The Coronavirus Outbreak

By Pam Belluck

Chills, muscle pain, sore throat and headache are among the ailments now considered potential indicators of the disease.

A coronavirus patient in the intensive care unit of Stamford Hospital in Connecticut.
A coronavirus patient in the intensive care unit of Stamford Hospital in Connecticut.Credit...John Moore/Getty Images
Pam Belluck

Echoing the observations of doctors treating thousands of patients in the pandemic, the federal health agency changed its website to cite the following symptoms as possible indicators of Covid-19, the infection caused by the coronavirus:

  • chills

  • repeated shaking with chills

  • muscle pain

  • headache

  • sore throat

  • and, new loss of taste or smell.

Previously it had listed just three symptoms: fever, cough and shortness of breath.

The C.D.C. added the six symptoms earlier this month after new recommendations were issued by an organization of public health epidemiologists that is responsible for defining which infectious diseases are tracked and reported to the agency. The organization, the Council of State and Territorial Epidemiologists or C.S.T.E., recommended that Covid-19 be considered a nationally reportable illness and gave guidelines about how cases should be defined and identified.

The group’s recommendations say that cases should be reported if there are positive lab tests, but also if there are clinical symptoms that meet one of several thresholds. One category involves people who have cough, shortness of breath or difficulty breathing. Another involves people with two of the following symptoms: fever, chills, shivers, muscle pain, headache, sore throat or new dysfunction of taste and smell. Cases of people in both categories should be reported as likely Covid-19 only if there is no other more plausible diagnosis, the recommendations say.

While people who become seriously ill from coronavirus infection primarily have acute respiratory distress, other symptoms that accompany the disease can vary widely, doctors and researchers have reported.

It has turned out, for example, that many people with Covid-19 don’t have fevers or that their fevers wax and wane and are sometimes accompanied by chills.

Shortness of breath can emerge at the same time as other symptoms or it can crop up suddenly a week or even 10 days after a person has been experiencing more manageable symptoms like cough and aches.

Some people report a notable loss of smell and taste, an effect that can also occur with other respiratory infections.

The revised C.D.C. list differs somewhat from the symptoms described by the World Health Organization on its website. The W.H.O. says the most common symptoms are fever, dry cough and tiredness. “Some patients may have aches and pains, nasal congestion, sore throat or diarrhea,” the W.H.O. says. “These symptoms are usually mild and begin gradually.”

Both agencies recommend that people seek emergency medical attention if they have trouble breathing or persistent pain or pressure in the chest. The C.D.C. also says that immediate medical attention should be sought if people experience sudden confusion, cannot be aroused or if their lips or face turn a bluish color.

  • Updated April 11, 2020

    • This is a difficult question, because a lot depends on how well the virus is contained. A better question might be: “How will we know when to reopen the country?” In an American Enterprise Institute report, Scott Gottlieb, Caitlin Rivers, Mark B. McClellan, Lauren Silvis and Crystal Watson staked out four goal posts for recovery: Hospitals in the state must be able to safely treat all patients requiring hospitalization, without resorting to crisis standards of care; the state needs to be able to at least test everyone who has symptoms; the state is able to conduct monitoring of confirmed cases and contacts; and there must be a sustained reduction in cases for at least 14 days.

    • If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.

    • The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.

    • It seems to spread very easily from person to person, especially in homes, hospitals and other confined spaces. The pathogen can be carried on tiny respiratory droplets that fall as they are coughed or sneezed out. It may also be transmitted when we touch a contaminated surface and then touch our face.

    • No. Clinical trials are underway in the United States, China and Europe. But American officials and pharmaceutical executives have said that a vaccine remains at least 12 to 18 months away.

    • Unlike the flu, there is no known treatment or vaccine, and little is known about this particular virus so far. It seems to be more lethal than the flu, but the numbers are still uncertain. And it hits the elderly and those with underlying conditions — not just those with respiratory diseases — particularly hard.

    • If the family member doesn’t need hospitalization and can be cared for at home, you should help him or her with basic needs and monitor the symptoms, while also keeping as much distance as possible, according to guidelines issued by the C.D.C. If there’s space, the sick family member should stay in a separate room and use a separate bathroom. If masks are available, both the sick person and the caregiver should wear them when the caregiver enters the room. Make sure not to share any dishes or other household items and to regularly clean surfaces like counters, doorknobs, toilets and tables. Don’t forget to wash your hands frequently.

    • Plan two weeks of meals if possible. But people should not hoard food or supplies. Despite the empty shelves, the supply chain remains strong. And remember to wipe the handle of the grocery cart with a disinfecting wipe and wash your hands as soon as you get home.

    • That’s not a good idea. Even if you’re retired, having a balanced portfolio of stocks and bonds so that your money keeps up with inflation, or even grows, makes sense. But retirees may want to think about having enough cash set aside for a year’s worth of living expenses and big payments needed over the next five years.