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Why is the coronavirus causing people to cough up blood?

Experts said that while the symptom might seem alarming, it doesn't necessarily mean you have a severe illness.
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A small percentage of COVID-19 patients have reported experiencing an unsettling symptom: coughing up blood. U.S. Sen. Amy Klobuchar shared that her husband, John Klobuchar, dealt with this scary symptom.

"John started to feel sick ... and like so many others who have had the disease, he thought it was just a cold," Amy Klobuchar wrote in a Medium post published on March 23 where she detailed her husband's symptoms. "He kept having a temperature and a bad, bad cough and when he started coughing up blood he got a test and a chest X-ray and they checked him into a hospital in Virginia."

In mid-March, 29-year-old Tarek Soliman told TODAY that he had experienced similar symptoms.

“The fever went away on the seventh or eighth day, but by then, the virus had extended to my lungs, and I started developing pneumonia,” said Soliman, who is based in New York City. “There was fluid in my lungs, and I was coughing blood. It freaked me out.”

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Experts said that the symptom might seem scary, but you shouldn't panic.

Why are people coughing up blood?

According to NBC News medical correspondent Dr. John Torres, a small study out of China found that "1% of COVID-19 patients complained of coughing up blood."

"With pneumonias, coughing up blood can be a symptom, regardless of what caused the pneumonia, so it makes sense it could happen with COVID-19 as well," Torres told TODAY, via email.

According to Dr. Albert Rizzo, the chief medical officer of the American Lung Association, there are many reasons for why someone might be coughing up blood.

"What happens is, airway inflammation sometimes leads to a very fragile lining of the airways, and those small blood vessels, or capillaries, might be affected, causing blood to come out," he said, adding that coughing up blood can be caused by common illnesses like bronchitis or more severe diseases like lung cancer.

Plenty of things, including common illnesses like bronchitis, can lead people to cough up blood.
Plenty of things, including common illnesses like bronchitis, can lead people to cough up blood. Getty Images

"The main issue is hemoptysis (coughing up blood or blood-stained mucus) is a sign of airway inflammation," Rizzo continued. "Certainly that can happen with COVID-19, and it speaks potentially to the severity of the inflammation when blood is being spit up along with mucus."

Rizzo also said that the amount of blood one is coughing up can indicate how severe the situation is.

"Some people will cough up sputum (saliva and mucus) that has some blood streaks in it; others will bring up mucus that might look infected, yellow or green, with some blood in it as well," he said. "Others might cough up what they say is 'frank blood,' just blood with very little mucus at all. ... It can be a wide range, and many times when we're trying to consider how significant the hemoptysis is, we see how much they're coughing up over time."

Rizzo warned that coughing up clots frequently is something that is very concerning, but less severe symptoms might not need immediate treatment.

If you cough up blood, should you immediately go to the ER?

Despite the scariness of the symptom, Rizzo and Torres both cautioned that people shouldn't immediately go to the emergency room.

"If you have access to a doctor or telemedicine it would be better to do it that way, since it might be something minor," Torres said. "If you do notice (blood), you should at least talk to a doctor to see if you need an X-Ray or CT scan."

Experts recommend checking symptoms over telemedicine before seeking in-person care.
Experts recommend checking symptoms over telemedicine before seeking in-person care. Getty Images

Rizzo said that if someone is experiencing hemoptysis and other COVID-19 symptoms like a fever or dry cough, they should seek out medical care, and said that if you do decide to go to the ER or an urgent care, you should call ahead to let medical staff know you're coming.

"Try to call ahead and notify someone that you’re coming in because you may not have COVID-19 but right now people with those symptoms are being assumed to have COVID-19 and the proper precautions need to be taken," Rizzo said. "The key thing in all this is communication — what is the symptom, what are the other symptoms, let the health care provider make the decision about sitting at home or seeking further care."