The novel coronavirus that causes COVID-19 is a slippery customer. The trio of characteristic symptoms is supposed to be cough, fever, and trouble breathing. But clinicians are learning that in a subset of patients with COVID-19, gastrointestinal issues can be the first—and sometimes only—symptom. (In another subset, loss of smell and taste is.)

As early as January, patients in China were showing up at clinics with diarrhea and testing positive for COVID-19. One epidemiological study of 206 patients in China found that 48 of them had no other symptoms but gut issues. In that study, patients with digestive symptoms had a “low severity of disease,” the authors say, but they took longer to clear the virus, especially from the stool.

True to its reputation for unpredictability, in another study—also chronicling patients in China—COVID-19 with gut symptoms was linked to worse findings. These researchers concluded that patients with digestive symptoms showed more evidence of liver and blood clotting problems than those who did not.

What the two studies had in common was that about a third of the patients had some kind of gastrointestinal symptom, usually diarrhea. Nausea and vomiting were more rare.

The same pattern is turning up outside of China, including in Europe (a third of patients, again), and the U.S. Centers for Disease Control and Prevention (CDC) has added nausea, vomiting, and diarrhea to its online coronavirus self-checker.

When should you worry about your diarrhea?

The CDC defines diarrhea as 3 or more loose stool events in 24 hours, or a rate of these events that’s unusual for you. If you experience this, in the current climate, you might want to consider isolating yourself as you would if you developed a more common COVID-19 symptom.

The time to call your doctor is if you have blood in your stool, says Peter Chin-Hong, M.D., professor of medicine and an infectious disease specialist at the University of California, San Francisco. “That would be a red flag,” he says, as would having five or more bowel movements a day. If that happens, “you should probably contact somebody,” he says.

What can you take for diarrhea right now?

Not much in the way of pills. “We know of nothing that can alter the course of the disease,” says Tim Lahey, M.D., an infectious disease doctor and ethicist at the University of Vermont Medical Center. Furthermore, sometimes, GI symptoms can be the result of anxiety about COVID-19 giving you diarrhea, he says.

Dr. Chin-Hong says that if you develop diarrhea, you’ll want to avoid nonspicy foods and take clear liquids, “all the usual things around diarrhea,” he says. Nausea is more rare in his experience, he says, representing probably less than 10 percent of cases.

One concern with diarrhea, especially if you have fever, too, is losing too many electrolytes. Replacement options include Pedialyte, Gatorade, or other electrolyte-replacing beverages.

The thing you want to try to avoid, says Dr. Chin-Hong, is reaching for the Imodium. If your diarrhea is bothersome in its frequency or you’re seeing blood in your stool, “you should probably contact somebody before you try to suppress it” with drugs, he says. With diarrhea, often what’s in there needs to get out.

How long will it last?

The reports from China describe diarrhea as lasting from 1 to 14 days, with an average of 5.4 days. The average frequency of loose stools was 4.3 a day.

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