AARP Hearing Center
Baruch Taylor/ EyeEm/ Getty Images
Fever, cough and shortness of breath are not the only warning signs of a coronavirus infection, even if they are some of the most common. Over the past year doctors have documented a handful of otherwise unexpected symptoms in patients with COVID-19, the illness caused by the coronavirus.
Some are reporting red or purple lesions on patients’ hands and feet; others are treating people with diarrhea and severe appetite loss. There are also patients who have lost their sense of taste and smell. These symptoms, strange as they may seem, reinforce what experts around the world have come to realize: The coronavirus (SARS-CoV-2) is capable of causing more than a respiratory illness; it can launch a full-body attack.
“It takes a while for the full range of symptoms to kind of be known” when you’re dealing with a new virus, explains Lisa Winston, M.D., an epidemiologist and professor of clinical medicine at the University of California, San Francisco (UCSF). At the start of the U.S. outbreak, the focus was primarily on treating the sickest patients, many of whom experienced classic respiratory symptoms and needed help breathing. “And then, as time went on and people saw more cases, they started to recognize some of the things that are a bit less typical,” Winston says.
Here are some uncommon signs of COVID-19 that fall outside the hallmark symptoms.
‘COVID toes’
If you had asked dermatologist Esther Freeman, M.D., in 2019 what type of skin ailment a future viral pandemic might bring about, she never would have predicted red- and purple-colored toes that swell, burn and itch. But that’s exactly what she and other experts have seen in patients during the pandemic, leading this unusual symptom to be dubbed “COVID toes.”
“The good news is, they do go away,” says Freeman, director of Massachusetts General Hospital Global Health Dermatology and assistant professor of dermatology at Harvard Medical School, who is also overseeing an international registry that catalogs the dermatological manifestations of COVID-19. “So we’re not seeing that this is going to cause permanent damage.”
Another plus: The majority of people with COVID toes — which Freeman likens to chilblains (also called pernio), an inflammatory skin condition that often occurs after exposure to very cold temperatures — don’t experience other symptoms of a coronavirus infection and don’t require hospitalization for care. “Many patients are developing these toe lesions well after their infection, or they’re otherwise completely asymptomatic, except for the toes,” she adds.
Though most cases of COVID toes occur in the feet, the hands can be affected, too. Rashes similar to those that result from hives and chicken pox have also been reported in people who test positive for the coronavirus.
If you notice a lesionlike rash on your hands or feet, contact your doctor or dermatologist about your symptoms, since it could signify a coronavirus infection. That said, it’s important to keep in mind that “not everything on your toes right now is from COVID,” Freeman says. “There’s certainly lots of other things that can appear on the feet, and there’s things that can even look similar,” which is why it’s important to talk with an expert. There is no specific treatment for COVID toes, but a high-potency topical steroid might reduce inflammation.
Loss of taste or smell
On the CDC’s list of common COVID-19 symptoms, one stands out. In addition to fever, chills and a sore throat, the public health agency recognizes new loss of taste or smell as evidence of a coronavirus infection.
“People who have colds, if they get a really stuffy nose, they may complain of lack of smell, but, you know, that’s sort of an unusual [symptom] right now in the absence of COVID,” UCSF’s Winston says. But it may be one of the best indicators of a coronavirus infection.
A study published in the journal Nature Medicine tracked more than 2.5 million participants who reported their potential symptoms of COVID-19 on a smartphone app. About 65 percent of people who tested positive for COVID-19 reported loss of taste and smell, making it one of the strongest predictors of the illness among those studied. Similarly, researchers from the University of California, San Diego, found that smell and taste loss were reported in 68 and 71 percent of COVID-19–positive subjects, respectively.
Diarrhea, nausea, vomiting and severe appetite loss
COVID-19 is producing symptoms of diarrhea, nausea, vomiting and appetite loss in a number of patients young and old. A study out of Stanford University School of Medicine found that nearly one-third of 116 patients infected with the coronavirus reported mild gastrointestinal (GI) symptoms. Earlier reports showed that among roughly 200 patients in China, more than half experienced diarrhea, nausea or vomiting. The Centers for Disease Control and Prevention (CDC) has also acknowledged GI issues on its list of COVID-19 warning signs.
Hair Loss: Another COVID-19 effect?
More than 20 percent of COVID-19 patients report hair loss two to four months after infection, studies show. Doctors say it’s likely a reaction to the stress brought on by the disease, rather than a symptom of the virus itself.
Westend61 / Getty Images
“There’s no question at this point that GI symptoms can be a manifestation of COVID-19,” says William Chey, M.D., professor of gastroenterology and nutrition sciences at the University of Michigan. And oftentimes these symptoms can come on even in the absence of “the more typical and recognized” markers of a coronavirus infection, such as fever and cough, he adds.
Experts point to a few explanations for the tummy trouble. Chey says the virus can directly infect the cells that line the GI tract, which is why some patients can test positive for the virus with a stool sample, even if results from a nasal swab come back negative. GI issues could also be an indirect result of the body’s fight against infection.
If you don’t have a history of GI trouble and experience a sudden onset of diarrhea, nausea, vomiting or loss of appetite — with or without other COVID-19 symptoms — check in with your doctor. Your symptoms might warrant a coronavirus test.
And if you are diagnosed with COVID-19, consider confining yourself to your own room and bathroom, separate from others in your house.
Headaches, dizziness and confusion
Beyond loss of taste and smell, doctors are noting a growing list of neurological effects in COVID-19 patients. Other indicators of the illness include dizziness, headache and confusion.
In fact, a study in JAMA Neurology found that more than 36 percent of 214 patients in Wuhan, China, experienced neurological symptoms during their bout of COVID-19. More recent research published in Annals of Clinical and Translational Neurology found that neurological manifestations — headaches, dizziness, confusion, etc. — were present in 42 percent of patients at the onset of COVID-19 symptoms and in 82 percent of patients at any time during the disease course.
For older adults, in particular, these neurological effects can be just as devastating as the pulmonary impacts of a coronavirus infection, says XinQi Dong, M.D., director of the Institute for Health, Health Care Policy and Aging Research at Rutgers University-New Brunswick. They can also be easily overlooked or dismissed as dementia or other diseases common with aging.
More on health
The Coronavirus and Cancer: What You Need to Know Now
Those already battling a chronic health condition are at higher risk of infection and complications from COVID-19
Coronavirus and Older Adults: Your Questions Answered
A CDC official explains why more risk comes with age from COVID-19This Is What a Coronavirus Infection Feels Like
CDC expands list of COVID-19 symptoms and emergency warning signs