Yet another bizarre symptom of Covid-19 is ischemia of the fingers and toes, a reduction of blood flow that cause

“We’ve never seen such high levels before,” says Salata, the Case Western physician. One woman recently had levels that were “just not heard of before,” he said. He and his colleagues are finding major clots as well as unusual numbers of smaller clots that can damage the heart, lungs, kidneys, and other organs.

Inflammatory syndrome in children
In late April and early May, a mysterious toxic shock syndrome began showing up in children in various countries, causing at least three deaths in New York. Some cases have been firmly tied to Covid-19 diagnoses; others have not.

The symptoms of pediatric multisystem inflammatory syndrome, as it’s being called, resemble an unrelated syndrome called Kawasaki disease, a leading cause of heart disease in children. Both are marked by high fever, rash, cracked lips, and bloodshot eyes.

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It’s not clear yet if Covid-19 and Kawasaki disease are perhaps occurring simultaneously, but Salata thinks the new cases are probably yet another severe immune-system reaction to Covid-19 that only looks like Kawasaki disease. “We don’t know for sure,” Salata says, “but that’s what it really looks like.”

Loss of smell and taste
The loss of smell, called anosmia, can be caused by the common cold, when congestion mucks up nose and nasal passages. Other diseases can trigger anosmia by disrupting or killing the olfactory nerves high in the nasal cavity.

But doctors were surprised earlier this year when people with anosmia and no other symptoms, or only mild symptoms, tested positive for Covid-19. It’s not yet certain how Covid-19 triggers anosmia, but remember those receptor cells that readily receive the coronavirus, present in the lungs and elsewhere? Similar cells exist in the olfactory epithelium, a layer of skin containing the neurons that detect scents.

Covid toes
Yet another bizarre symptom of Covid-19 is ischemia of the fingers and toes, a reduction of blood flow that causes red or purplish lesions at the ends of the digits. Dubbed Covid toes, the condition can be painful and, if left untreated, can lead to tissue death. It’s showing up mostly but not exclusively in younger people, who sometimes have few other symptoms or none.

Like anosmia, Covid toe tends to heal without long-term complications, but both can be signs that someone has Covid-19 and is infectious, even if they feel no other symptoms.

Like many other complications of Covid-19, researchers have barely had time to study the reasons beyond this symptom, but one analysis, published April 15 in The Lancet, suggests it’s due to reduced function in small blood vessels.

What’s next?
Covid-19 is not alone among germs in generating a range of mild to serious outcomes.

“Viruses are so weird,” says Yonatan Grad, MD, an assistant professor of immunology and infectious diseases at Harvard T.H. Chan School of Public Health. Grad doesn’t mean to discount the devastating effects viruses can have, but he says they can bring “all sorts of unusual manifestations.”

The herpes virus causes unsightly cold sores, for example, but can also prompt a deadly swelling of the brain. The poliovirus generates no visible symptoms in most people while about 1 in 200 ends up with parts of their bodies paralyzed.

Meanwhile, Covid-19 likely has more surprises in store.

“We don’t know everything about this virus,” Salata says. “So stay tuned. I’m not sure we’ve seen it all yet.”