A bloody nose, medically known as epistaxis, occurs when a blood vessel inside the nose breaks. Epistaxis is not a primary symptom of COVID-19, which is characterized by fever, cough, and fatigue. However, a correlation has been observed where some individuals with a COVID-19 infection experience nosebleeds. This is generally considered an indirect effect rather than a direct viral symptom, but the systemic and local effects of the illness can significantly increase the risk of a nosebleed.
Bloody Noses and COVID-19 Symptoms
The link between a COVID-19 infection and a bloody nose is often due to several indirect mechanisms related to the body’s response to the virus. Inflammation in the nasal passages (rhinitis) is a common reaction to the SARS-CoV-2 virus. This inflammation can irritate and dry out the delicate nasal lining, making the tiny blood vessels beneath more fragile and prone to rupture. Excessive sneezing, coughing, or vigorous nose-blowing associated with the infection also creates physical trauma on the already irritated nasal mucosa.
Fever, a common symptom, can contribute to systemic dehydration, further drying the nasal membranes and increasing their vulnerability to bleeding. For hospitalized patients, supplemental oxygen delivered through a nasal cannula can cause significant nasal dryness and crusting, which directly increases the risk of a nosebleed. Furthermore, some patients with severe COVID-19 receive anticoagulant medications (blood thinners) to prevent dangerous blood clots. A side effect of these medications is an increased tendency to bleed, including from the nose. Nasal swab testing can also cause minor, temporary trauma to the nasal lining, sometimes resulting in a small nosebleed.
Understanding the Underlying Causes of Epistaxis
The vast majority of epistaxis cases stem from common, non-infectious causes. The nasal lining contains numerous small blood vessels close to the surface, making them easily damaged. Low humidity, especially in winter when indoor heating dries the air, is a frequent culprit, causing the nasal membrane to dry out, crack, and bleed.
Physical trauma, such as picking the nose or repeatedly blowing it forcefully, is the most common local cause of a nosebleed. Chronic conditions like allergies and sinusitis cause persistent inflammation and irritation of the nasal lining, weakening vessel walls over time. The use of certain medications also plays a role. Blood-thinning agents like aspirin or warfarin inhibit clotting, resulting in longer and heavier nosebleeds. Nasal steroid sprays, used for allergies, can also dry out the nasal passages if not used correctly, increasing the likelihood of bleeding.
When to Seek Medical Attention
Most nosebleeds are anterior, originating from the front of the nose, and can be managed at home by sitting up, leaning forward, and pinching the nostrils shut for 10 to 15 minutes. However, certain warning signs indicate the need for immediate medical intervention. Bleeding that does not stop after 15 to 20 minutes of continuous pressure warrants emergency care, as this may indicate a more severe issue or a posterior nosebleed.
Seek prompt medical attention if the bleeding is very heavy, or if you experience symptoms like dizziness, lightheadedness, a rapid pulse, or excessive swallowing of blood, which can lead to vomiting. A bloody nose that occurs after a significant injury, such as a blow to the head or face, requires immediate evaluation to rule out a fracture or other serious underlying trauma. Individuals who experience frequent, recurring nosebleeds or those taking blood-thinning medications should consult a healthcare provider to explore potential underlying causes or medication adjustments.