Pulmonologist Dr Humberto Choi stresses that the major symptoms people should continue to look for are the common signs such as a fever, cough and muscle aches, but he is aware that additional symptoms such as confusion, dizziness, loss of smell, and so-called ‘COVID toes’, are getting a lot of attention.

Unexpected symptoms including dizziness, confusion and a loss of smell have become associated with coronavirus, which he says can be a result of dehydration [Image: Shutterstock].

Dr Choi says: “Confusion in elderly people is something that we see often, especially when someone is admitted to the hospital and critically ill. In some of these cases, it is not the infection affecting the brain; it is just how the brain responds to the presence of an infection.”

He adds that in some cases, confusion can be the result of a urinary tract infection or another medical condition. “Depending on the situation, we may need to evaluate the patient for signs of meningitis or an infection that could be affecting the central nervous system. Dizziness has also been associated with coronavirus, which he says can be a result of dehydration.

“When someone has a fever, they actually lose a lot of water just from the fever itself. Some people come to the hospital with infections and they are actually very dehydrated. So, one of the first things that they need is an IV of fluids,” he says. A coronavirus symptom that has been more common recently is the loss of the sense of smell, Dr Choi.

“This signifies that the infection has caused inflammation in the nerve endings inside of the nose that are responsible for our sense of smell. However, not everyone will experience loss of smell, but not experiencing it doesn’t mean that you don’t have the virus.” In addition, rashes and toe lesions seem to be more common in COVID-19 compared with all other viral infections, but Dr Choi says, at this time, they have not affected a majority of people.

He adds: “It’s not uncommon for someone to have a viral infection and have a rash or blotchy areas on their body. This can happen with other viral infections like measles. In addition,sometimes antibiotics might cause skin rashes. But at this time, there is no specific rash pattern that’s associated with COVID-19.” Dr Choi says, like rashes, COVID toes are just another way that the body can respond to a viral infection.

“It is a different form of manifestation and it is still not very clear what causes it. One pattern of COVID toes that people are reporting is red lesions typically on the soles. It is possible that this is a skin reaction or caused by inflammation of small blood vessels or a small clog or micro clots in the blood vessels found in the toes,” he says.

Dr Choi adds that he has seen this before with ICU patients with sepsis or people on life support. These clogs in the vessels can lead to discolouration in the toes, which is why COVID toes look the way they do. However, at this time, the medical community has not found an exact correlation between COVID toes and how mild or severe the virus is within the body. Dr Choi emphasises that COVID toes, like rashes, are still fairly uncommon at this point in time.

“Should a person notice a rash or COVID toes in addition to the common symptoms of the coronavirus, it is best to contact your health authority or healthcare provider sooner than later. During the pandemic, when someone has a specific symptom and they are wondering whether that could be from COVID-19, my best advice would be to get tested,” Dr Choi concludes.