Dizziness is a general term describing feelings of lightheadedness, unsteadiness, or a sense of being faint. This differs from true vertigo, which is the sensation that you or your surroundings are spinning or moving when they are not. While not among the most frequently reported symptoms, dizziness can be a manifestation of acute COVID-19 infection and is also commonly reported as a lingering symptom.
Dizziness and COVID-19 Symptom Profile
Dizziness is recognized as a potential symptom of COVID-19, though it is less common compared to hallmark symptoms like fever, cough, and fatigue. Studies have indicated that dizziness or vertigo is reported in approximately 12% to 20% of acute COVID-19 cases. This prevalence places it significantly lower than the nearly 60% reporting cough or the majority reporting fatigue, but high enough to be relevant.
The symptom can appear early in the infection, sometimes even before the onset of respiratory issues. In some instances, dizziness or vertigo has been reported as the initial or only clinical sign of the infection, suggesting its presence should not be dismissed when other COVID-19 symptoms are present. Dizziness and vertigo are also frequently noted among the symptoms of Long COVID, affecting up to one in four people experiencing post-viral syndrome.
Biological Mechanisms Causing Dizziness
Dizziness during COVID-19 infection is attributed to a combination of systemic effects and specific neurological involvement. One common indirect cause is the systemic reaction to the viral illness, such as fever and dehydration. High fever causes generalized lightheadedness, and dehydration from reduced fluid intake lowers blood pressure, resulting in presyncope, or near-fainting.
The virus may also directly affect the body’s balance system, which involves the inner ear and the central nervous system. The SARS-CoV-2 virus can affect nerve tissues, potentially through the ACE2 receptors present in the brain and inner ear structures. This direct viral action or the resulting inflammation can damage the vestibular system, the part of the inner ear responsible for balance, leading to true vertigo.
Inflammation throughout the body, triggered by the immune system’s response, is a significant factor. The “cytokine storm,” an excessive release of inflammatory proteins, can impact the central nervous system and inner ear structures, contributing to vestibular dysfunction. The increased risk of blood clotting and decreased blood flow associated with severe COVID-19 can also damage the small blood vessels supplying the vestibular and hearing organs. In some cases, the infection can trigger autonomic nervous system disorders like Postural Orthostatic Tachycardia Syndrome (POTS), which causes orthostatic dizziness upon standing due to blood pressure regulation issues.
When to Seek Medical Attention
While mild dizziness often resolves on its own with rest and hydration, it is important to recognize warning signs that indicate a more serious underlying issue. Immediate medical attention is necessary if the dizziness is severe enough to prevent safe movement or is accompanied by a sudden inability to walk. Emergency care should also be sought if dizziness is combined with symptoms such as a severe headache, confusion, weakness or numbness on one side of the body, or loss of consciousness.
If you suspect COVID-19 infection, seeking a test is advisable, especially if you are at high risk for severe illness or will be around vulnerable individuals. Dizziness that persists for weeks or months after the initial infection has cleared should prompt a consultation with a healthcare provider, as this may be a sign of Long COVID. The symptom should also be evaluated if it is accompanied by hearing loss or a continuous ringing in the ears, which suggests specific inner ear involvement. People with pre-existing conditions like heart disease, diabetes, or high blood pressure should consult their doctor if they experience dizziness during an illness, as it may signal that their underlying condition is worsening.