CMAAO Coronavirus Facts and Myth Buster 74

(With regular inputs from Dr Monica Vasudev)

What are COVID toes

Purple or red lesions on the toes and hands, have been termed “COVID toes” and has gained clinicians’ attention over the recent weeks.

What should patients do if they notice them?

Pernio, also known as chilblains, is a condition where red or purple tender bumps develop on the fingers or toes. It is usually a reaction to cold temperatures. In COVID-19, it is called “pernio-like” rather than pernio. A lot of these patients deny being exposed to cold temperatures. These skin lesions have been termed as “COVID toes.”

Patients are experiencing red or purple bumps on their toes or hands, as well as a burning sensation, often with pain and tenderness. It seems to go away after about 2-3 weeks.

If patients notice them, they should contact a dermatologist or their primary care physician.

What should dermatologists do when patients report them?

People should follow CDC and local guidelines for self-isolating. Some patients who develop pernio-like lesions of their feet may still be infectious and test PCR positive for the virus. Therefore, there is a potential risk of transmitting the virus to others. Some people may develop these lesions while they are still infectious, while others may develop them later during the disease course.

This has public health implications. If the patient is potentially still infectious when they develop these lesions, it is a different scenario than if they are not infectious and they are beyond the infectious stage of the virus.

We see other virally induced rashes and eruptions such as morbilliform, also known as measles-like eruptions, and urticaria, also known as hives, among many others.

Steam disinfection

Researchers in Texas showed in a letter published in Infection Control & Hospital Epidemiology that the masks can be safely disinfected with steam.

Steam sterilization could possibly be one of the safest ways to sterilize them, stated study coauthor Firas Zabaneh, director of system infection prevention and control at Houston Methodist Sugarland Hospital.

It does not involve the use of any chemicals or anything that could alter the makeup or structure of the mask.

Pulmonary embolism

A pair of letters published April 24 in Radiology report that 23% of COVID-19 patients had acute pulmonary embolus (PE) on CT angiography at a US center as did 30% seen at a French tertiary care center.

Remdesivir as the preferred antiviral in children

In new guidance, a panel of pediatric infectious diseases physicians and pharmacists have suggested that supportive care alone is sufficient to treat most children with COVID-19. Among children who develop severe or critical cases, though rare, the panel suggested the use of remdesivir as the preferred antiviral.

Immunotherapy with neutralizing antibodies present in convalescent plasma (CP)

NEJM: Immunotherapy with neutralizing antibodies present in convalescent plasma (CP) has been proven to be effective and safe for patients with SARS (severe acute respiratory syndrome), MERS (Middle East respiratory syndrome), and the 2009 H1N1 influenza viruses.

Researchers in Wuhan, China, conducted a study in 10 severely ill COVID-19 patients to test if CP would benefit COVID-19 patients. These patients were also given many different antivirals. Median age of the patients was 53; 4 had chronic illnesses, and 3 were on ventilators.

Within 3 days of CP therapy, most patients had improvement in clinical symptoms, higher levels of blood oxygen and lymphocytes, lower C-reactive protein levels, undetectable viral loads, and improved chest computed tomography scans; two patients were weaned from ventilators. Treatment was specifically a success if CP was given within 14 days of symptom onset. No adverse effects were noted. Researchers constructed a historical control group of 10 COVID-19 patients in the same hospitals and of the same age, sex, and disease severity. Of the 10 CP-treated patients, 3 were discharged and 7 showed much improvement, while in the control group, 3 patients died, 6 were stable, and 1 improved.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA

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