Coronavirus symptoms update: There are six ‘types’ of COVID-19 – see which one you have

Coronavirus unleashed its destructive power in 2020 but its effects will be felt for many years to come. Much about the virus remains unanswered: where did it originate and how did it spread? Having paid a hefty price for being caught off guard, it is safe to say that a steady stream of investment will be poured into monitoring viruses to prevent recurrent pandemics. It is easy to become pessimistic about humanity’s response but the scientific community has learned a staggering amount in a short timeframe.

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The response has been particularly heartening in the area of symptoms, where research bodies have established an expansive map.

Now data from the COVID Symptom Study app, led by researchers from King’s College London and the health technology company ZOE, has made an important to contribution to our understanding.

It has revealed that there are six distinct ‘types’ of COVID-19, each distinguished by a particular cluster of symptoms.

Moreover, the team found that these types differed in the severity of the disease and the need for respiratory support during hospitalisation.

The findings have major implications for clinical management of COVID-19, and could help doctors predict who is most at risk and likely to need hospital care in a second wave of coronavirus infections.

Launched in March in the UK and extended to the US and Sweden, the COVID Symptom Study app asks participants to log their health and any new potential symptoms of COVID-19 on a daily basis. With more than 4 million users, this represents the largest study of its kind in the world.

Although continuous cough, fever and loss of smell (anosmia) are usually highlighted as the three key symptoms of COVID-19, data gathered from app users shows that people can experience a wide range of different symptoms including headaches, muscle pains, fatigue, diarrhoea, confusion, loss of appetite, shortness of breath and more.

The progression and outcomes also vary significantly between people, ranging from mild flu-like symptoms or a simple rash to severe or fatal disease.

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To find out whether particular symptoms tend to appear together and how this related to the progression of the disease, the research team used a machine learning algorithm to analyse data from a subset of around 1,600 users in the UK and US with confirmed COVID-19 who had regularly logged their symptoms using the app in March and April.

The analysis revealed six specific groupings of symptoms emerging at characteristic timepoints in the progression of the illness, representing six distinct ‘types’ of COVID-19.

The algorithm was then tested by running it on a second independent dataset of 1,000 users in the UK, US and Sweden, who had logged their symptoms during May.

All people reporting symptoms experienced headache and loss of smell, with varying combinations of additional symptoms at various times.

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Some of these, such as confusion, abdominal pain and shortness of breath, are not widely known as COVID-19 symptoms, yet are hallmarks of the most severe forms of the disease.

The six clusters are as follows:

1. (‘flu-like’ with no fever): Headache, loss of smell, muscle pains, cough, sore throat, chest pain, no fever.
2. (‘flu-like’ with fever): Headache, loss of smell, cough, sore throat, hoarseness, fever, loss of appetite.
3.  (gastrointestinal): Headache, loss of smell, loss of appetite, diarrhea, sore throat, chest pain, no cough.
4. (severe level one, fatigue): Headache, loss of smell, cough, fever, hoarseness, chest pain, fatigue.
5.  (severe level two, confusion): Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain.
6. (severe level three, abdominal and respiratory): Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain, shortness of breath, diarrhea, abdominal pain.

Next, the team investigated whether people experiencing particular symptom clusters were more likely to require breathing support in the form of ventilation or additional oxygen.

They discovered that only 1.5 percent of people with cluster one, 4.4 percent of people with cluster two and 3.3 percent of people with cluster three COVID-19 required breathing support.

These figures were 8.6 percent, 9.9 percent and 19.8 percent for clusters four, five and six respectively.

Furthermore, nearly half of the patients in cluster six ended up in hospital, compared with just 16 percent of those in cluster one.

Broadly, people with cluster four, five or six COVID-19 symptoms tended to be older and frailer, and were more likely to be overweight and have pre-existing conditions such as diabetes or lung disease than those with type one, two or three.

What to do if you recognise any of the specified symptoms

According to the NHS, if you have any of the main symptoms of coronavirus:

• Get a test to check if you have coronavirus as soon as possible.
• Stay at home and do not have visitors until you get your test result – only leave your home to have a test.

“Anyone you live with, and anyone in your support bubble, must also stay at home until you get your result,” advises the health body.

Use the NHS 111 online coronavirus service if:

• You’re worried about your symptoms
• You’re not sure what to do.

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