Kawasaki disease, frostbite on toes, lack of oxygen but not uncomfortable... What other strange symptoms are there of new coronavirus infection?

I have never seen a mysterious virus like this.

by Dr. Anthony Fauci

By Ji Zhi

As the number of people infected with the new coronavirus increases, more and more atypical symptoms of infection have appeared clinically, prompting us to have a deeper understanding of this emerging viral disease. In late April, the CDC (Centers for Disease Control and Prevention) updated the list of symptoms for COVID-19. Prior to this, the CDC had always defined "fever, cough, and shortness of breath" as clinical symptoms of COVID-19 infection, but as the number of clinically observed symptoms increased, the CDC included "repeated shivering, body chills, muscle pain, headache, sore throat, loss of taste or smell, etc." in the list of suspected infection symptoms of COVID-19.

CDC updates its COVID-19 symptom list | Source: U.S. CDC website

In addition, more atypical symptoms have appeared in larger patient samples. Although some symptoms are only seen in very isolated cases, they should not be ignored. There is increasing evidence that the symptoms after infection depend on the age of the patient. However, scientists are not sure whether these symptoms are directly caused by the new coronavirus. In this article, we will introduce these atypical infection symptoms.

1. Paediatric multisystem inflammatory syndrome

Recently, rare cases of pediatric inflammatory syndrome associated with the new coronavirus have appeared in many countries. On May 4, the New York City Department of Health issued a warning that the city had found 15 cases of hospitalization due to multisystem inflammatory syndrome, all of which were children aged 2 to 15 years old. The report pointed out that these symptoms may be related to COVID-19 [1].

Similar cases of children have also been reported in Europe. According to the French Health Agency, 135 children in France have developed multisystem inflammatory syndrome in recent weeks, and one 9-year-old has died as a result.[2] According to The Guardian, in the UK, 12 children have required intensive care due to the syndrome, and a 14-year-old boy has died.[3] Currently, seven countries around the world have reported cases of such children, including the UK, the US, France, Spain, Switzerland and Australia.[4]

The children have had fever, and some have had rash, abdominal pain, vomiting, and diarrhea. Clinicians describe these symptoms as toxic shock syndrome or Kawasaki-like disease. A new study published in The Lancet suggests that this rare inflammatory syndrome in children is associated with the novel coronavirus.[5] Although this symptom is relatively rare—studies estimate that only one in a thousand children exposed to the coronavirus will be affected—it is still important to take seriously, especially since past experience has shown that children are at lower risk of contracting the coronavirus.

Children infected with the new coronavirus show symptoms similar to Kawasaki disease | Image source: https://healthier.stanfordchildrens.org/wp-content/uploads/2020/05/iStock-PIMS-Kawasaki-4.jpg

2. Strokes and blood clots

In adult patients, scientists around the world have observed an association between COVID-19 infection and blood clots, even in patients who were not at risk for blood clots.[6] A recent report in the New England Journal of Medicine analyzed five cases of COVID-19 infection and severe stroke symptoms in New York City. The patients were aged between 33 and 49, and only one of the five had a history of stroke.[7]

Although it is generally believed that young people are less likely to suffer a stroke from COVID-19, COVID-19 patients are likely to suffer from venous and arterial thromboembolism due to excessive inflammation, hypoxia, and disseminated intravascular coagulation caused by the infection. In April this year, a study published in the journal Thrombotic Research showed that 31% of COVID-19 patients in intensive care units in the Netherlands developed symptoms of "thrombotic complications" [8].

Blood clots caused by the virus can affect both the heart and the brain. Although it is not yet clear how the virus attacks, there are many preprints and papers that prove that this damage is universal. Some scientists even believe that blood clots caused by infection with the new coronavirus may become a major factor affecting the severity and mortality of COVID-19[9].

A recent report from the New England Journal of Medicine

3. “COVID toes”

In rare cases, scientists have observed a phenomenon called “COVID toes”: a reddish-purple rash that resembles frostbite or pernioles that sometimes develops on the toes of COVID-19 patients, particularly in young, healthy adults.[10] A recent paper published in the International Journal of Dermatology described six COVID-19 patients with toe lesions.[11]

Past experience tells us that some viral infections can cause inflammation of the human circulatory system and lead to similar skin damage, so some experts believe that this may also occur during COVID-19 infection.

