COVID Toes' might be the latest unusual sign that people are infected with the novel coronavirus

Purple and swollen toes that look like they've been frostbitten may be the latest indication of coronavirus infection, doctors say.

Dubbed, ' COVID Toes' by the dermatology community, this symptom could be the latest indication that you should get tested for coronavirus. Other have included anosmia, ot a loss of smell, and conjunctivitis, also known as pink eye, which the American Academy of Opthalmology recently suggested could be a sign of the virus.

The American Academy of Dermatology (AAD) launched a registry last week to track the dermatological effects that COVID-19 virus patients may be experiencing and received over 200 submissions from healthcare providers as of Wednesday afternoon.

A dermatologist and epideniologist said, around half of the cases in the registry note these lesions in the hands or feet that resemble frostbite.

The Dr's also seens several of these cases in her own patients in recent weeks. She said, she connected with patients through virtual consultations.

My message to the public would be, if you develop these, talk to your healthcare provider, she said.
If you go to a doctor, they'll ask questions about whether there may be any other reasons why you would be developing these lesions.

In the absence of another reason to have these COVID toes, you may want to consider testing abd think about potentially limiting the risk of spread to other people, she said.

What causes COVID toes?
A lot is unknown about what may be causing this condition, she said. She said there are a few main theories circling in the medical community.

One of the theories is that the lesion may be due to the virus causing general inflammation in the body. Another is that the virus may be causing vasculitis, meaning the walls of the blood vessel themselves are becoming inflamed. A 3rd possibility is that the lesions may be caused by blood clots in vessels in the skin. Doctors are increasingly seeing blood clots as a compilation of the virus.

But it may end up that more than one of these hypotheses ends up being true, she said. It could be a combination of these things or some patients may experience ' COVID toes' for one of the reasons while others may experience them for another.

It's possible that it's a spectrum, she said.An infectious disease specialist, recently posted a tweet about ' ACOVID Toes' that has garnered over 2,300 retweets and 3,500 likes on the site.

The Dr. said that though he hasn't yet seens COVID-19 patients with swollen toes in his own practice, what he has seen is immense interest from the medical community in the topic. He said, he's had several people leave comments on his post and send him private messages relaying their own experiences with the symptoms.

In recent webinar where he was presenting on the virus to family doctors, he said that an audience member also raised the question of whether he or others had seen lesions in the toes of coronavirus patients.

He said that though it's still early and the cases are mostly anectotal, he feels quite certain that the frost-bite like toes in some COVID-19 patients are a sign of the disease

But it's going to take a very large population that is surveyes to be able to make any definite findings, and that might still take a while, he said.

Patients with COVID toes tend to be younger, and may not have other symptoms
.
Most COVID-19 patients experiencing painful and swollen toes seem to be younger, a Prof. of dermatology said. Many of them appear to be relatively healthy and show few or no other symptoms of COVID-19.

She suggests that anyone experiencing these symptoms be tested with both a test to see if they're curently infected, and an antibody test, which shows if they're infected previously. However, she notes that the inflamed and purple toes themselves aren't necessarily indicative that someone may develop other serious symptoms of the virus.

The toe problems can show up during or after another coronavirus symptoms have subsided, she said.
COVID toes may reveal the scope of exposure to the coronavirus

Those frostbite-like symptoms can happen for reasons unrelated to the coronavirus, especially during the winter or in areas with cold climates. However, the sheer number of cases of these toe problems, called pernio, that the medical community has seen, especially in countries like Spain, Italy that have warmer climates, has prompted doctors to consider the cases as related to the virus.
 
It is an astonishing number of patients who have these symptoms in their toes she said.

She said that the lack of testing for the virus means we don't really know how many people have had it and these toe problems are another indication that the virus is widespread.

We're understanding that many more people than we ever thought were exposed to the virus, had it, because our testing has been so poor, she said.

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Loss of smell sense first sign of COVID-19

Summary: As many as one in three COVID-19 patients report smell loss as an early symptom of the infection. Researchers say the loss of smell could be used as a key clinical indicator of infection in otherwise symptom-free or pre-symptomatic carriers of coronavirus.


