Can COVID-19 Cause Nosebleeds? Yes, Here’s the Connection

Nosebleeds (epistaxis) are rarely dangerous. But they’re uncomfortable and messy. And sometimes they can be scary enough to send you to the emergency room. 

You may be familiar with common causes of nosebleeds, like injuries and dry air. But did you know that COVID-19 can cause nosebleeds? Like loss of smell and dizziness, nosebleeds are another unexpected COVID symptom. 

It’s not one of the most common COVID symptoms listed by the CDC. But research shows that people with COVID are over three times more likely to experience nosebleeds. In one study, nosebleeds were the only symptom experienced by 15% of people with COVID illness.

Here are three ways COVID can lead to nosebleeds. 

1. COVID causes damage to nasal passages

The COVID virus causes direct damage to the inside of your nose, which can lead to nosebleeds.

The virus that causes COVID often enters your body through your nasal passages, which are lined with small blood vessels and fragile tissue. When the COVID virus invades these nasal passages, it causes damage to the tissue and blood vessels. This can cause blood vessels to break and blood to leak out, causing nosebleeds.

2. COVID causes rhinitis

COVID causes nasal inflammation (rhinitis). Congestion and runny nose are common symptoms of COVID rhinitis. These symptoms irritate and dry out your nasal passages. Whenever the nasal tissue gets inflamed and dried out, it’s more prone to damage. This increases your risk of nosebleeds.

COVID isn’t the only bug that causes rhinitis. Other common cold viruses and seasonal allergies can also cause rhinitis. All of these conditions cause congestion and runny nose as well as increase the risk of nosebleeds. So, it’s no surprise that COVID infection also increases your chances of developing a nosebleed.

3. COVID testing causes nosebleeds

Nasal trauma is the most common cause of nosebleeds. But it’s not just blows to your nose that cause nosebleeds. Even minor trauma can break fragile blood vessels and lead to bleeding, especially when your nose is already inflamed.

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Unfortunately, if you might have COVID, you’ll experience nasal trauma in the form of a nasal swab for COVID testing. A nosebleed is the most common complication of nasal swabs — whether or not you have COVID.

Your chances of a nosebleed after your COVID swab are higher since your nose is already inflamed from the virus. 

Studies also suggest you’re more likely to develop a nosebleed after a COVID swab if you:

• Take anticoagulant medications (blood thinners) or antiplatelet therapy

• Have high blood pressure (hypertension)

• Have a history of nose injury or surgery

Can the COVID vaccine cause nosebleeds?

Yes, vaccines can lead to a nosebleed, but this is extremely rare.

The COVID vaccine can cause a rare reaction called “immune thrombocytopenia” (ITP). ITP destroys platelets, the cells your body uses to stop bleeding. 

People with fewer platelets are more likely to develop nosebleeds (and other types of bleeding). ITP can develop about 1 to 2 weeks after receiving the vaccine. 

But the COVID vaccine isn’t the only vaccine that can cause ITP. This reaction is rare: Only a few dozen cases have been reported out of the tens of millions of doses that have been given.

How to treat a COVID nosebleed at home

If you have COVID and develop a bloody nose, here’s how you can treat it at home:

• Pinch your nose shut for 5 to 10 minutes. Apply pressure to the cartilage near the tip (the soft part) of your nose — not the bone. Blood clots take time to form, so keep pressure for at least 5 minutes.

• As you apply pressure, lean forward and breathe through your mouth. This lets the blood drain from your nose instead of down the back of your throat.

• Stand or sit during this process and for about 1 hour after. This helps lower blood pressure in the blood vessels inside your nose, slowing the bleeding.

You may have heard that it helps to apply ice to your nose if it’s bleeding. But there’s limited evidence for this. One study found no evidence to support the idea that ice could actually help slow the bleeding. If you do apply ice, wrap it in a towel to avoid damaging your skin. And take it off after 10 minutes.

If the bleeding is very heavy or doesn’t stop after 20 minutes, you’ll need to seek medical care. Also get medical attention if your nosebleed occurs with other symptoms, like:

• Shortness of breath

• Trouble breathing

• Rapid heart rate 

• Fainting

How do you prevent COVID nosebleeds?

If you have COVID, here are some ways to lower your risk of nosebleeds: 

• Use a humidifier: Cold and dry air will dry out your nasal passages and increase your risk of developing a bloody nose. A humidifier will add moisture to the air and your nasal passages.

• Try nasal saline: Like humidifiers, nasal saline helps moisturize and soothe your nose. You can try nasal saline spray, gel, or rinses. 

• Treat allergies: Like air that’s cold and dry, allergies can also dry out and irritate your nasal passages. If you have seasonal allergies, use your regular allergy medications and avoid your allergens when possible. 

• Avoid trauma: While you may not be able to skip the nasal swab, try to avoid other nasal trauma. Avoid scratching or rubbing your nose. If you don’t have to retest, skip additional nasal swabs.

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Written by:

Ronald W. Dworkin, MD, PhD

Ronald W. Dworkin, MD, is a board-certified anesthesiologist who has been practicing anesthesiology in a community hospital for 30 years. He has taught in the honors program at George Washington University for over 10 years and works as a senior fellow at the Hudson Institute.

Edited by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

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