Unusual Manifestations of COVID-19

Unusual Manifestations of COVID-19

The official list of COVID-19 symptoms (according to the CDC) includes fever, dry cough, chills, runny nose or congestion, fatigue, muscle or body pain, headache, sore throat, loss of smell or taste, and breathing difficulty. These symptoms are obvious as the virus affects the lungs and causes pneumonia. But, the list also includes symptoms such as nausea, vomiting, and diarrhea, which are not commonly seen in respiratory illnesses. Recent studies have shown that the new Coronavirus (SARS-CoV-2) can affect almost every organ.


Most patients tested positive for COVID-19 show only the typical respiratory symptoms, but the following uncommon and atypical manifestations of COVID-19 should not be overlooked.

1) Skin Manifestations


Doctors are increasingly noting various skin manifestations in COVID-19 patients. These skin symptoms are commonly seen in otherwise asymptomatic children and young adults. The following skin changes were noted in a study conducted in Spain on 375 COVID-19 patients:

1. COVID Toes – 19 % of the patient had red blisters or swelling on the toes that were itchy and painful. As they resembled chilblains, a condition that results in inflammation of the small blood vessels in the skin due to exposure to cold, these blisters are called pseudo-chilblains or COVID toes.
2. Hives or Urticaria – 19 % of the patients had pink, raised, and itchy lesions, more commonly in the palms.
3. Small, Flat or Raised Skin Lesions – 47 % of the patients exhibited red bumps, which were small and slightly raised.
4. Chickenpox-Like Lesions – 9 % of the patients showed itchy blisters that looked like chickenpox lesions in the limbs and trunk.
5. Necrosis – In severely ill and older patients, poor blood circulation turned the skin red or blue.

2) Gastrointestinal (GI) Symptoms


Gastrointestinal symptoms, such as vomiting, nausea, loss of appetite, and diarrhea, have been commonly reported in earlier studies. Still, it was only recently added to the list of COVID-19 symptoms by the CDC. ACE2 cell receptors, the cells that the new coronavirus uses to bind and multiply, are present abundantly in the digestive tract. The virus that enters the GI tract gets killed by the acidic environment. But people who take antacids and medicines for reducing acid production in the stomach create a perfect setting for this virus to manifest, which might be the cause of these symptoms.

3) Loss of Smell and Taste


Most COVID-19 patients experience the loss of smell or taste or both, even before they develop other symptoms. This is why doctors are using it as an early indicator and an important sign to test for COVID-19. Loss of smell or taste is commonly associated with nasal congestion, but in COVID-19 patients, these symptoms usually occur without nasal congestion and last for about 9 to 14 days.

4) “Happy” Hypoxia


A drop in the oxygen level in the body is called hypoxia. Hypoxia results in breathing difficulties or shortness of breath, which is listed in the official COVID-19 symptoms. But, some COVID-19 patients with dangerously low blood oxygen levels continue to breathe normally and do not exhibit any symptoms, which is called silent or “happy” hypoxia. It can result in fatal complications, as the patient is usually unaware of the falling oxygen levels, and fails to get help.

5) Blood Clots


A few COVID-19 patients, especially young adults, are experiencing unexplained blood clots. These blood clots block small blood vessels in various parts of the body or the blood supply to the heart and brain, resulting in heart attacks and strokes. It can also block the blood flow to the lungs, resulting in pulmonary embolism (PE). These blood clots do not respond to blood thinners and usually need surgery.


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