Exploring Uncommon Symptoms of COVID-19

The official list of COVID-19 symptoms recognized by 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 quite straightforward, as the virus primarily impacts the lungs and can lead to pneumonia. However, there are also gastrointestinal symptoms like nausea, vomiting, and diarrhea that are less typical for respiratory illnesses. Recent research has revealed that the new Coronavirus (SARS-CoV-2) can influence almost every organ in the body, including the gastrointestinal tract, where ACE2 receptors are abundantly expressed, making it a susceptible target for infection ^[2].

You might be surprised to know that most patients who test positive for COVID-19 typically display only the obvious respiratory symptoms. However, we should definitely pay attention to these unusual and atypical manifestations of the virus, as gastrointestinal symptoms have been shown to correlate with poorer outcomes in some patients ^[1].

1) Skin Manifestations

Doctors have been increasingly observing various skin reactions in COVID-19 patients. Interestingly, these skin issues often appear in otherwise asymptomatic children and young adults. A study conducted in Spain involving 375 COVID-19 patients noted the following skin changes:

1. COVID Toes – About 19% of patients experienced red blisters or swelling on the toes, which were itchy and painful. These blisters resemble chilblains, a condition caused by inflammation of small blood vessels due to cold exposure, hence they are referred to as pseudo-chilblains or COVID toes.
2. Hives or Urticaria – Also, 19% of patients developed raised, itchy lesions, primarily on their palms.
3. Small, Flat or Raised Skin Lesions – A significant 47% exhibited small, slightly raised red bumps.
4. Chickenpox-Like Lesions – Approximately 9% of patients showed itchy blisters resembling chickenpox lesions on their limbs and trunk.
5. Necrosis – In severely ill and older patients, poor blood circulation can lead to the skin appearing red or blue.

2) Gastrointestinal (GI) Symptoms

Gastrointestinal issues such as vomiting, nausea, loss of appetite, and diarrhea are frequently reported in earlier studies. Interestingly, these symptoms were only recently included in the CDC's list of COVID-19 indicators. The ACE2 cell receptors, which the new coronavirus uses to bind and replicate, are abundantly found in the digestive tract. While the acidic environment in the GI tract typically kills the virus, individuals who take antacids or medications to reduce stomach acid may inadvertently create a favorable environment for the virus, possibly leading to these symptoms ^[4].

3) Loss of Smell and Taste

Many COVID-19 patients report losing their sense of smell or taste, often before other symptoms occur. This is why healthcare professionals have started recognizing it as an early warning sign to test for the virus. Interestingly, this loss of smell or taste commonly occurs without nasal congestion and can last from about 9 to 14 days, indicating its significance as a potential indicator of infection ^[3].

4) “Happy” Hypoxia

Hypoxia refers to a drop in oxygen levels in the body. It typically leads to breathing difficulties or shortness of breath, which are standard COVID-19 symptoms. However, some patients with dangerously low blood oxygen levels continue to breathe normally and don't show any symptoms — this phenomenon is termed silent or “happy” hypoxia. It's quite alarming because it can lead to severe complications, as these patients often remain unaware of their declining oxygen levels and fail to seek help.

5) Blood Clots

Interestingly, a subset of COVID-19 patients, especially younger adults, are experiencing unexplained blood clots. These clots can obstruct small blood vessels in various parts of the body or impede blood flow to the heart and brain, potentially causing heart attacks and strokes. They may also block blood flow to the lungs, resulting in pulmonary embolism (PE) ^[5]. Unfortunately, these blood clots often don't respond to traditional blood thinners and usually require surgical intervention.

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