By now, we know the symptoms of COVID-19 to watch for:
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- Fever or chills.
- Shortness of breath or difficulty breathing.
- Muscle or body aches.
- Loss of taste or smell.
- Sore throat.
- Congestion or runny nose.
- Nausea or vomiting.
In addition to these, the CDC recommends seeking emergency medical care if you experience:
- Trouble breathing.
- Persistent pain or pressure in the chest.
- New confusion.
- Inability to wake or stay awake.
- Bluish lips or face.
While the aforementioned symptoms seem to be more common, there have also been some outliers.
Throughout the pandemic, we’ve heard about COVID toes and rashes, pink eye and even people losing their appetite. So why does it seem like every time we turn around, some new symptom is making a special guest appearance?
According to pulmonary and critical care physician Joseph Khabbaza, MD, some of these reactions are quite normal, while others are symptoms that the medical community is still learning about.
Why are COVID-19 symptoms all over the place?
“Really, nothing is off the table when it comes to COVID. I always get texts from people asking if something they’re experiencing is normal. Well, there’s nothing that’s truly abnormal when it comes to COVID — literally almost anything goes and we don’t exactly know why,” says Dr. Khabbaza.
Dr. Khabbaza says that two people who might appear to be similar on paper can react in totally different ways to COVID-19. As for uncommon symptoms of the virus, he says the following have popped up frequently.
Brain fog, confusion, hallucinations or delirium
Dr. Khabbaza reports that he’s seen these symptoms quite often. While the medical community is still trying to figure out what causes brain fog, it’s believed that it’s likely a result of the body’s immune response to the virus or inflammation throughout the nervous system and blood vessels that lead to the brain. As for hallucinations and delirium, those, too, stem from the body fighting off the virus.
“Brain fog is kind of a big one. It’s a kind of mental cloudiness — like you’re in a daze. You hear a lot about it with mild outpatients, but we also see it more severely in the ICU. Hallucinations and confusion are commonly experienced during all sorts of severe illnesses. When you have a kind stressor like COVID-19 in the body, you’re more likely to be confused, especially if you are elderly. This symptom is very common with older people as the body is trying to fight off an infection. COVID patients in the ICU sometimes experience a really bad delirium, worse than it seems with other patients who are critically ill. This delirium can worsen during a hospital stay when you’re not sleeping normally or if you’re in pain. Some medications that are used to keep patients comfortable on ventilators can even intensify delirium. With COVID-19, as someone gets worse, the type of brain manifestation that they experience can get worse as well. This can be due to a combination of blood flow and inflammation in the body or potentially alterations in blood flow at the microvascular level that cause these reactions.”
Elevated heart rate and temperature
Dr. Khabbaza says he’s seen patients’ heart rates shoot up after minimal activity shortly after becoming infected. This along with elevated temperatures are a result of autonomic dysfunction.
“We’re seeing this more and more. When it occurs, our immune system is attacking autonomic nerves — so nerves that regulate things in the body like heart rate and temperature — that thermostat can be thrown off. When this occurs, people’s heart rates are not being regulated. Once you lose that balance, you can have a super-high heart rate or elevated temperature for no reason. We’ve seen that in a lot of people and it seems to be an immune-mediated response, meaning the antibodies that you make somehow attack these kinds of nerves. That’s most likely playing a role in a lot of the unusual symptoms that we’re seeing,” says Dr. Khabbaza.
Skin is the body’s largest organ, so it has the largest number of blood vessels. Dr. Khabbaza says skin irritations like rashes or discoloration isn’t out of the ordinary when viruses or even autoimmune diseases are present.
“When you think about it, anywhere where blood flows could be affected. Skin is the body’s largest organ so it has the most blood vessels. It’s natural to see manifestations of illness in our skin. A lot of autoimmune diseases, in general, are associated with skin manifestations, especially viruses.”
He adds that we can look back at our childhoods for evidence of this. Mainly, the rashes that developed during illness.
“The skin is a place where a lot of things end up. If your blood count gets very low, your blood is too thick or you form tiny clots in the vessels, that sometimes can cause changes in your skin’s appearance.”
While skin irritations aren’t as common, Dr. Khabbaza said they’re still something that the medical community is trying to understand as it battles COVID-19.
Vocal cord neuropathy and loss of taste or smell
Loss of taste or smell have been associated with COVID-19, and while they’re alarming, Dr. Khabbaza says there’s no need to panic if you experience these symptoms.
“When this occurs, those senses are just not working normally. Nerves can be inflamed or secondarily irritated by our own immune system. But gradually with time, we should gain the ability to use them again.”
Vocal cord neuropathy can occur when the nerves of the vocal cords are not working normally. This can often be a result of upper respiratory infections and can cause hoarseness or speaking problems, shortness of breath or swallowing issues. Dr. Khabbaza says this is mainly related to the vagus nerve being irritated and not working normally. This is the nerve that regulates digestion, heart rate, respiratory rate and reflex actions like coughing, sneezing and swallowing. Symptoms of vocal cord neuropathy, especially after a viral infection, often are first confused with post-viral asthma, but the symptoms often don’t improve with the use of inhalers.
Should you panic if you have any of these unusual symptoms of COVID-19?
Dr. Khabbaza says experiencing one of these weird or unusual COVID symptoms isn’t automatically a reason to panic, but if it does affect your ability to do daily activities, let your healthcare provider know sooner than later.
“Most things are going to run their course and should gradually improve, but it can be a very slow process. If anything occurring is significantly affecting your daily living, your healthcare provider needs to know about it. If your heart rate shoots up to 170 when you’re just walking down the hall, that’s going to affect your ability to do anything, so that’s something that warrants prompt attention. If a symptom is affecting your ability to work or your ability to accomplish your normal day-to-day activities, tell your healthcare provider. There may not always be some intervention that can be done, but COVID changes every day. We learn more every day and there are so many moving parts. If you’re having difficulty, you always want to make sure your healthcare provider is aware of everything.”