As the Centers for Disease Control and Prevention expands its list of possible symptoms for COVID-19, health providers have been reporting other problems in patients with the virus. A pulmonologist explores possible causes.
The CDC initially listed cough, fever and shortness of breath as symptoms of the virus.
But the agency has since added a second category of possible symptoms:
- repeated shaking with chills
- muscle pain
- sore throat
- new loss of taste or smell.
Healthcare Providers Are Reporting Other Problems
In a letter in the New England Journal of Medicine, a team of doctors from Mount Sinai Health System in New York contends COVID-19 can cause blood clots that can lead to stroke and other health concerns.
Also, dermatologists have reported “COVID toes”or frostbite-like patches showing up on people’s toes. This harmless rash often went away on its own without treatment, but many of the same patients tested positive for COVID-19.
"One thing that has become exceedingly clear in taking care of COVID patients is it's not simply a respiratory disease,” said Dr. John Hollingsworth II, a pulmonologist associated with Texas Health Harris Methodist Hospital Fort Worth. “It's a systemic disease and really can affect all the organ systems depending on the severity of disease.”
The skin is one of the largest organ systems in the body and with many systemic infections or diseases, we see manifestations in the skin. We're seeing that with COVID-19 also, we see the changes in the distal extremities and toes. It's been described in a number of reports where people get rashes across the torso, and this is very common in what we see with other diseases that involve the vasculature and have a vasculitis-like picture. So, this is very consistent with what we see with other viruses that you have dermatologic manifestations.
Blood Clots And Strokes Associated With COVID-19, As Well As Liver Failure
- The virus clearly can enter a number of different cell types in many different organ systems. In fact, when you look at organs like the neurologic tissue or in the kidney or even in blood cells, I mean it appears as though there are viral inclusions and entry of the virus into these cells. So it's not entirely surprising that there are neurologic manifestations.
- Stroke, on the other hand, is a much more rare complication that has been described in a number of case reports. In our hospital, I've seen the same thing where people will present without other risk factors and present with stroke and also have COVID-19. There's a lot of emerging evidence that COVID does cause a microvascular disease or microvascular thrombosis which can also cause the vascular changes as well as a hypercoagulable-like state where you can develop either stroke, pulmonary embolus or a blood clot in the legs.
So, How Does A Doctor Know Whether To Test For Or Suspect COVID-19?
This is becoming more and more difficult to discern who actually has COVID-19. Part of that depends on a prevalence of disease in the community. As the prevalence of disease increases, the suspicion that people have COVID actually has to go quite higher with a number of different symptoms. I think that's in part the reason the CDC and the WHO (World Health Organization) have both very broad symptoms when they're thinking about COVID-19.
How Should The Public React To All This?
- I think it boils down to controlling spread of disease, social distancing, hand-washing, not getting out into public when you're sick. The rationale behind that is just buying time. So we have new therapies to treat patients effectively when they do end up in the hospital.
- I think it's very confusing to people because there is so much information that comes out and some of that information is accurate, but some of that information is incomplete or even misinformation. So, I would really rely on experts in the field like Dr. Tony Fauci who give good sound advice about how to approach this disease moving forward.
- When approached in the hospital, I strongly encourage people to participate in those (clinical) trials because that's really the way we move the market forward as a society to have new novel therapies that actually effectively treat patients once they have this infection.