Vomiting With COVID: What Helps?

Although people generally associate COVID-19 with respiratory symptoms, vomiting is increasingly recognized as an early sign of the disease, along with other gastrointestinal (GI) symptoms such as diarrhea and abdominal pain. For some people, nausea and vomiting may be the first signs of infection.

Because people often fail to link COVID with vomiting, the risk of illness and hospitalization is greater because they assume something else—like stomach flu—is involved and don't seek treatment. Certain treatments for COVID can also cause nausea and vomiting, as can the emotional stress of having (or thinking you have) COVID.

This article describes the GI symptoms of COVID-19 and how the virus causes vomiting in some people. It also explains how to manage vomiting if you have COVID and when to see a healthcare provider.

Vomiting in COVID: Symptoms to Know About

Studies have shown GI symptoms are more common with COVID-19 than some might think. A large retrospective study conducted at Rush University Medical Center in Chicago reported more than 1 in 5 people with COVID-19 (22.4%) had a GI symptom as the first sign of infection.

GI symptoms, by order of frequency, are:

• Diarrhea (69.9%)
• Nausea and vomiting (61.7%)
• Abdominal pain (25.2%)

Moreover, 1 in 3 had more than one of these symptoms, and 1 out of 10 had all three symptoms.

In around 3% of cases, a person with COVID may experience GI symptoms like vomiting, diarrhea, and a loss of appetite and have no respiratory symptoms whatsoever.

The early occurrence of GI symptoms can worsen outcomes in people with COVID-19, including an increased risk of hospitalization, intensive care unit (ICU) admissions, and intubation (insertion of a breathing tube). Those with GI symptoms, including nausea and vomiting, also tend to have longer hospital stays.

Less common GI symptoms of COVID include:

• Belching
• Acid reflux
• Heartburn
• GI bleeding

Duration of COVID Vomiting Symptoms

Generally speaking, GI symptoms of COVID-19, such as vomiting, will precede the respiratory symptoms by several days. Thereafter, the duration of vomiting can vary, with some cases lasting up to seven days. Other cases may last for only one or a few days.

In fact, the first confirmed case of COVID-19 in the United States was in a person who experienced two days of vomiting before the infection was officially diagnosed.

However, the GI symptoms of COVID-19 are not always short-lived. People with long COVID—broadly defined as COVID symptoms that persist for more than 12 weeks after the infection has cleared—will often experience ongoing diarrhea, abdominal pain, vomiting, and other symptoms.

A 2021 study in Lancet Gastroenterology and Hepatology reported that no less than 45% of people hospitalized for COVID had one or more GI symptoms 12 weeks after their discharge, including:

• Nausea (18%)
• Acid reflux (18%)
• Diarrhea (15%)
• Belching (10%)
• Vomiting (9%)
• Abdominal pain (7%)

While there is no way to tell how long a long-COVID event might last, a 2021 study from Egypt suggested that the average duration is 175 days.

Treatment to Manage Vomiting With COVID

There is no specific guideline for treating GI symptoms of COVID-19. For mild COVID-19 infections, the treatment focuses on managing symptoms at home.

For nausea and vomiting, you may be advised to:

• Drink plenty of fluids to avoid dehydration. If you are having trouble keeping liquids down, sip small amounts frequently.
• Eat bland foods, steering clear of spicy, salty, or fatty foods.
• Eat smaller, snack-sized meals rather than three meals a day.
• Avoid strong smells that can trigger nausea and vomiting.
• Sip ginger tea or a flat ginger ale to help ease nausea. Sucking on a ginger candy or even a sliver of fresh ginger may also help.
  

In severe cases of vomiting, intravenous (IV) fluids may need to be administered in a hospital to replace lost fluids and electrolytes.

Antiemetic drugs used to ease nausea and vomiting—like Reglan (metoclopramide), Zofran (ondansetron), or Compazine (prochlorperazine)—may also be administered by IV.

Why Does COVID Cause Vomiting?

SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) is a strain of coronavirus that causes COVID-19,

The virus establishes an infection by attaching to proteins on the surface of cells called angiotensin-converting enzyme 2 (ACE2) and using them to "unlock" and enter the cells. If the immune system cannot control the virus, it will actively replicate (make copies of itself), killing the infected cells and leading to symptoms of COVID.

Though there is a high concentration of ACE2 in the lining of the respiratory tract, there is also ACE2 throughout the digestive tract that SARS-CoV-2 can attach to. When these cells are affected, the loss of gastrointestinal function and rapid onset of inflammation can lead to nausea and vomiting that's sometimes severe.

Respiratory symptoms tend to be more predominant with COVID simply because there is more ACE2 in the lungs than in the stomach or intestine. Even so, an infection in the GI tract can often trigger symptoms earlier than an infection in the lungs and airways.

Other Causes

Vomiting associated with COVID-19 is not solely caused by the virus. In some cases, medications used to treat the infection can trigger nausea, vomiting, and other upper GI symptoms. These include drugs like:

• Veklury (remdesivir)
• Olumiant (baricitinib)
• Paxlovid (nirmatrelvir and ritonavir)

With that said, the newer drugs used to treat COVID have a lower risk of vomiting compared to some of the earlier treatments, such as Plaquenil (hydroxychloroquine) and lopinavir/ritonavir (the latter of which caused vomiting in 1 of every 15 people).

Another independent cause of vomiting in people with COVID-19 is anxiety and stress. During the height of the pandemic, studies suggest nearly 1 of 5 people (19.24%) who tested negative for COVID-19 experienced nausea and vomiting due to COVID-related stress.

While it can reasonably be assumed that public fears have decreased since that time, a 2021 study from the Columbia University Medical Center suggests that psychological distress can significantly aggravate GI symptoms in people with long-term COVID-19.

According to the research, mental health issues like anxiety and sadness independently increase the odds of diarrhea, vomiting, and other GI symptoms by no less than sixfold compared to people with no mental health issues.

When to Get COVID Tested

According to the Centers for Disease Control and Prevention (CDC), anyone with symptoms of COVID-19 should stay home and away from others until their symptoms improve.

These include symptoms like:

• Fever or chills
• Cough
• Shortness of breath or difficulty breathing
• Fatigue
• Muscle or body aches
• Headache
• A loss of taste or smell
• Sore throat
• Congestion or runny nose
• Nausea or vomiting
• Diarrhea

COVID should be suspected when stomach flu-like symptoms are followed by fever, cough, shortness of breath, or other typical COVID symptoms one or several days later.

If you do not have symptoms but think that you've been exposed, wait at least a full five days before taking a test. Testing any earlier may result in a false negative result (meaning that you have the virus even if the test says that you don't).

Symptoms That Warrant a Provider Visit

Whatever the cause, vomiting can turn serious if left untreated, leading to severe dehydration and complications such as seizures, kidney failure, and shock.

In light of these concerns, see your healthcare provider immediately if you or your child:

• Cannot keep any food or liquids down
• Vomit three or more times in one day
• Have nausea for more than 48 hours
• Have high fever and extreme weakness
• Have not urinated for eight hours or more

Summary

Vomiting and other gastrointestinal symptoms (like nausea, diarrhea, and abdominal pain) may be early signs of COVID-19 and may precede the respiratory symptoms of COVID by one or more days. Though the symptoms tend to last from a few days to a week in people with mild COVID-19, they can sometimes recur for months in people with long COVID.

COVID-19 can cause vomiting by attacking the lining of the digestive tract in the same way that it attacks the lining of the respiratory tract. Psychological distress and certain medications used to treat COVID can also cause nausea and vomiting.