COVID-19 Roundup: New Symptoms, Case Estimates, “COVID Toes”

3 New Symptoms

The CDC has added congestion or runny nose, diarrhea, and nausea to their official list of potential COVID-19 symptoms. The list also includes fever, chills, shortness of breath, fatigue, body aches, headache, loss of smell or taste, and sore throat.1


US Cases May be 10 Times Higher Than Thought

In a press briefing on June 25, 2020, Robert Redfield, MD, director of the US Centers for Disease Control and prevention, discussed the possibility of the current count of US cases of COVID-19 being a significant understatement.2

"Our best estimate right now is that for every case that we've recorded, there actually were 10 other infections," he said, which would mean the 2.3 million cases currently counted in the US would actually be more than 20 million. This new estimate comes after increased testing efforts helped to improve understanding of the scope of asymptomatic cases present in the country.


“COVID Toes” Probably Not Caused by SARS-CoV-19

So-called “COVID Toes” may actually be caused by lifestyle changes associated with shelter in place orders in response to the COVID-19 pandemic, and not the disease itself, according to the results of 2 recent studies.

The studies, published in JAMA Dermatology, examined children, adolescents, and young adults with newly onset acral inflammatory lesions (n = 20)3 or chilblain lesions on the toes and/or fingers (n = 31)4 who underwent reverse transcriptase–polymerase chain reaction for SARS-CoV-2 as well as a number of other blood tests for potential causes of the lesions.

Overall, the results of both studies suggested that the “clinical, histologic, and laboratory test results were compatible with a diagnosis of perniosis, and no evidence was found to support the implication of SARS-CoV-2 infection.”3

“Lifestyle changes associated with community containment and lockdown measures are a possible explanation for these lesions.”4

—Michael Potts


Symptoms of coronavirus. Centers for Disease Control and Prevention. Accessed June 26, 2020.

Cecelia Smith-Schoenwalder. CDC: coronavirus has infected 10 times more people than previously thought. US News and World Report. June 25, 2020.

Roca-Gines J, Torres-Navarro I, Sanchez-Arraez, J, et al. Assessment of acute acral lesions in a case series of children and adolescents during the COVID-19 pandemic. Published online June 25, 2020. JAMA Dermatol. doi:10.1001/jamadermatol.2020.2340

Herman A, Peeters C, Verroken A, et al. Evaluation of chilblains as a manifestation of the COVID-19 pandemic. Published online June 25, 2020.  JAMA Dermatol. doi:10.1001/jamadermatol.2020.2368