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Science Monday 18 May 2020
'COVID toes,' other rashes latest possible rare virus signs

By LAURAN NEERGAARD abled the rapid recognition the skin, or perhaps caus-
AP Medical Writer of skin signs by dermatolo- ing microscopic blood
Skin doctors suddenly are gists. It is now time for rigor- clots?
looking at a lot of toes — ous science" to understand "The public health message
whether by emailed pic- the link, Dr. Kanade Shinkai is not to panic," Freeman
ture or video visit — as con- of the University of Califor- said, noting that most toe
cern grows that for some nia, San Francisco wrote in patients she's seen haven't
people, a sign of COVID-19 a recent JAMA Dermatol- become severely ill.
may pop up in an unusual ogy editorial. Are they contagious? "We
spot. Boston's Freeman directs can't tell just by looking at
Boston dermatologist Esther an international COVID-19 your toes," she said. Other
Freeman expected to see registry for doctors to re- medical conditions, such
skin complaints as the pan- port cases of possibly vi- as lupus, can cause simi-
demic unfolded — various rus-linked skin symptoms. lar spots — another rea-
kinds of rashes occur when Of 500 reports since late son doctors should discuss
people get very ill from oth- March, about half are chil- each patient's overall
er viruses. blain-like spots on the feet, health and next steps for
"But I was not anticipating she said. testing or other needed
those would be toes," said Chilblains, what doctors care.q
Freeman of Massachusetts call "pernio," are an inflam-
General Hospital, who has matory reaction. When
viewed via telemedicine pernio-like reactions ap-
more toes in the last several This April 21, 2020 photo provided by Northwestern University pear in coronavirus-in-
weeks than in her entire ca- shows discoloration on a teenage patient's toes 4 weeks after fected patients is one of
reer. the onset of the condition informally called "COVID toes." many mysteries. For some
They're being called "CO- Associated Press people, it's the first or even
VID toes," red, sore and only symptom they notice.
sometimes itchy swellings for urgent care. Doctors In one report, dermatolo- Others see the toe problem
on toes that look like chil- then should decide if the gists evaluated 88 COV- at the same time or even a
blains, something doc- patient should stay in home ID-19 patients in an Italian few weeks after experienc-
tors normally see on the isolation or get tested. hospital and found 1 in 5 ing more common and se-
feet and hands of people The most common corona- had some sort of skin symp- rious COVID-19 symptoms.
who've spent a long time virus symptoms are fever, a tom, mostly red rashes over It's showing up in young
outdoors in the cold. dry cough and shortness of the trunk. In another, Span- people too, according to
Don't race to the emergen- breath -- and some people ish doctors reported a se- Dr. Amy Paller of Northwest-
cy room if toes are the only are contagious despite ries of 375 confirmed virus ern University, who is part of
worry, said the American never experiencing symp- patients with a range of a pediatric dermatology
Academy of Dermatology. toms. But as this bewildering skin complaints, from hives registry also collecting im-
Earlier this month, it issued virus continues to spread, to chickenpox-like lesions ages of patients' toes.
advice that a telemedicine less common symptoms are to the toe swellings. Among the theories: Is it just
check is the first step for being reported including Pictures of reddened toes inflammation triggered by
people wondering if they loss of smell, vomiting and and rashes all over social an infection instead of the
have "COVID toes" and diarrhea, and increasingly, media and doctor chat cold? Is the virus irritating
who have no other reason a variety of skin problems. groups have "already en- the lining of blood vessels in

FDA probes accuracy issue with Abbott’s rapid virus test

By MATTHEW PERRONE warning came one day af-
AP Health Writer ter researchers at New York
WASHINGTON (AP) — Fed- University reported results
eral health officials are suggesting Abbott's test
alerting doctors to a po- can miss up to half the in-
tential accuracy problem fections caught by a rival
with a rapid test for COV- test made by Cepheid.
ID-19 used at thousands of The research has not been
hospitals, clinics and testing peer-reviewed or published
sites across the U.S., includ- in a medical journal and
ing the White House. The was based on about 100
Food and Drug Administra- patients. The researchers
tion said late Thursday it is found that Abbott's test, run
investigating preliminary on the company's portable
data suggesting Abbott ID NOW system, missed
Laboratories' 15-minute test one-third of the infections In this April 10, 2020, file image made from video, a lab
can miss COVID-19 cases, caught by Cepheid's test technician dips a sample into the Abbott Laboratories ID Now
falsely clearing patients of when swabs were stored in testing machine at the Detroit Health Center in Detroit.
infection. The test is used liquid used to transport lab- Associated Press
daily at the White House oratory samples. When the test's performance "unac- knowledged shortcomings
to test President Donald samples were kept dry the ceptable," due to the risk of the study, including the
Trump and key members test missed 48% of the cases of falsely clearing patients time needed to transport
of his staff, including the flagged by Cepheid's test. who could spread the in- patient samples to the de-
coronavirus task force. The The researchers called the fection to others. They ac- vice for processing.q