The sensation of intensely painful throat, often described as burning or “on fire,” is a common and distressing symptom reported by many people with COVID-19. This severe pharyngitis is particularly associated with newer variants of the SARS-CoV-2 virus, such as Omicron and its subvariants. For many, this throat pain is one of the first and most debilitating signs of infection. Understanding the biological reason behind this discomfort helps in managing symptoms effectively.
The Viral Cause of Severe Throat Pain
The pain is a direct consequence of how the SARS-CoV-2 virus interacts with the tissues lining your upper respiratory tract. Unlike earlier variants that more heavily targeted the lungs, newer strains often demonstrate a preference for the epithelial cells in the throat and larynx. The virus rapidly replicates within these cells, causing widespread tissue damage and triggering a profound immune response.
This viral invasion prompts the body to release pro-inflammatory signaling molecules called cytokines, such as interleukin-6 (IL-6). The release of these chemicals causes inflammation, congestion, and swelling of the throat’s mucous membranes, known as pharyngitis. This inflammation leads to the feeling of a scratchy, raw, or razor-like pain, especially when swallowing. In some severe cases, local inflammation can even result in small ulcers on the throat lining due to the shedding of infected epithelial cells.
Strategies for Pain Relief
Managing the discomfort of a COVID-related sore throat often requires a dual approach using pharmacological and non-pharmacological methods. Over-the-counter (OTC) pain relievers are a primary line of defense, working systemically to reduce inflammation. Non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can decrease inflammation and pain, while acetaminophen can effectively manage pain and fever.
It is important to follow the package instructions for proper dosing and frequency, especially for acetaminophen, where the daily maximum dosage should not be exceeded due to liver health concerns. Numbing agents, such as throat lozenges and sprays containing benzocaine, dyclonine, or menthol, can provide rapid, temporary relief by blocking local nerve signals. These sprays should be used cautiously and only as directed, as excessive use can numb the back of the throat and increase the risk of mistakenly swallowing food or liquid into the airway.
Non-pharmacological strategies focus on soothing the irritated tissue and keeping it moist. Gargling with warm salt water—a mixture of about half a teaspoon of salt dissolved in eight ounces of warm water—can reduce swelling and help draw fluid out of the inflamed tissue. You can repeat this every three hours as needed.
Additionally, temperature therapy can offer comfort. Cold liquids, ice chips, or popsicles work like a localized ice pack, numbing the pain receptors and reducing swelling on contact. Conversely, warm, soothing liquids like broth or caffeine-free tea with honey can also calm irritation and keep the throat hydrated. Using a cool-mist humidifier in your room, especially at night, helps prevent the throat from drying out, which can worsen the burning sensation.
Warning Signs Requiring Medical Care
While home care is sufficient for the majority of severe COVID sore throat cases, certain red-flag symptoms indicate the need for medical attention. Any sudden and significant difficulty breathing, including a high-pitched, wheezing sound when inhaling (stridor), requires an immediate emergency medical call. Constant chest pain or pressure, confusion, or a bluish discoloration of the lips, face, or nail beds are also signs of a life-threatening emergency.
Pain that is so severe it prevents swallowing even saliva or small sips of water is a serious concern, as it can lead to rapid dehydration. This extreme difficulty swallowing (odynophagia), especially when accompanied by a muffled voice or drooling, can sometimes signal the development of a rare but serious condition like acute epiglottitis. This condition causes the flap covering the windpipe to swell and can quickly obstruct the airway.
A rapidly worsening pain localized to one side of the throat, possibly combined with difficulty opening the mouth fully, may indicate a secondary bacterial infection like a peritonsillar abscess. If your fever remains high and persistent, or if your throat pain worsens noticeably after five to seven days instead of beginning to improve, a medical consultation is necessary. These symptoms suggest a possible complication or a bacterial infection that may require prescription antibiotics.