A new study published in The American Journal of Gastroenterology reports that some people who get the coronavirus will experience digestive symptoms like diarrhea as a first sign of the virus.

COVID-19 is a new-to-humans coronavirus that primarily attacks the lungs and respiratory system. Its primary symptoms include fever, cough, shortness or breath and, if the infection worsens, chest pain, pneumonia and difficulty breathing. As medicals experts around the world race to learn new information, however, the list of the symptoms expands.

The new study published in the American Journal of Gastroenterology looked at data from 204 patients with COVID-19 in China’s Hubei province. Researchers found that 48.5% of these patients arrived at the hospital with digestive symptoms such as diarrhea, vomiting, or abdominal pain. The study suggested digestive symptoms may present before the respiratory symptoms of COVID-19. Those with digestive symptoms included in this study also had a more severe course of illness.

This study’s findings add additional evidence to mounting suspicion that COVID-19 causes gastrointestinal symptoms for some people. A case report published in the New England Journal of Medicine on the first known COVID-19 patient in the United States, for example, noted the patient experienced loose stool and abdominal discomfort during their second day of hospitalization. Other research has found evidence the virus is shed in fecal matter, similar to other coronaviruses like SARS and MERS.

While more research is needed to understand the role and impact of digestive symptoms in those who get COVID-19, Brennan M.R. Spiegel, M.D., co-editor-in-chief of the American Journal of Gastroenterology, said in a press release that an awareness of digestive symptoms can aid efforts to detect COVID-19 earlier:

In this study, COVID-19 patients with digestive symptoms have a worse clinical outcome and higher risk of mortality compared to those without digestive symptoms, emphasizing the importance of including symptoms like diarrhea to suspect COVID-19 early in the disease course before respiratory symptoms develop. This may lead to earlier diagnosis of COVID-19, which can lead to earlier treatment and more expeditious quarantine to minimize transmission from people who otherwise remain undiagnosed.

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