A health official wearing a Personal Protective Equipment (PPE) suit collects a swab sample from a man to test for the COVID-19 coronavirus, at a temporary testing facility in New Delhi. AP Photo

The virus SARS-COV-2 has wrought havoc all over the world. While SARS-COV-2 is known to cause substantial pulmonary diseases such as pneumonia and acute respiratory distress syndrome (ARDS), clinicians have observed other presentations of this disease.

Dr Y Gopi Krishna, senior interventional pulmonologist, Yashoda Hospitals, tells us that scientists are now documenting a growing list of atypical coronavirus infection symptoms, thus providing doctors with more insights into the emerging disease.

The new and surprising symptoms that have appeared include stroke, blood clotting, the rare Kawasaki disease, purple toe rashes and ‘silent hypoxia’.

According to Dr Gopi Krishna, however, many of these symptoms are rare, and scientists aren’t yet certain if they are directly caused by the SARS-CoV-2 coronavirus.

Read on to understand the various types of symptoms and possible damage the virus could cause.

The unusual symptoms

* Direct damage to blood vessels, leading to blood clots formation
* Dysregulation or over-activation of one’s own immune system

Hematologic manifestations (blood-related changes)

* Lymphopenia (WBS, lymphocytes are reduced)
* Platelets are reduced (blood clots formation)
* Thrombosis

Cardio manifestation (heart-related manifestation)

* Myocarditis (heart muscle damage)
* Arrhythmia (irregular heart beat)
* Sudden cardiac arrests
* Sudden heart and lung failure (Cor pulmonale)

COVID-19 and acute kidney damages

* Acute kidney injury (AKI) (seen in 10% of patients)
* Proteinuria (loss of protein in urine)
* Hematuria (loss of blood in urine)
* Electrolyte disturbances (potassium and sodium salts in body can go up and down causing disturbances in BP and heartbeat rate)

Gastrointestinal manifestations

* Severe nausea
* Severe loss of hunger
* Loose motions (seen in 30% patients)
* Liver Injury (white jaundice and yellow jaundice for some)

Another couple of issues that Dr Gopi Krishna points out include Kawasaki disease, that is, joint pains and blood vessels affected, which leads to discolouration of toes and fingers (underlying mechanisms being blood vessels damage). The doctor also talks of many patients presenting other symptoms including high blood sugar (hyperglycemia), sometimes going into a state called ketoacidosis in patients with previously undiagnosed diabetes or no diabetes.

Neurological manifestations

* Anosmia (loss of smell)
* Severe dizziness, myalgias, headaches and fatigue

Dr Gopi Krishna also talks of cases in which a few patients had suddenly gone into brain stroke (paralysis) while a few others have suffered encephalitis (brain Injury). “In one case, we witnessed a dangerous manifestation of the Guillain–Barre syndrome, in which the protecting muscles and nerves are suddenly affected, which leads to sudden respiratory arrest,” the doctor adds.

Dermatological (skin) manifestation

* Rashes
* Vesicles (like chicken pox lesions)
* Petechiae (dark spots on skin)

“Other than causing life-threatening pulmonary (lung) complications, the virus can affect major organ systems because even a small clot formation in those organs can lead to an organ failure,” adds Dr Gopi Krishna.

Treatment

* Oxygen
* Steroids
* Plasma therapy
* Antivirals (Remidesivir and Favipiravir)
* Vitamins (Vitamin C, Vitamin D and Zinc)
* Blood thinners (low molecular weight heparin)
* Rarely (anti-inflammatory drugs to Tocilizumab)

However, Dr Gopi Krishna cautions that all these trial medications and therapies are to reduce the severity of the disease and that none assure cure.