Healthcare workers on the frontline are starting to report a disturbing finding when it comes to caring for COVID-19 patients.

Time and again, they are seeing patients who come to the emergency room with “mild symptoms” that can be managed at home; then, 1-2 days later, these patients are back and they’re drastically sicker. One ER doc describes it like this: ”It’s slow, slow, slow, and then bang – people are suddenly really sick and crashing. It can be really scary to see.”

Some patients are describing a similar experience. They may be having mild symptoms like cough, fatigue, and muscle aches for a few days, and then suddenly experiencing severe shortness of breath, making it almost impossible to fill their lungs with air.

Doctors are also finding that some patients report that they are starting to feel a little better after about a week, then over the course of 1-2 days, the symptoms come back with a vengeance requiring higher level care in the hospital – including high levels of oxygen and breathing tube placement.

What does the spectrum of COVID-19 illness look like?

From current data, it looks like about 25-30% of people can be asymptomatic or “pre-symptomatic” spreading COVID-19 without even knowing that they have it. About 80% of people go on to have mild to moderate illness, and don’t go past this stage. But about 16% of people do worsen and go on to have more serious disease.

From what we are seeing in terms of patient’s experiences with COVID-19 it appears that mild symptoms can feel like a cold: runny nose, cough, sore throat. Mild-moderate may feel more like the flu or “walking pneumonia”: wiped out for days, deep, dry cough, fever, shortness of breath, taking a few weeks to recover, potentially needing care in a hospital. Patients with severe-critical cases experience severe shortness of breath, air hunger, deep cough, needing to be hospitalized, needing oxygen, needing ICU level care, needing ventilator, with a high risk for death.

(It’s also important to remember that the list of possible symptoms has grown beyond fever, cough, and shortness of breath; symptoms may also include: headache, runny nose, sore throat, weakness, fatigue, muscle aches and pains, nausea, stomach upset, vomiting, diarrhea, loss of smell and taste, red eyes.)