Medical experts in countries hit by COVID-19 are reporting the first tell-tale signs of the virus may be in an unexpected loss of smell.

Ear, nose, and throat (ENT) surgeons say loss of smell, as the virus causes swelling in the olfactory mucosa more than other viruses, could be used as a key clinical indicator in otherwise symptom-free carriers of COVID-19.

“It is these ‘silent carriers’ who may remain undetected by current screening procedures, which may explain why the disease has progressed so rapidly in so many countries around the world,” says South Australian specialist Flinders University Professor Simon Carney, from the Southern ENT and Adelaide Sinus Centre.

“While further research is required, loss of smell, or anosmia, has been reported in as many as one in three patients in South Korea and, in Germany, this figure was as high as two in three patients,” says Professor of Otolaryngology (head and neck surgery) at Flinders University.

“An ENT professor in London has reported seeing a dramatic increase in patients with anosmia as their only symptom of COVID-19 infection.”

As Australia struggles to contain the spread of COVID-10, the identification of these carriers could help to slow the spread of infection.

“In the UK, ENT surgeons are pushing to have anosmia highlighted as an important symptom that may signify a patient may be an asymptomatic carrier,” says Professor Carney, immediate past president of the Australia and New Zealand Rhinologic Society.


“Australia is in a position to take advantage of these findings overseas to try and ‘flatten the curve’ while we still can.”

Doctors and COVID-19 detection centers could use this subtle sign and unexplained sudden anosmia the testing criteria, he says.

Patients should also consider calling their GP with this early symptom as a precursor for possible treatment.

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Lost Sense of Smell May Be Peculiar Clue to Coronavirus Infection

A mother who was infected with the coronavirus couldn’t smell her baby’s full diaper. Cooks who can usually name every spice in a restaurant dish can’t smell curry or garlic, and food tastes bland. Others say they can’t pick up the sweet scent of shampoo or the foul odor of kitty litter.

Anosmia, the loss of sense of smell, and ageusia, an accompanying diminished sense of taste, have emerged as peculiar telltale signs of Covid-19, the disease caused by the coronavirus, and possible markers of infection.

On Friday, British ear, nose and throat doctors, citing reports from colleagues around the world, called on adults who lose their senses of smell to isolate themselves for seven days, even if they have no other symptoms, to slow the disease’s spread. The published data is limited, but doctors are concerned enough to raise warnings.

“We really want to raise awareness that this is a sign of infection and that anyone who develops loss of sense of smell should self-isolate,” Prof. Claire Hopkins, president of the British Rhinological Society, wrote in an email. “It could contribute to slowing transmission and save lives.”

She and Nirmal Kumar, president of ENT UK, a group representing ear, nose and throat doctors in Britain, issued a joint statement urging health care workers to use personal protective equipment when treating any patients who have lost their senses of smell, and advised against performing nonessential sinus endoscopy procedures on anyone, because the virus replicates in the nose and the throat and an exam can prompt coughs or sneezes that expose the doctor to a high level of virus.

Two ear, nose and throat specialists in Britain who have been infected with the coronavirus are in critical condition, Dr. Hopkins said. Earlier reports from Wuhan, China, where the coronavirus first emerged, had warned that ear, nose and throat specialists as well as eye doctors were infected and dying in large numbers, Dr. Hopkins said.

The British physicians cited reports from other countries indicating that significant numbers of coronavirus patients experienced anosmia, saying that in South Korea, where testing has been widespread, 30 percent of 2,000 patients who tested positive experienced anosmia as their major presenting symptom (these were mild cases).

The American Academy of Otolaryngology on Sunday posted information on its website saying that mounting anecdotal evidence indicates that lost or reduced sense of smell and loss of taste are significant symptoms associated with Covid-19, and that they have been seen in patients who ultimately tested positive with no other symptoms.

