COVID-19 Congestion and Runny Nose: How to Deal - Everyday Health

One night in June 2022, Nina Rayburn Dec started feeling sniffly and congested. She took a rapid home test for COVID-19: negative.

So when she woke up the next morning with a runny nose and a scratchy throat, "I thought I had a cold, allergies, or strep throat," says Dec, who is the executive director of the Bridgehampton Museum on Long Island in New York.

Still, a slight fever and abundance of mucus prompted her to mask up and drive to see an urgent care physician. A PCR test showed that she did, in fact, have COVID-19.

Her runny nose and congestion persisted for about 12 days, she says.

In the omicron era, congestion and a runny nose are common signs of COVID-19, particularly in people like Dec who are vaccinated and boosted, or who have some measure of immunity from a prior bout of COVID-19.

Results of the U.K.-based Zoe COVID Symptoms Study, published in December 2021 in the BMJ, showed that runny nose is among the top five symptoms reported for omicron infection, along with headache, mild or severe fatigue, sneezing, and sore throat.

A COVID-19 runny nose can last anywhere from a few days to a week or more. To add to the misery, it can lead to a nagging cough from excess mucus running down the back of the throat (post nasal drip).

Do You Have COVID-19, a Cold, or Allergies?

With so many similarities between symptoms of COVID-19 and those of allergies, colds, and the flu, it can be difficult — and puzzling — to figure out exactly what's causing a runny nose or congestion.

"It seems like now more than at any point in the pandemic, there's no easy way to differentiate COVID-19 from allergies or from other respiratory viruses such as flu or the common cold," says Joseph Khabazza, MD, a pulmonary and critical care physician at the Cleveland Clinic in Ohio.

This is especially true in people who have immunity from vaccination and boosters or previous COVID-19 infection, which can result in milder symptoms, Dr. Khabazza says.

The best way for anyone to find out whether or not a runny nose or nasal congestion is a symptom of COVID-19 is to get tested, especially if they've had close contact with someone who is infected.

Congestion and Runny Nose Are Increasingly Common Symptoms

Many infectious disease specialists aren't surprised that runny nose and congestion are cited as main symptoms of COVID-19.

"Runny nose has been an initial symptom with virtually every wave and variant of COVID-19 I've seen," says Priya Nori, MD, an associate professor in the department of medicine (infectious diseases) at the Albert Einstein College of Medicine and medical director of the Antibiotic Stewardship Program at Montefiore Health System in New York City.

Like other respiratory viruses, the SARS-CoV-2 coronavirus that causes COVID-19 triggers inflammation of the membranes lining the nose and sinuses — an immune response, Dr. Nori explains. The inflamed cells cause the nose to make clear mucus, which traps the virus and helps flush it out of the body.

A runny nose may be more common with omicron than previous variants such as delta, Nori says. That's because omicron tends to "live" in the upper respiratory tract — the nose, throat, and mouth — while earlier variants were more likely to move down the respiratory tract into the lungs.

Congestion and Runny Nose Are Signs of an Immune System at Work

Interestingly, individuals who are vaccinated and boosted may experience more nasal and sinus symptoms of COVID-19 than those who aren't.

A recent pre-print study (not peer-reviewed) posted on the site medRxiv examined data from over 63,000 people who visited a walk-up COVID-19 community testing site in San Francisco over a one-year period. The researchers found that individuals with COVID-19 who had been vaccinated and boosted had more congestion compared with those who were unboosted.

Jorge Caballero, MD, a data-driven anesthesiologist at Stanford Medicine in California, broke down the study on Twitter (@DataDrivenMD). He tweeted, "What seems to be going [on] is that the immune system of persons who were boosted [was] able to respond more quickly to the first sign of an omicron infection — in the nose. The congestion is the body's way of slowing down the infection — it's flooding the virus in sludge."

"If that fails, the virus migrates down to your throat where it causes a sore throat, a cough, or croup in the case of young children," he added.

In Kids, Is a Runny Nose a Sign of COVID-19?

With children, runny nose isn't always the most common symptom of COVID-19.

According to Vidya Mony, MD, a pediatric infectious diseases specialist and an associate hospital epidemiologist at the Santa Clara Valley Medical Center in California, the most prevalent signs of COVID-19 in children are usually fever, cough, and sore throat.

"It's also important to remember that there are multiple other viruses that are circulating right now, so it's possible that your child may not actually have COVID, but could have another virus," she says.

These other viruses include rhinovirus (responsible for the common cold) and RSV (respiratory syncytial virus), which typically peaks in winter but surged last summer in the U.S. as mask wearing and other COVID-19 restrictions lifted.

The easiest way to figure out if your child has COVID-19 is testing. "If your child had a known exposure to COVID and is symptomatic and the home antigen test is negative, it's probably worthwhile to get a PCR to be sure," Dr. Mony says. "Otherwise, you can always remember to do the home antigen test multiple days in a row."

Mony urges parents to vaccinate children age 6 months and up, and to make sure kids who are 5 and older are both vaccinated and boosted (if eligible).

Here's How to Treat COVID-19 Runny Nose and Congestion

For adults with cold-like symptoms of COVID-19, Nori recommends recuperating at home by taking any over-the-counter decongestant, cough suppressant, or fever reducer — as long as your healthcare provider gives you the okay (even by phone).

You want to be sure that any drug, even an over-the-counter one, won't interact with other medications you take or raise blood pressure (for adults with hypertension) or blood sugars (for those with diabetes).

Adults at high risk of becoming very sick from COVID-19 should talk to a doctor about antiviral therapies such as the oral medication nirmatrelvir and ritonavir (Paxlovid). Children may be eligible if they are 12 or over and weigh at least 88 pounds.

Finally, anyone who is sick from COVID-19 — even if it just feels like a case of the sniffles — should be sure to isolate at home and mask up! Masking remains a tried and true measure to prevent the spread of COVID-19.

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