study published in the pre-print repository
medRxiv (which has not been peer-reviewed) looked at data from 1,099 patients. Less than 4% of
those people experienced diarrhea and about 5% experienced vomiting.

These uncommon symptoms aren't emphasized in official guidelines from the US Centers for Dis-
ease Control and Prevention (CDC). But the agency's guidance for healthcare professionals does
make a brief mention of diarrhea as an uncommonly reported symptom, along with "a general feel-
ing of being unwell."

Watching for nausea, vomiting, and diarrhea could help

contain the outbreak
Health workers wear full protective clothing during a clean up operation at Amoy
Gardens in Hong Kong, where over 200 residents were infected with SARS, April 4, 2003.
Christian Keenan/Getty Images

This is not the first time scientists have found a coronavirus in patients' poop. Research indicated
that SARS traveled through a Hong Kong apartment's sewage system to infect some residents after
one sick person had diarrhea.

Dr. Susan Kline, a spokesperson for the Infectious Diseases Society of America, told MedPage
Today that gastrointestinal symptoms were "not unusual" in SARS patients during the virus's deadly
2003 outbreak.

The coronavirus has killed more than 1,000 people — a higher death toll in six weeks than SARS had
in eight months.

Kline said that many illnesses cause nausea, diarrhea, and vomiting, even if those aren't the pri-
mary symptoms. Looking for them can be crucial in the early stages of a new outbreak, as it was
with SARS and Ebola.

"It was not recognized early on that [Ebola] patients had prominent diarrhea. Later, as [there were]
reports of large numbers of patients, it became more obvious that it could be a predominant part of
the illness," Kline said.

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Kline added that it's important not to assume that all patients will have gastrointestinal problems,
though. Still, including those symptoms in official guidelines could help catch more coronavirus
cases early on.

"That would be helpful for clinicians to have, so they could at least consider that a patient with
novel coronavirus might have vomiting or diarrhea," she said.

Have you been personally impacted by the coronavirus epidemic? Is your city or
community on the front lines of this disease? Have you or someone you know been
tested or diagnosed? We want to hear your story. Please email science+corona-
virus@businessinsider.com
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headache, nausea, vomiting, or diarrhea.
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