More on persistent and unusual COVID-19 symptoms– and a verified case of reinfection

The New York Times on August 5-6 published an article about unusual and persistent COVID-19 symptoms titled “The Many Symptoms of Covid-19” that added the term “brain fog” and symptoms like dizziness, impaired thinking, lightheadedness, confusion, inability to wake, and uncoordinated movement. Signs of stroke like facial drooping, numbness, and garbled speech have been seen. Eye pain, itching, tearing, and redness are common. Transient rashes, blisters on the fingers and toes, or even bumpy, smooth, itchy, or innocuous-looking rashes may occur.

Blood clots can cause dangerous loss of circulation in the extremities. Sudden onset of severe pain in the thighs, legs, or buttocks is a dangerous sign and should prompt emergent evaluation for blocked arteries.

Monitoring oxygen saturation with a widely available monitor can be done safely at home. Low oxygen saturation, into the 70% range, can be transient, but if it persists, this is a sign that hospitalization for oxygen therapy is needed.

Mental symptoms like confusion, dizziness, and incoordination, are common; if mild, they can be observed, but if severe, evaluation for stroke is needed emergently at the hospital.

Children often have mild symptoms, but persistent high fevers, lethargy and irritability, with loss of appetite are danger signs. Rashes are also danger signs in children. Rarely, a disease resembling Kawasaki syndrome now called multisystem inflammatory syndrome (MISC) can occur; it is not usually fatal but requires hospital treatment. Often MISC appears after a week or more of illness.

The comments section of this article has many personal accounts of similar symptoms, particularly of the persistent variety, that make for wrenching reading.

The latest news brings a report of a patient who was confirmed to be re-infected with a different strain of SARS-COV-2 four and a half months after recovering from COVID-19. The patient travelled from Asia to Europe and was infected there with a distinct strain of the virus that was confirmed by genetic testing. The report can be found in today’s New York Times and is not paywalled (their coronavirus reporting is free.)

This rigorously confirmed report of a repeat infection indicates that the disease stimulates an immune response that is simply insufficient to prevent re-infection. Fortunately, the patient had only mild symptoms the first time and was asymptomatic the second time– his infection was caught by surveillance of travellers. We can only hope that patients prone to more severe symptoms develop more protective antibodies that last more than four months.