COLUMBUS, Ohio (WCMH) – Patients who contract COVID-19 are showing new symptoms previously not associated with the virus, according to Ohio Department of Health Director Dr. Amy Acton.

Acton said some of the data, particularly out of Cuyahoga County, show patients exhibiting gastrointestinal upset, more fatigue, and sometimes not showing a fever, in addition to the previous flu-like symptoms.

“My best advice to everyone is if you don’t feel well in any way, stay home and make that call,” she said.

Previously, symptoms of viral infection were thought to be limited to those similar to the flu – fever, tiredness, and a dry cough, with difficulty breathing in more severe cases. Patients continue to show those symptoms as well.

A small study out of China found similar cases. Published in the American Journal of Gastroenterology, the study found that GI upset, not previously considered to be a common symptom, were the “chief complaint” in almost half of the COVID-19 cases studied, CNN reports. Symptoms ranged from loss of appetite to diarrhea and vomiting.

The study involved 204 confirmed COVID-19 patients in Hubei Province, China.

Researchers warned, “If clinicians solely monitor for respiratory symptoms to establish case definitions for COVID-19, they may miss cases initially presenting with extra-pulmonary symptoms, or the disease may not be diagnosed later until respiratory symptoms emerge.”

They went on to suggest that missing early GI symptoms could have contributed to the early spread of the virus among health care workers in China.