Sore Throat in COVID

A sore throat is a common symptom of many illnesses, ranging from nonserious to life-threatening. Sore throat is also a sign of the coronavirus disease 2019 (COVID-19), the contagious disease caused by the SARS-CoV-2 virus.

While it is rare, it is possible to have COVID-19 with a sore throat as the only symptom. A sore throat might also be the first or one of the earliest symptoms. However, fever is more likely to present first or with a sore throat. Additional early symptoms may include loss of taste and smell. It is also possible to have COVID-19 and not have a sore throat.

This article will describe sore throat symptoms in COVID-19, sore throat linked to long COVID-19, non-COVID causes, treatments for a COVID-19 sore throat, and more. 

Describing Sore Throat Symptoms in COVID

No evidence suggests that a COVID-19 sore throat feels different from a sore throat related to another cause, including the common cold, strep throat, or the flu.

Feeling of Throat Pain 

If you have a sore throat from COVID-19, you will likely experience general sore throat symptoms.

Such symptoms include:

• Pain or a feeling of stiffness, especially when talking and swallowing 
• A dry or scratchy feeling in the throat 
• Redness and soreness at the back of the throat

As COVID-19 worsens, you may experience a persistent cough, worsening throat pain, and additional symptoms.

How Long It Lasts

Symptoms of COVID-19 occur two to 14 days after exposure to the virus. In the first few days, you will experience mild symptoms, including sore throat. You might also experience fever, which is an increase in body temperature. These symptoms will last a few days before additional symptoms start.

You may experience cough, congestion, headaches, and body aches following sore throat and fever. Once you experience more severe symptoms, your sore throat may improve.

If a sore throat is your only symptom, your COVID-19 illness is considered mild. Around 81% of people who had COVID-19 had a mild or moderate illness. Most people with mild to moderate COVID-19 can recover at home. 

Even with mild symptoms of COVID-19, monitor your symptoms since it's possible for symptoms to worsen and for breathing troubles or severe pneumonia to develop.

Sore Throat in Long COVID 

Long COVID is the term used to describe ongoing health problems and symptoms that affect some people after getting over COVID-19. Anyone experiencing COVID-19 symptoms at least four weeks after symptoms started might have long COVID. It is also possible to have long COVID and not know when you were infected. 

People with long COVID may have symptoms that last weeks, months, and years after infection. However, a persistent sore throat is not a symptom of long COVID and is more likely related to other conditions. 

Conditions that might lead to a persistent sore throat include:

• Smoking: Both smoking and secondhand smoke can cause a sore throat. Smoking can lead to asthma, bronchitis, and emphysema and is also a risk factor for throat cancer.
• Allergies: A sore throat related to allergies can cause a sore throat from postnasal drip (when sinuses drain into the throat). Common allergens include pollen, dust mites, and pet dander.
• Acid reflux: Stomach acid can enter the esophagus (the connecting tube from the mouth to the stomach) while you sleep. As a result, you will awaken to a sore throat. Acid reflux can also cause cough, excess throat mucus, and voice hoarseness. 
• Mouth breathing: Most people breathe through both the nose and mouth. However, allergies, a cold, or another condition might lead to mouth breathing (breathing through the mouth only). Mouth breathing can cause sore throat, dry mouth, bad breath, voice hoarseness, snoring, and sleep problems.
• Throat cancer: While a rare cause of sore throat, a throat tumor or growth might cause a sore throat.
  

Non-COVID Causes of Sore Throat

A sore throat does not always mean COVID-19. Additional causes of sore throat include strep throat, the common cold, flu, tonsillitis, laryngitis, various viral infections, or a throat injury, as follows:

• Strep throat: Strep is an infection caused by Streptococcus pyogenes bacteria. In addition to sore throat, it causes fever, chills, swollen lymph nodes in the neck, inflamed tonsils, and small red spots at the roof of the mouth.
• The common cold: The common cold is caused by a viral infection and can produce a sore throat. Additional symptoms include fatigue, stuffy nose, headache, sneezing, and cough.
• Influenza: The flu is also caused by a viral infection and produces symptoms similar to the common cold, including a sore throat. But the symptoms are much worse, and the flu causes fever, chills, and body aches.
• Tonsillitis: This is an infection of the tonsils by viruses and bacteria. Tonsillitis can also cause sore throat, swollen tonsils and lymph nodes, and fever.
• Laryngitis: Laryngitis refers to inflammation of the voice box. It can produce a sore throat and might be caused by a viral infection. Additional symptoms include voice loss, a tickling sensation in the throat, a dry throat, and a cough.
• Other viral infections: Additional viral infections that can lead to a sore throat include mononucleosis, chickenpox, measles, and mumps. It is possible to prevent chickenpox, measles, and mumps or lessen their severity with vaccination. 
• A throat injury: You can experience a sore throat after a blunt force trauma to the throat. This could be related to an automobile accident, physical assault, or sports injury.
• Throat surgery: If you have had throat surgery to remove the thyroid or tumor, you might experience a sore throat following the surgery.
  

How Do You Tell the Difference?

