How to tell if your cough is a sign of coronavirus

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Like many during the coronavirus pandemic — which has made more than nine million people sick, and killed at least 469,000 worldwide, the New York Times reported Monday night — I’ve been especially vigilant about any symptoms I might be exhibiting. Among those commonly listed: a cough. But as an ever-curious health reporter, not to mention someone genuinely concerned about contracting and transmitting COVID-19, I want to know more. Is it just any cough that should concern me? Should I worry only if I’m coughing intensely? What type of cough could indicate coronavirus?

Coughs tend to fall into one of two categories: wet or dry, says Panagis Galiatsatos, director of the Tobacco Treatment Clinic and an assistant professor of medicine at Johns Hopkins Medicine. A wet cough involves expelling phlegm and sputum, while a dry cough doesn’t.

COVID-19 patients more commonly have a dry cough, which is typical of viral infections, Galiatsatos explains, whereas bacterial infections, like tuberculosis, tend to result in wet coughs.

The novel coronavirus, which causes COVID-19, activates the lungs' cough receptors, making you cough and spread the virus, but it doesn’t cause the lungs to secrete mucus or initiate other defense mechanisms, Galiatsatos says — hence a wheezy cough with no moisture, instead of a wet, gurgly cough.

In other words, it triggers an immune response in the lungs, but not enough to ravage them. That said, it’s crucial to stress that even if you display only subtle symptoms of the disease, you could still spread it to people who are at higher risk of severe COVID-19 illness, such as those age 65 and older, and those with an underlying medical condition.

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It makes sense: Viruses, including the novel coronavirus, need to be inside a living host to replicate, while bacteria don’t. “A virus depends on its life source to spread,” Galiatsatos tells me. “It doesn’t have the tools to grow on its own.” As a result, viruses need to walk a fine line — infect their hosts, but without completely debilitating or killing them, he says. That's why, although COVID-19 is causing cases of serious disease and even death, “there’s a larger portion [of infected people] that just aren’t having major complications. The majority of the impact on the lungs is subtle.”

In fact, as COVID-19 progresses in an infected person, there doesn’t seem to be an increase in mucus secretion in the lungs, but rather, impaired oxygenation, or the flow of oxygen from the lungs to the blood vessels, which carry it to the rest of the body, Galiatsatos says. The COVID-19 patients he sees who do have wet coughs have underlying lung conditions like asthma or chronic obstructive pulmonary disease, which probably “pre-triggered” their lungs to produce mucus. But don't totally relax just because your cough is wet. If you do have a wet cough, you still want to keep an eye out for other symptoms of COVID-19, too, such as a fever, body aches, or loss of smell or taste.

Notify a healthcare professional at the first sign of a cough, or any other potential COVID-19 symptoms, Galiatsatos says. Rather than risk exposing yourself or others by showing up at a hospital, call your medical provider first and ask if it makes sense for you to get tested. “Flood the phone lines, and not the hospital lines,” he advises. Don’t worry about overreacting, especially because the symptoms of COVID-19 can indeed be very subtle, and if you do have the disease, you want to begin self-isolation as early as possible.

“If you a have new cough, you 100% should notify your healthcare professional,” even if you think it’s due to an underlying lung condition like asthma, Galiatsatos says. “You should still let them know and let them help you decipher, ‘Yes, this is asthma,’ or ‘No, this is something else’…. We all should have a very ultra-conservative mentality over this.”