Tonsillitis is an inflammation of the tonsils, which are the two lymph nodes located at the back of your throat. The virus that causes COVID-19, SARS-CoV-2, can lead to this condition. While a sore throat is a highly common symptom of COVID-19, the specific, visible inflammation known as tonsillitis is a less frequent manifestation of the infection. SARS-CoV-2 primarily targets cells in the upper respiratory tract, and the resulting inflammation can sometimes be localized to the tonsils. For many individuals, this throat discomfort is one of the first complaints during a COVID-19 infection.
The Mechanism of Viral-Induced Tonsil Inflammation
The process begins when the SARS-CoV-2 virus enters the body and uses its spike protein to bind to the Angiotensin-Converting Enzyme 2 (ACE2) receptor on human cells. This receptor is present throughout the respiratory tract, including the throat and nasal passages, serving as the main entry point for the virus. Once inside, the virus replicates, triggering a strong local immune response.
This viral activity in the upper airway leads to the release of inflammatory molecules as the immune system fights the infection. The tonsils, as specialized lymph nodes and a major part of the immune system, react strongly to this viral invasion. The resulting inflammation causes the tonsils to become red, swollen, and painful, defining tonsillitis.
In COVID-19, tonsil inflammation is generally an indirect result of the body’s reaction to the virus replicating in nearby throat tissues. High concentrations of the virus have been detected in the oropharyngeal area, which includes the throat and tonsils. While this viral-induced tonsillitis is usually self-limiting, the inflammation can be severe enough to cause difficulty swallowing.
Distinguishing COVID-Related Tonsillitis from Other Infections
Differentiating COVID-19-related tonsillitis from other causes, such as bacterial strep throat or other viral infections, is difficult based on symptoms alone. Tonsillitis caused by Group A Streptococcus bacteria, commonly known as strep throat, often presents with a rapid onset of severe throat pain and a high fever. A key visual difference in bacterial strep throat is the frequent presence of white pus spots or streaks on the swollen tonsils, sometimes with tiny red spots on the roof of the mouth.
Viral causes like COVID-19 are more commonly associated with other upper respiratory symptoms that are typically absent in strep throat. A cough, congestion, and a runny nose are highly suggestive of a viral infection, including COVID-19. The onset of COVID-19 symptoms also tends to be more gradual compared to the sudden start of strep throat.
Other viruses, like the Epstein-Barr virus (mononucleosis), can also lead to tonsillitis with white patches or pus, making visual diagnosis complex. A definitive diagnosis requires testing, such as a rapid strep test or throat culture to rule out bacteria, and a SARS-CoV-2 test for COVID-19. The presence of non-throat symptoms like body aches, loss of taste or smell, or digestive issues also increases the likelihood of a COVID-19 infection.
At-Home Management of Throat and Tonsil Symptoms
Managing the discomfort of tonsillitis caused by a viral infection like COVID-19 focuses on soothing the inflammation and supporting recovery. Over-the-counter pain relievers, such as acetaminophen or ibuprofen, can effectively reduce both throat pain and fever by lessening the inflammatory response.
Maintaining adequate hydration is important, as fever and illness can lead to dehydration; liquids also help keep the throat moist. Gargling with a warm saltwater solution, made by mixing a small amount of salt into warm water, can offer temporary relief by reducing swelling in the throat tissues. Sucking on medicated lozenges or hard candies stimulates saliva production, which helps to soothe the throat.
Using a cool-mist humidifier, especially while sleeping, can help moisten the air and ease throat irritation. While most viral sore throats resolve within a week to ten days, seek prompt medical attention if you experience severe difficulty breathing, chest pain, an inability to swallow liquids, or a new onset of confusion.