Stomach Ache And Diarrhea May Be Among The First Signs Of COVID-19 Coronavirus Page 1 of 6

593,299 views | Mar 20, 2020, 12:48pm EDT

Robert Glatter, MD Contributor

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Woman suffering from abdominal pain. (Photo by: BSIP/Universal Images Group via Getty Images) UNIVERSAL

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While we are focused on cough and fever as the initial signs of COVID-19, it’s
also important to be aware that abdominal pain, vomiting and diarrhea could
precede respiratory symptoms in some people.

Results of a new study published in the American Journal of Gastroenterology

indicate that a subset of persons could develop symptoms such as vomiting and
diarrhea along with abdominal pain during early stages of infection with SARS -
CoV-2, the virus that causes COVID-19.

That said, its still important to realize that respiratory symptoms are the more
common presentation—fever and dry cough—as COVID-19 mainly affects the
lungs. The potential for also having minimal early symptoms (nasal congestion,
aches pains, and sore throat)—or none at all— has also been described, and is
believed to be associated with ongoing asymptomatic transmission.

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In the small study of 204 patients diagnosed with COVID-19 in the Hubei
province of China, researchers noted that nearly 49% of these patients
presented to the emergency department with gastrointestinal (GI) symptoms
such as vomiting, diarrhea or abdominal pain. This subset of patients with
abdominal pain as their chief presenting symptom also had a more severe
course of their illness, while also taking longer to seek medical care.

“The authors provide detailed clinical information from 204 patients suggesting
that a small minority (7/204) had only GI symptoms without any respiratory
symptoms, through 45% had both respiratory and GI symptoms,” said Arun
Swaminath MD, FACG, Associate Professor of Medicine, Zucker School of
Medicine at Hofstra/Northwell, Director Inflammatory Bowel Disease Program,
Lenox Hill Hospital, Northwell Health.

“The public and patients should understand that some GI symptoms (such as
loose stools up to 3 times per day) may accompany respiratory complaints in
almost half of patients. Physicians evaluating new GI complaints should
consider COVID-19 and take appropriate precautions,” explained Swaminath.

Swaminath also qualified that “no patients with underlying bowel diseases were
included, so we don't know how COVID-19 affects patients with underlying
bowel diseases, such as Crohn's disease and ulcerative colitis.”

“Given that COVID-19 is found in stool, it's probably best to use meticulous
hand hygiene and bleach/antiseptic wipes in shared bathrooms (if self-
quarantined). If the luxury of a second bathroom exists, then one should be for
exclusive use of the quarantined patient,” added Swaminath.

The take-away from this study is that COVID-19 patients diagnosed with GI
symptoms had an adverse outcome and increased risk of death compared to
those without GI symptoms. This underscores the need to evaluate GI
symptoms— nausea, vomiting or diarrhea— as a potential presentation of
COVID-19, prior to development of respiratory symptoms.

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At the same time, it’s also possible to realize that such symptoms could also be
due to influenza or the common cold, emphasizing the importance of testing for
COVID-19 , as well as influenza and other common respiratory pathogens.

Based on data from The WHO, nearly 1 in 6 persons who is diagnosed with
COVID-19 will develop severe illness and respiratory compromise that may lead
to the need for mechanical ventilation.

A recent study of 21 elderly patients in Seattle early in the outbreak noted that
71% of patients ended up requiring mechanical ventilation, with 100% of these
patients developing acute respiratory distress syndrome (ARDS). The
researchers in this study further noted that those with congestive heart failure,
diabetes, and chronic kidney disease were at highest risk for adverse outcomes
including death.

SARS-CoV-2 is primarily transmitted by droplets, via coughing or sneezing, as

opposed to transfer from surfaces, according to the CDC. (The virus can be
active on hard surfaces such as plastic or stainless steel for 2-3 days and
cardboard for 1 day) While the virus may potentially be aerosolized via droplets
for several hours (< 3 hours), this is not believed to be the primary mode of
transmission.

Data thus far indicates that people who typically require hospitalization arrive at
the hospital within 7-9 days of onset of symptoms, with a peak in mortality seen
at 3 weeks after initial symptoms.

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Robert Glatter, MD

I am an emergency physician on staff at Lenox Hill Hospital in New York City, where I have
practiced for the past 15 years. I also serve as an adviser and editor to… Read More

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