New symptoms of COVID-19 have emerged recently and the prevalence of these has included pediatric cases. According to a lung health expert, the symptoms are not uncommon in viral infections, but the ones from COVID-19 are yet to be fully explained.
The emergence of uncommon symptoms of COVID-19, especially among pediatric cases, was confirmed by a pulmonologist at Cleveland Clinic, an American academic medical center. These uncommon symptoms include COVID toes and skin rash. While not the usual clinical signs, the expert said that skin rash is a classical sign in many viral infections. For doctors, it would be critical to determine the combination of symptoms to know if testing is needed.
The Emergence of COVID Toes and Skin Rash
The common symptoms of a person who contracted SARS-CoV-2, the virus of COVID-19, are cough, shortness of breath or difficulty breathing, chills, fever, muscle pain, loss of taste or smell, and sore throat. These symptoms have similarities to other typical illnesses, like the flu. But a careful examination of the combination of symptoms and history of the patient can differentiate a COVID-19 case from influenza.
However, weeks after those most common symptoms were confirmed, new symptoms stole the spotlight and many associated cases are pediatric. The emerging symptoms were COVID toes and skin rash. These symptoms were added to the list of unusual clinical signs, which include nausea, vomiting, and diarrhea. The emergence of the symptoms has been speculated as a different reaction of some patients against the disease. While most patients experience flu-like symptoms, a few others develop skin rash or lesions that would confuse physicians.
"It's important for everyone to know that the most common symptoms for COVID-19 are really respiratory symptoms and symptoms that are similar to those of the flu. For example, a dry cough, heavy fever, and feeling tired," explained Dr. Humberto Choi, a pulmonologist at Cleveland Clinic.
COVID toes refer to the changes in the appearance of the patient's toes. One indicator of COVID toes is the sudden appearance of red lesions on toes, but it is more common on the soles. The red lesions may be explained by a skin reaction, or the clogs or tiny clots in the small blood vessels in the toes. Though, the red lesions Dr. Choi has observed were in patients on life support or in those with sepsis, a life-threatening immune-related complication. The clogs in the toes can induce discoloration – the reason why it is called COVID toes.
Meanwhile, the skin rash attributed to COVID-19 is characterized by blotchy areas on the patient's body. It can be similar to the skin of other viral infections, most notably measles. Dr. Choi clarifies that viruses capable of infecting people are known to trigger skin reactions. Likewise, antibiotics administered to patients who may be prone or already have a secondary bacterial infection can exhibit rashes, a side effect of antibiotics.
Unfortunately, clinicians around the globe have not found specific patterns of skin rash in COVID-19. The rashes seem to look like the same ones in other viral infections. For COVID toes, doctors have not yet discovered its direct correlation to COVID-19. If they find the connection, it will help medical professionals to determine the severity of the disease in patients. For example, if COVID toes normally occur in some patients with moderate or severe symptoms, medical frontliners may examine the toes of COVID-19 sufferers to track down the disease. It may provide a strong hint to administer last resort treatments, like plasma therapy, before the patient completely crashes.
Multi-System Inflammatory Syndrome and COVID-19
In COVID-19 pediatric cases, an unusual development of the disease in children stunned clinicians and medical researchers. Certain pediatric cases highlighted the symptoms of Kawasaki disease or KD, a vascular disorder in young children. The hallmark symptom of KD is inflammation and for some reason, few pediatric patients expressed a major inflammatory reaction against the coronavirus. It was unusual because young children do not have a mature immune system to react wildly against the virus.
According to Healthy Children, an online magazine published by the American Academy of Pediatrics, the Kawasaki-like inflammation is defined as multi-system inflammatory syndrome in children (MIS-C). It is considered a rare but serious complication in children infected by SARS-CoV-2. Although the number of cases with MIS-C is still low, experts are watching this closely because the complication may lead to premature death or permanent organ damage.
So far, experts have differentiated MIS-C from KD and they have listed the symptoms of the former. The typical symptoms of MIS-C are fever lasting for more than 24 hours, vomiting, diarrhea, or stomach pain, skin rashes or changes in skin color, and confusion or oversleeping. These signs may warrant the child to get a COVID-19 test. Similar to COVID toes, experts have no idea yet who is at risk of MIS-C.
Frequency of Common Symptoms in Pediatric and Adult Cases of COVID-19
According to the Centers for Disease Control and Prevention, a US agency, a total of 10,944 adults and 291 children tested positive for COVID-19 in the US, between February 12 and April 2, 2020. Experts were able to record the symptoms experienced by these patients and calculated the incidence of those symptoms. The symptoms with the highest incidence were fever at 71% of all adult cases and 56% of all pediatric cases, and cough at 80% of all adult cases and 54% of all pediatric cases. In cases with combined symptoms of fever, cough, and shortness of breath, the incidence was 93% of all adult cases and 73% of all pediatric cases.
The least common symptom from those cases was a runny nose. It was only confirmed in 6.9% of all adult cases and 7.2% of all pediatric cases. This would suggest that SARS-CoV-2 rarely causes a runny nose compared to the virus of the common cold. The second-least common symptom was abdominal pain confirmed in 12% of all adult cases and 5.8% of all pediatric cases.
Dr. Choi said that both COVID toes and skin rash are very uncommon and are only found in a select number of patients. Even though these symptoms are possible, the public should be wary of the most common symptoms first. The common symptoms mentioned earlier are normally what most patients develop initially before anything else.