The symptoms, in the absence of allergies or sinusitis, should alert doctors to screen patients for the virus and “warrant serious consideration for self isolation and testing of these individuals,” the academy said. The organization has reminded its members that the Centers for Disease Control and Prevention has urged all clinicians to prioritize urgent and emergency visits for the next several weeks and to reschedule elective and routine procedures.

“There is evolving evidence that otolaryngologists are among the highest risk group when performing upper airway surgeries and examinations,” said a notice posted on the academy’s website on Friday. “A high rate of transmission of Covid-19 to otolaryngologists has been reported from China, Italy and Iran, many resulting in death.”

Dr. Rachel Kaye, an assistant professor of otolaryngology at Rutgers, said colleagues in New Rochelle, N.Y., which has been the center of an outbreak, first alerted her to the smell loss associated with the coronavirus, sharing that patients who had first complained of anosmia later tested positive for the coronavirus. “This raised a lot of alarms for me personally,” Dr. Kaye said, because those patients “won’t know to self quarantine.”

“Most ENTs have on their own accord tried to scale down,” she said, adding that her department at Rutgers had already started using personal protective equipment and stopped performing nonessential exams.

In the areas of Italy most heavily affected by the virus, doctors say they have concluded that loss of taste and smell is an indication that a person who otherwise seems healthy is in fact carrying the virus and may be spreading it to others.

“Almost everybody who is hospitalized has this same story,” said Dr. Marco Metra, chief of the cardiology department at the main hospital in Brescia, where 700 of 1,200 inpatients have the coronavirus. “You ask about the patient’s wife or husband. And the patient says, ‘My wife has just lost her smell and taste but otherwise she is well.’ So she is likely infected, and she is spreading it with a very mild form.”

Hendrik Streeck, a German virologist from the University of Bonn who went from house to house in the country’s Heinsberg district to interview coronavirus patients, has said in interviews that at least two-thirds of the more than 100 he talked to with mild disease reported experiencing loss of smell and taste lasting several days.

Another physician who studied a cluster of coronavirus patients in Germany said in an email that roughly half of the patients had experienced a smell or taste disorder, and that the sensory loss usually presented after the first symptoms of respiratory illness, but could be used to distinguish people who should be tested.

Dr. Clemens Wendtner, a professor of medicine at the Academic Teaching Hospital of Ludwig-Maximilians University of Munich, said that the patients regained their ability to smell after a few days or weeks, and that the loss occurred regardless of how sick they got or whether they were congested. Using nasal drops or sprays did not help, Dr. Wendtner said.

Several American patients who have had symptoms consistent with the coronavirus, but who have not been tested or are still awaiting test results, described losing their senses of smell and taste, even though their noses were clear and they were not congested.

Andrew Berry, 30, developed a fever and body aches about 10 days ago, and then a sore throat and debilitating headaches. He tested negative for influenza and has not gotten the result of a coronavirus test taken four days ago, but his physician was convinced that he had the virus, he said.

Now, Mr. Berry said, he literally cannot smell the coffee.

“Even with a clear nose, I just realized I couldn’t smell the food that I was cooking, and I couldn’t taste the food that I was making,” said Mr. Berry, a tattoo artist based in Orlando, Fla. He was cooking a plantain dish with onions and vinegar, yet he could not smell it.

Amy Plattmier, a woman from Brooklyn, was not tested for the coronavirus during a recent illness, but her husband then became sick and had a positive test. Ms. Plattmier said she usually had a very sensitive nose, but now could barely smell anything — not the bleach she was using to clean the counters, which usually makes her feel nauseated, or the dog’s accident in the bathroom, which she cleaned up.

Mr. Berry has also lost some weight, because he has not had much of an appetite. “Hopefully it’s not a prolonged effect,” he said. “I can imagine it changes the quality of life.”

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8 Possible Reasons Why You Can't Smell

Imagine drinking a glass of milk and having no idea it’s gone bad until you’re in the E.R. with food poisoning? Worse yet, imagine leaving the gas in your stove on, and not noticing until it’s too late?