If you or a family member has a sore throat that has lasted for a few days and is not getting better or is present with other symptoms, you should contact your healthcare provider. The only way to know for sure if COVID-19 is causing your sore throat is to get tested. 

Determining the cause of sore throat might be possible based on your symptoms. For example, COVID-19 can cause a loss of smell or taste, while other causes generally do not. Common cold symptoms come on gradually, and fever and shortness of breath are rare with the common cold.

Like COVID-19, the symptoms of the flu come on suddenly and get worse quickly. However, COVID-19 symptoms tend to be more severe and could last weeks, while most people with the flu get better in about five to seven days.

Strep throat will come on quickly, and most people with this condition will have a high fever. Strep throat will typically not cause a cough or a runny nose, which are more common with COVID-19.

Allergies can cause a sore throat, runny or stuffy nose, itchy, watery eyes, and sneezing. Allergies will not present with fever, body aches, fatigue, or shortness of breath like COVID-19.

Even if you think you know what is wrong with you or if you test negative for COVID-19, you should contact your healthcare provider if you are experiencing severe symptoms, are not getting better, or have risk factors and preexisting health conditions.

Such risk factors include being older than 65, having a health condition and taking medication that affects your immune system's ability to fight off infections, or having a chronic condition like asthma, heart disease, obesity, or diabetes.

Treatments to Manage COVID Throat Pain 

There is no cure for a COVID-19 sore throat. It will improve on its own. But there are things you can try to ease throat pain and discomfort. 

You can try one or more of these home remedies to manage your sore throat pain:

• Cold drinks and foods: Drink cold liquids and eat cold foods to soothe your throat pain. Try ice water, chilled juices, popsicles, and ice cream.
• Stay hydrated: Drink plenty of liquids to help you recover quicker. Consider broths and tea with honey to help soothe throat discomfort and soreness.
• Gargle with salt water: A saltwater solution can help reduce soreness and lessen throat pain. 
• Throat lozenges and sprays: Over-the-counter (OTC) throat lozenges and sprays can relieve pain. Their numbing effect can make a sore throat feel better.
• Honey: This is a natural option that coats the throat to provide pain relief. While there is no evidence to suggest that it helps relieve sore throat related to COVID-19, research shows it can offer pain relief after tonsil removal surgery. Honey is safe for anyone over 12 months old. 
• Use a humidifier: A humidifier can add moisture to the air to help ease throat irritation. 
• OTC pain relievers: Tylenol (acetaminophen), Advil or Motrin (ibuprofen), Aleve (naproxen), and aspirin can all ease throat pain.
• Rest your throat: You should avoid things that worsen your sore throat. This includes crunchy foods with sharp edges, spicy and acidic foods, and smoking. Consider resting your voice by not shouting or yelling. 
• Antiviral medicine: If you are at high risk for complications from COVID-19, your healthcare provider might prescribe an antiviral treatment. An antiviral like Paxlovid (nirmatrelvir and ritonavir) keeps you from getting severely sick. Your healthcare provider might prescribe additional treatments, if necessary. 
  

When to Get Tested

If you have symptoms, you can get a test to determine if you have COVID-19, advises the Centers for Disease Control and Prevention (CDC). If you are not experiencing symptoms and have been exposed to COVID-19, you should wait at least five days after exposure to get tested.

You can test at home using a rapid antigen test available at most pharmacies. These tests can detect higher amounts of virus particles but can also give false negatives. That means a false test does not mean you are not contagious or do not have COVID-19; it just means you have not reached the test's threshold for viral particles. 

A polymerase chain reaction (PCR) test is more sensitive and can be done at your healthcare provider's office or a COVID-19 testing location. These tests can detect smaller amounts of the virus earlier.

Symptoms That Warrant a Provider Visit 

You should contact your healthcare provider if you experience symptoms of COVID-19 and test positive. This is especially important if you have a chronic condition or a compromised immune system. Your healthcare provider can advise you on treatment options based on your unique health situation and symptoms experienced. 

Most people can treat COVID-19 at home with rest and OTC therapies to manage symptoms. Others, however, may experience more severe symptoms.

Keep an eye out for the following severe symptoms of COVID-19 in yourself or others, such as:

• Breathing troubles
• Chest pain or pressure on the chest
• Confusion
• Inability to wake up or stay awake 
• Pale or blue-colored skin, lips, or nails
  

If you or someone you're with is experiencing these symptoms, call 911 or head to your local emergency department.

Summary

A sore throat is a common symptom of COVID-19. It can occur as an early symptom and as a lone symptom. It is also possible to not experience a sore throat with COVID-19.

If you develop a sore throat and think you may have COVID-19, stay home and call your healthcare provider. They can advise you on testing and treatment. 

Use OTC pain relievers, lozenges, and sprays to manage sore throat pain and discomfort. Consider additional ways to soothe your sore throat, such as eating and drinking cold foods and drinks and resting your voice.

Depending on your health status and the symptoms experienced, your healthcare provider might prescribe an antiviral medication or other treatments. 

You should contact your healthcare provider for more severe symptoms of COVID-19. Get emergency care for breathing troubles, chest pain or pressure, confusion, inability to stay awake or wake up, or pale or blue-colored lips, skin, or nails.