This type of red inflammation is usually associated with exposure to cold air, but similar conditions have also been seen in Covid-19 patients. | Image source: https://static01.nyt.com/images/2020/04/30/science/30VIRUS-COVIDTOE/merlin_172080117_c3a7b19b-1404-4a2c-abbd-e7f682113861-jumbo.jpg?quality=90&auto=webp

4. Silent hypoxia

Dyspnea is generally considered a common symptom of COVID-19 and can put a great burden on the human body. However, in some cases, scientists have observed that when patients' bodies show extremely low blood oxygen levels, they do not show signs of dyspnea, and some patients are even awake [12]. This phenomenon is called "silent hypoxia." Why does COVID-19 cause this abnormal form of hypoxia? This medical mystery that has puzzled scientists is still under study.

In some cases, it was observed that when patients showed extremely low blood oxygen levels, they did not show signs of breathing difficulties | Image source https://cdn.the-scientist.com

5. Gastrointestinal issues

In a study of 116 COVID-19 patients published in the journal Gastroenterology in April, researchers in California found that 32% of patients had mild gastrointestinal symptoms, such as loss of appetite, nausea, and diarrhea. Scientists analyzed that the new coronavirus can bind to the ACE2 cell receptor, which is widely distributed in the gastrointestinal tract and other parts of the human body, which may be the reason for the occurrence of such symptoms.

6. Various forms of brain disease (such as delirium)

In some elderly patients, researchers have observed that COVID-19 infection is accompanied by symptoms such as disorientation and confusion. Researchers at the University of Lausanne Hospital published clinical guidelines in the Revue Medicale Suisse to provide better diagnosis for elderly COVID-19 patients [15]. Common symptoms in the guidelines include fever, gastrointestinal diseases, easy falls, and mental disorders. Although further investigation and research have not yet been conducted, the link between confusion and symptoms such as urinary tract infections in elderly patients is well known [16]. The association between COVID-19 infection and these brain diseases still needs further study.

References

[1] https://www1.nyc.gov/assets/doh/downloads/pdf/han/alert/2020/covid-19-pediatric-multi-system-inflammatory-syndrome.pdf

[2] https://www.lefigaro.fr/sciences/coronavirus-135-enfants-francais-atteints-d-une-forme-proche-de-la-maladie-de-kawasaki-un-mort-20200515

[3] https://www.theguardian.com/world/2020/apr/27/nhs-warns-of-rise-in-children-with-new-illness-that-may-be-linked-to-coronavirus

[4] https://www.businessinsider.com/doctors-find-link-between-coronavirus-and-kawasaki-like-child-disease-2020-5

[5] https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31103-X/fulltext

[6] https://www.webmd.com/lung/news/20200424/blood-clots-are-another-dangerous-covid-19-mystery

[7] https://www.nejm.org/doi/full/10.1056/NEJMc2009787

[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146714/

[9] https://www.sciencemag.org/news/2020/04/how-does-coronavirus-kill-clinicians-trace-ferocious-rampage-through-body-brain-toes#

[10] https://www.nytimes.com/2020/05/01/health/coronavirus-covid-toe.html

[11] https://onlinelibrary.wiley.com/doi/10.1111/ijd.14937

[12] https://www.theguardian.com/world/2020/may/03/happy-hypoxia-unusual-coronavirus-effect-baffles-doctors

[13] https://www.gastrojournal.org/article/S0016-5085(20)30471-6/fulltext

[14] https://www.the-scientist.com/news-opinion/receptors-for-sars-cov-2-present-in-wide-variety-of-human-cells-67496

[15] https://www.revmed.ch/RMS/2020/RMS-N-691-2/Infection-COVID-19-chez-les-personnes-agees-en-Suisse-Romande.-Un-etat-des-lieux-entre-croyances-convictions-et-certitudes

[16] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6360770/

This article is partially translated from https://www.the-scientist.com/news-opinion/the-unusual-symptoms-of-covid-19-67522