A severe sore throat is a widely recognized symptom of COVID-19. This discomfort can range from mild irritation to intense pain, making swallowing difficult. Understanding this symptom involves how the SARS-CoV-2 virus interacts with the body and the immune response it triggers.
How the Virus Affects Your Throat
The SARS-CoV-2 virus directly contributes to throat pain by targeting specific cells lining the respiratory tract, including those in the throat. The virus primarily enters the body through the nose, mouth, and throat, which are all part of the upper respiratory tract. The virus uses a particular protein on its surface, known as the spike protein, to attach to human cells through a receptor called angiotensin-converting enzyme 2 (ACE2). These ACE2 receptors are abundant on the surface of epithelial cells that form the inner lining of the throat and airways.
Once attached, the virus enters these cells and begins to replicate, producing many new viral particles. This viral replication process can damage or destroy the infected throat cells. The direct cellular injury and the presence of the replicating virus irritate the delicate tissues in the throat, contributing to the initial sensation of pain and discomfort.
Your Body’s Painful Response
Following viral infection, the body’s immune system launches a protective response in the throat, which unfortunately also contributes significantly to the pain experienced. When SARS-CoV-2 infects throat cells, it triggers the release of signaling molecules known as inflammatory mediators. These include cytokines and chemokines, which are small proteins that orchestrate the immune response. The symptoms of a sore throat are not solely from the virus itself, but also from this inflammatory reaction.
These mediators cause local inflammation, characterized by increased blood flow, fluid buildup, redness, and swelling in the throat tissues. The swelling can put pressure on nerve endings, while the inflammatory chemicals directly stimulate pain receptors. This immune-driven inflammation is a defense mechanism aimed at clearing the infection, but it results in the severe discomfort and pain associated with a COVID-19 sore throat.
Why Some Cases Are More Severe
Several factors can influence why some individuals experience a significantly more severe sore throat with COVID-19 compared to others. One contributing element is the viral load, which refers to the amount of virus present in the upper respiratory tract; a higher viral load can lead to more extensive cellular damage and a stronger inflammatory response. Certain variants of SARS-CoV-2 have also been associated with differing symptom profiles.
For instance, the Omicron variant and its sublineages, like Nimbus (NB.1.8.1), have frequently been linked to a higher incidence and intensity of upper respiratory symptoms, including sore throat, compared to earlier strains. This is partly because Omicron variants tend to concentrate more in the upper respiratory tract and bind more strongly to ACE2 receptors in the throat. Individual variations in the immune system also play a role; some people’s immune responses may produce a more robust inflammatory reaction, leading to greater pain. These combined factors contribute to the wide spectrum of sore throat severity observed among those infected with COVID-19.
What Makes COVID Sore Throats Unique
The sore throat experienced with COVID-19 often possesses distinct characteristics that differentiate it from those caused by other common respiratory infections, such as the common cold, flu, or strep throat. Many individuals report a sensation far more intense than typical, often described as feeling like “swallowing glass shards” or having an extremely raw and burning sensation. This particular qualitative difference goes beyond the usual scratchiness or mild pain.
The discomfort can be unusually prolonged and severe, making even sips of water painful. While other infections cause sore throats, the specific combination of intensity, burning, and the feeling of extreme rawness can make a COVID-19 sore throat feel uniquely debilitating.