COVID-19 Considerations in 2021: Uncommon Symptoms and Manifestations

In 2021, the COVID-19 pandemic presented with a variety of symptoms, some of which were not commonly recognized. Besides the well-known symptoms such as fever, cough, and shortness of breath, other manifestations included significant hair loss (telogen effluvium), loss of taste and smell (anosmia), unusual skin changes like red and purple bumps on toes (COVID toes), and eye problems. Telogen effluvium, a temporary form of hair loss associated with stress, was triggered by a stressor event about 12 to 16 weeks prior to the hair loss and typically lasted for 3 to 6 months. Anosmia was present in 30% to 98% of hospitalized people. COVID toes, similar to chilblains, were more common in younger people and were thought to be an inflammatory reaction to the virus. Eye problems included enlarged red blood vessels, eyelid swelling, and manifestations of conjunctivitis. Health care professionals were encouraged to remain open to these unique and unusual COVID-19 presentations.