While fever, fatigue, and cough are the most common signs of COVID-19, the illness caused by the novel coronavirus, shortness of breath is another possible symptom. People with anxiety can face a dilemma: if they’re having difficulty breathing, it can be hard to tell the difference between coronavirus-related shortness of breath and a panic attack.

"It can be difficult to tell the difference between panic attack shortness of breath, and shortness of breath from a viral infection like COVID-19," Dr. Larry Burchett, M.D., an emergency physician, tells Bustle. His current emergency-room protocol involves asking people if they have any other symptoms of coronavirus, such as cough, fever, or body aches. If they’ve had these symptoms for a week or so, and are experiencing worsening shortness of breath, it’s more likely that the cause is coronavirus. "This is especially true in someone with a lung disease like asthma or chronic obstructive pulmonary disease, or who smokes," he says.

Anxiety-related shortness of breath has specific traits, Dr. Cara Pensabene, M.D., an internist at EHE Health, tells Bustle. "Panicked breathing happens because of the body’s natural response to the movement of stress hormones through the body. This encourages your lungs to breathe faster, getting more oxygen to your brain," she says. Anxious breathing is self-limiting; it doesn’t get worse over several days. After the anxiety passes, breathing calms.

Pensabene says that if your breathing rate is rapid and shallow, you feel a bit dizzy, but you can take a big breath if you need to, it’s likely that it’s related to anxiety. If your breathing is slow as you try to pull in more air, and your lungs feel heavy, full and painful, it could be related to a respiratory illness like COVID-19. "If you’re unsure, take a few deep breaths," she says "Anxiety tends to calm down when you slow your heart rate naturally." If you can’t breathe deeply and symptoms don’t improve, call your doctor or a telehealth service for guidance.

The shortness of breath that comes with COVID-19 also tends to worsen over time. "Coronavirus patients can sometimes have chest pressure tightness, and shortness of breath that is constant and usually worsens. They feel winded and fatigued with just a few steps," Dr. Janette Nesheiwat, M.D., an emergency physician, tells Bustle. Coronavirus is known to damage and inflame the interior of the lungs, making it hard for them to expand, and can also lead to pneumonia, which fills lungs with fluid and can cause a crackling noise when breathing.

It’s worth noting that panic about coronavirus may be causing heightened anxiety symptoms right now, Dr. Burchett says, and it’s possible to both be anxious and have the illness. "Sometimes it’s not easy to tell coronavirus and anxiety apart, and you need to see a doctor help you figure it out." He says nobody should feel ashamed to ask for help.

If you think you’re showing symptoms of coronavirus, which include fever, shortness of breath, and coughing, call NHS 111 in the UK or visit the CDC website in the U.S. for up-to-date information and resources. You can find all Bustle’s coverage of coronavirus here, and UK-specific updates on coronavirus here.

Experts:

Dr. Larry Burchett M.D., emergency physician

Dr. Janette Nesheiwat M.D., emergency physician

Dr. Cara Pensabene M.D., internist

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