Though not as obviously crucial as sight and hearing, our sense of scent is incredibly important, as it alerts us to potential hazards like those mentioned above as well as wild animals, smoke and more. Beyond that, much of our sense of flavor is actually derived from smelling (taste and pain are the other two senses informing our culinary experience).

Typically speaking, the loss of smell (called anosmia) is the result of nasal congestion and will pass with the cold or allergic response which caused it. However, there may be other factors causing anosmia, some of which quite severe.

The way our sense of scent works is that molecules in the air travel up our nose, about 3 inches behind the nostrils, where they stimulate our olfactory receptors, which then activate sensory neurons, nerve cells found at the roof of the nasal cavity. Damage to the nerves or physical obstacles in the nose that might inhibit this process may cause anosmia.
 

Beyond nasal congestion, possible causes for anosmia are:

 

1. Polyps

Benign, painless non-cancerous growths may obstruct the nasal cavity, stopping particles from reaching the olfactory system. Polyps might be caused by an inflammation of the nasal lining and can be treated with steroids or safely removed via surgery. They are rather common, and affect anywhere between 4-40% of the world's population.

2. Solvents

Long-term inhalation and exposure to solvents like nail polish and turpentine may cause a condition referred to as chronic painters’ syndrome, the symptoms of which include memory loss, loss of cognitive and psychomotor abilities, personality shifts and loss or impairment of color vision and smell.

3. Trauma

Head trauma, such as that caused by facial and skull fractures and concussions, as well as botched surgeries, might cause damage to the nasal cavity or olfactory nerves, causing anosmia. This type of damage might be temporary, lasting up to six months after the fact, or permanent.

4. Drugs

The snorting of drugs like cocaine and methamphetamines, as well as illicit recreational snorting of legal opioids, such as oxycodone, is done with the intent of achieving a more potent and fast-onset high. The resultant damage to the nasal cavity and nerves can cause anosmia, as well as a perforation of the septum (the barrier separating the nostrils).

5. Medicine

Decongestant nasal sprays (such as otrivine) may provide temporary relief to cold-related anosmia, but may trigger long-term loss of smell. Likewise, homeopathic nasal sprays which incorporate zinc may cause anosmia. Some oral medicine, such as nifedipine and aspirin (and other non-steroidal anti-inflammatory drugs) may also trigger anosmia.

6. Neurodegeneration

Diseases and medical conditions that target the nervous system, such as Parkinson’s, multiple sclerosis and Lewy body dementia (a variant of dementia characterized by abnormal protein bodies developing inside nerve cells) may hamper or cause complete loss of the sense of smell. In these cases, anosmia can be a warning sign of degenerative progression.

7. Radiotherapy

Radiation treatment for cranial or neck cancer may cause anosmia as a side-effect. As unfortunate and unwanted as that may be, it should not be a factor in considering treatment for cancer.

8. Aging

Much like other senses and faculties, one possible symptom of old age can be a declining sense of smell. Among octogenarians, 60%-80% have experienced either partial loss of smell (hyposmia) or total anosmia.

In any case you find you sense of smell has been impaired inexplicably, tell a doctor. A family doctor should be able to diagnose or rule out inflammation or polyps, if those are causing your anosmia.

Treatment

In congestion-caused anosmia, the simplest treatment is taking decongestant drugs, though you should avoid nasal sprays (why? Read above). If the cold or rhinitis have passed and the anosmia still persists, tell a doctor.

If the cause of your anosmia is a polyp in your nasal passage, steroidal spray may shrink or eliminate the polyps. If ineffective, a surgery may be required to remove them and regain the sense of smell.

If your sense of smell is declining and you’re worried that a drug you’re taking might be the cause, consult with your doctor. Do not, however, stop taking prescribed medicine because of a hunch, before hearing a qualified professional's opinion.

Anosmia might be temporary or permanent. In cases where it is untreatable, as in anosmia caused by old age, you might want to make adjustments to your household and lifestyle. Take extra care when consuming perishable goods, read the expiration date and install smoke and gas leak detectors in your house.

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