Are There 6 Types of Coronavirus 2019? What New Research Has to Say

Symptoms have been broken down into six categories.

By Michael Bohl, MD, MPH
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August 3, 2020 — 6:00 a.m. EST

A recent report out of King’s College London suggests there are six different “types'' of coronavirus disease 2019 (COVID-19). This headline might immediately cause thoughts of worry and panic as you think about the virus being even more complex and problematic. However, when looking at the research, it’s actually just more specific information that could potentially help us in the fight against COVID-19. We’ve broken down exactly what this new research might mean, but before we dive in, it’s important to note that this report was published on medRxiv, which is a platform that preprints preliminary research. As of now, the King’s College London report has not been peer-reviewed or accepted to any peer-reviewed journals.

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So, what did the research find?

The study looked at 1,653 patients who were diagnosed with COVID-19. Using an app, the patients input their symptoms from the time they began to when symptoms either started getting better or the patients were hospitalized. Based on this data, the researchers divided the patients into one of six “types” of disease. The six types and their associated symptoms were:

  1. Flu-like without fever: Headache, loss of smell, muscle pain, cough, sore throat, and chest pain
  2. Flu-like with fever: Headache, loss of smell, cough, sore throat, hoarseness, fever, and loss of appetite
  3. Gastrointestinal: Headache, loss of smell, loss of appetite, diarrhea, sore throat, and chest pain
  4. Severe level 1, fatigue: Headache, loss of smell, cough, fever, hoarseness, chest pain, and fatigue
  5. Severe level 2, confusion: Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, and muscle pain
  6. Severe level 3, abdominal & respiratory: Headache, loss of smell, loss of appetite, cough, fever, hoarseness, sore throat, chest pain, fatigue, confusion, muscle pain, shortness of breath, diarrhea, and abdominal pain

Some symptoms — such as headache and loss of smell — were present in all types. Others were specific to just one or two types. However, it’s important to realize that these six types shouldn’t be thought of as different diseases. They are all the same disease — COVID-19. The six types just represent one possible way to categorize the different clusters of symptoms that occur in patients with COVID-19. There’s no way to predict who will be one type versus another, or if certain behaviors contribute in any way.

However, one thing the King’s College London report did suggest is that, by categorizing patients by these different types, healthcare professionals may be able to predict who is more at risk of requiring hospitalization and/or breathing support. For instance, based on this research, only 1.5% of people with type 1 go on to require breathing assistance while 19.8% of type 6 do. Similarly, only 16% of type 1 patients go to the hospital while a significantly higher percentage of patients with type 6 go. By being able to predict these outcomes, healthcare providers may be able to better prepare for the sickest patients.

Are there different types of coronavirus that do actually exist?

Moving beyond this research, it is true that there are different types of coronavirus. Coronaviruses are actually a large family of viruses that are so named because of their distinctive shape under an electron microscope (it looks like they have a “corona,” or crown). Many types of coronaviruses infect animals and seven main types infect humans. Four of these are relatively common and cause the “common cold.” They are called:

  • HCoV-229E
  • HCoV-NL63
  • HCoV-OC43
  • HCoV-HKU1

The three others have been responsible for notable disease outbreaks in the 21st century. They are:

  • SARS-CoV (the virus that causes severe acute respiratory syndrome, or SARS)
  • MERS-CoV (the virus that causes Middle East Respiratory Syndrome, or MERS)
  • SARS-CoV-2 (the virus causing the current pandemic of COVID-19)

An early report out of China suggested that SARS-CoV-2 could be further broken down into two types, which they named L and S. However, whether these two different types actually exist is not well documented and is controversial in the scientific community.

Research has also discovered that SARS-CoV-2 has changed one of its amino acids (the building blocks of proteins). This has created a G614 variant of SARS-CoV-2, replacing the D614 variant. This is a minor change and, again, it’s unclear whether this actually means anything in terms of how the disease spreads or how it affects patients.

At least for now, regardless of headlines, there is still only one COVID-19. Different people may experience different symptoms and have different outcomes, but this is likely due to individual factors — not because of different types of viruses.The best defense against COVID-19 is washing your hands frequently, wearing a mask when outside the house, and social distancing whenever possible.

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Article written by Michael Bohl, MD, MPH