Epistaxis, the medical term for a nosebleed, is a common occurrence that involves bleeding from the delicate blood vessels lining the inside of the nose. Acute respiratory infections often cause irritation in the nasal passages, which can sometimes lead to minor bleeding. The question of whether the specific infection caused by the SARS-CoV-2 virus, known as COVID-19, has a unique association with nosebleeds has been a point of investigation since the start of the pandemic.
Frequency of Nosebleeds in COVID Patients
Nosebleeds are not listed among the primary, most common symptoms of a COVID-19 infection, such as fever, cough, or fatigue. However, data collected from clinical settings suggest that people with COVID-19 may experience nosebleeds more frequently than the general population. In one study, researchers found that 15% of patients presenting with nosebleeds tested positive for the virus, a statistically significant difference compared to a control group.
Other small-scale studies have reported variability in the prevalence of epistaxis among confirmed COVID-19 patients, with figures ranging from approximately 11% to 30% in specific hospital cohorts. This variability is likely due to differences in patient severity, variant type, and treatment protocols. While the correlation suggests an increased risk, nosebleeds remain a relatively infrequent manifestation compared to the typical respiratory symptoms associated with the infection.
Biological and Environmental Causes
The increased risk of epistaxis during a COVID-19 illness is attributable to a combination of direct viral effects and secondary factors related to the infection and its management. The SARS-CoV-2 virus targets cells in the nasal lining that express the ACE-2 receptor, which are present in high concentrations within the nasal respiratory epithelium. This viral entry and replication can induce a localized inflammation, known as rhinitis, causing the nasal mucosa to swell and become fragile.
This inflammation makes the small blood vessels, particularly those in the anterior part of the septum (Kiesselbach’s plexus), more susceptible to rupture. Systemic effects of a severe infection can also involve changes in the body’s blood clotting mechanism, potentially increasing bleeding tendency.
Environmental and treatment-related factors also play a substantial role in triggering bleeding episodes. The presence of a fever or the use of forced air heating or cooling during illness can lead to significant dryness in the nasal passages, which irritates the already fragile mucosa. In hospitalized patients, the use of non-humidified oxygen delivered via a nasal cannula is a known risk factor, as it dries the nasal lining and promotes crust formation. Additionally, aggressive nose blowing due to congestion or repeated nasal swabbing can cause mechanical trauma to the delicate blood vessels. For patients with severe illness, the use of anticoagulant medications to manage clotting complications also elevates the risk of a bleeding event.
First Aid and Medical Triage
If a nosebleed occurs while a person is ill, there are specific steps for immediate home management to stop the flow of blood.
- Sit up straight and lean the head and body slightly forward; this helps prevent blood from running down the back of the throat.
- Using the thumb and index finger, firmly pinch the soft part of the nose just above the nostrils.
- Maintain continuous pressure for a full 10 to 15 minutes without releasing the pressure to check the bleeding.
- Breathe through the mouth, and apply a cold compress to the bridge of the nose to constrict the blood vessels.
Most nosebleeds will stop with this simple pressure, but certain signs require seeking professional medical attention for triage.
- The bleeding persists continuously for longer than 20 minutes despite proper pressure application.
- The blood loss is heavy, requiring medical consultation.
- The nosebleed occurs after a head injury.
- The bleeding is accompanied by symptoms such as lightheadedness, dizziness, or a rapid heart rate.
- Recurrent nosebleeds or those associated with new bruising elsewhere on the body also signal a need for prompt medical evaluation.