Is a Runny Nose a Sign of COVID-19?

COVID-19 symptoms have evolved since the pandemic began in 2020. While a runny or stuffy nose was rare in early coronavirus strains, it’s now one of the most frequently reported symptoms of currently circulating variants.

But COVID is not the only reason your nose is running. It’s understandable that you might be tempted to blame the common cold or seasonal allergies for your symptoms instead of COVID.

Still, doctors stress the importance of considering COVID-19 as a possible culprit. While mild COVID is now more common than severe COVID in the general population, the coronavirus still has the potential to cause life-threatening illness, especially in babies and older adults.

Early strains of COVID-19 caused a range of symptoms, many of them serious or unusual — high fever, for instance, or loss of taste and smell. Why has that morphed to relatively minor and commonplace symptoms like a runny nose?

One reason is that most people have developed some level of immune protection against COVID due to prior infection, vaccination, or both, says Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security in Baltimore.

“There is so much immunity in the population now that COVID symptoms have tended to be milder,” he says.

Virus mutations over the past six years may also be a factor. The currently dominant virus type, Omicron, affects the body differently than its predecessors.

“There is some evidence that the Omicron variants are evolutionarily better suited for the upper respiratory tract versus the lower respiratory tract,” Dr. Adalja says.

As a result, current variants are more likely than previous ones to lead to upper respiratory tract issues like a runny nose, sore throat, and cough, rather than problems affecting the lower respiratory tract, like bronchitis and pneumonia.

A quick analysis of your symptoms could help point you in the right direction, but can’t provide a definitive diagnosis.

Possible Fever “Some viruses such as those that cause COVID are more likely to cause fevers and chills than other viruses that cause the common cold,” Adalja says.

However, “You may just have cold-like symptoms with COVID-19 and that's it,” says Thomas Russo, MD, professor and chief of infectious disease at the University at Buffalo in New York.

If you’re prone to seasonal allergies it can be tempting to brush off a runny nose as a reaction to irritants like pollen. But there are a few potential signs that the culprit might be COVID.

Low Pollen Count If your symptoms do not coincide with an increase in outdoor pollen counts, it may be more likely that COVID is to blame for your runny nose, Dr. Russo says.

Absence of Other Allergy Symptoms Usually pollen exposure will lead to itchy eyes and nose as well as a runny nose, Russo says. If you’re not experiencing the full array of allergy symptoms, this suggests you have a viral illness like COVID, he notes.

Possible Fever “With allergies, you wouldn’t expect a fever,” Russo says. COVID, on the other hand, can sometimes result in fever and chills.

Fatigue Intense, lingering fatigue isn’t common with allergies, but it is with COVID. “Fatigue can hang on sometimes for one to three weeks,” says Janet O’Mahony, MD, an internal medicine physician at Mercy Medical Center in Baltimore.

While there are some indicators that a runny nose is due to COVID instead of something else, “The only way to be sure is to test,” Dr. O’Mahony says. “The over-the-counter tests for COVID are actually very reliable.”

If you’re in a high-risk group or are frequently around someone who’s considered high-risk, O’Mahony recommends testing yourself, even if you have a minor sniffle.

Here’s who’s considered high risk:

If you have symptoms of COVID-19 and get a negative test result, Russo recommends waiting a day or two before testing yourself again.

When you have a runny nose for any reason, hydration and rest are helpful. But COVID-19 could require medical intervention.

O’Mahony recommends calling your healthcare provider. “This can be done often over video conference,” she says. Together you can decide if your symptoms suggest you should take an antiviral treatment like nirmatrelvir-ritonavir (Paxlovid) or whether it would be okay to simply rest and treat your symptoms.

The goal of treatment is to prevent an upper respiratory infection from progressing to a lower respiratory infection that can pose a serious health risk.

“Viral pneumonia would cause chest pain, shortness of breath, lower oxygen levels, or a general sense of not feeling well,” Russo says.

“Most of us feel that if you’re in a high-risk group or if you interact with someone in a high-risk group, taking Paxlovid may be helpful,” he adds

• A runny or stuffy nose can be a vague symptom of an illness and possibly a sign of COVID-19.
• It’s easy to brush off nasal symptoms as a common cold or allergies, but there are a few signs you may be dealing with one over the other, according to doctors.
• The only way to know whether you have COVID-19 is to take a test.
• Identifying COVID correctly can help you decide to take antiviral medication if you are vulnerable to severe disease or are in close contact with anyone who is at high risk of severe COVID, particularly very young children, seniors, and pregnant women.