Three years into the COVID-19 pandemic, much more is known about the long COVID phenomenon, including strange and unusual symptoms that wouldn’t necessarily be connected to the virus and its subvariants. While symptoms such as loss of taste and smell and brain fog are fairly well-known, strange symptoms such as hairy tongue and nerve damage are being reported.
«Long COVID or what’s now — through the National Institutes of Health — being referred to as ‘post-acute sequelae of COVID-19,’ is persistent symptoms or new symptoms that develop, generally speaking, at least four to eight weeks after the initial infection with COVID-19,» says says Jason Maley, MD, MS, Harvard Medical School instructor in medicine and director of BIDMC’s Critical Illness and COVID-19 Survivorship Program. «It can include the continuation of symptoms that happened when a person was first sick, like shortness of breath, or fatigue, or it can be new symptoms where a patient feels like they’ve improved and they’re recovering and then a month after being infected, they have worsening chest discomfort and brain fog and difficulty thinking, and all sorts of symptoms from head to toe that can either persist or develop somewhat newly after they’re infected.
«Some people, for the initial two weeks of their infection, had just cold-like symptoms that lasted for three days. They felt like they were fine and then over the ensuing four months they are just so fatigued. They can barely breathe when they walk around, and they have these other severe symptoms that are really out of proportion to the initial symptoms. Groups of patients follow different time courses. Some people, not uncommonly, are very slow to recover, and it takes them three to six months to get back to feeling like they have their normal level of energy and that their breathing is improving. Others are nine or 12 months out from their infection, and they still haven’t noticed any improvement. They’re exhausted all day long, and they have severe difficulty doing their jobs because of memory and thinking issues, breathing discomfort, and other symptoms.» Here are five unusual symptoms of COVID-19, according to experts. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.
COVID tongue—where the surface of the tongue is covered in white or yellow fuzz that is difficult to remove—has been reported since 2021. «Seeing increasing numbers of COVID tongues and strange mouth ulcers. If you have a strange symptom or even just headache and fatigue stay at home!» said Tim Spector, professor of genetic epidemiology at King’s College London. «It’s a good reminder that there are so many different manifestations of this virus rather than just the classical ones. The whole question of why we have this huge range of symptoms of the virus is still unknown.»
According to Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco, COVID tongue is caused by old tongue cells lingering and building on top of each other. «I know it looks really scary to people,» he says, recommending anyone with these symptoms continue to practice good oral hygiene and not allow themselves to get «freaked out.»
Erectile dysfunction is one of the more unusual symptoms of COVID, doctors say. According to a Dr. Ranjith Ramasamy, director of reproductive urology at the University of Miami’s Desai Sethi Urology Institute, the risk of erectile dysfunction and low sperm counts increased by 20% after getting the virus. «Six months after the initial infection, patients had gotten better overall, but they continued to complain of these problems,» Dr. Ramasamy says. «Communicating that the disease can affect your sexual life is a tremendously powerful message. The evidence is very strong.»
According to Dr. Emmanuele Jannini, a professor of endocrinology and medical sexology at the University of Rome Tor Vergata, men who have been infected are six times as likely to report impotence. «Communicating that the disease can affect your sexual life is a tremendously powerful message,» Dr. Jannini says. «The evidence is very strong… If you have a patient who survived Covid, and you want to know if he has long Covid or not, just ask him how it’s going in bed. If he’s having a normal sex life, the possibility of him having serious long Covid is very, very low.»
Many people have reported peripheral neuropathy—a pain or tingling in the hands and feet—associated with COVID-19. «Several viral infections — such as HIV and shingles — are associated with peripheral neuropathy because viruses can damage nerves,» says Simon Haroutounian, PhD, chief of clinical research at the Washington University Pain Center. «We found that nearly 30% of patients who tested positive for COVID-19 also reported symptoms at the time of their diagnosis, and that for 6% to 7% of them, the symptoms persisted for at least two weeks, and up to three months, suggesting this virus may have lingering effects on peripheral nerves.»
«As I’ve talked to people who are experiencing this, there are some who just find no peace. Their bodies are no longer under their control and these symptoms are creating a living hell for them,» says Dr. Harlan Krumholz, a cardiologist and scientist at Yale University. It’s believed that an out-of-control immune response is causing the tingling, according to Dr. Waleed Javaid, director of infection prevention and control at Mount Sinai Downtown in New York. «There’s a widespread immune response that is happening. Our immune cells get activated so a lot of chemicals get released throughout our body and that can present or feel like there’s some fizzing,» Dr. Javaid says. «When our immune response is acting up, people can feel different sensations… I have heard of similar experiences in the past with other illnesses.»
COVID psychosis is another strange symptom of long COVID. «For a small number of people, COVID infection may be accompanied by an episode of post-COVID psychosis, a break from reality which can be frightening for the patient and their loved ones,» says Sarah Hellewell, Research Fellow, Faculty of Health Sciences, Curtin University, and The Perron Institute for Neurological and Translational Science, Curtin University. «Psychosis is a condition characterized by confused thoughts, delusions and hallucinations. People with psychosis can struggle to tell what’s real from what isn’t. Psychosis occurs in ‘episodes’ which may last for days or weeks. Since the start of the COVID pandemic, reports of post-COVID psychosis have come from all over the world.»
Reports of virus-related psychosis has been reported for years now. «Maybe this is Covid-related, maybe it’s not,» says Long Island psychiatrist Dr. Hisam Goueli, who noticed a pattern emerging in his inpatient psychiatric treatment program for Covid-19 patients. «But then we saw a second case, a third case and a fourth case, and we’re like, ‘There’s something happening.'» «My guess is any place that is seeing Covid is probably seeing this,» said Dr. Colin Smith at Duke University Medical Center in Durham. The reason why this might be happening? Experts believe the psychosis is linked to COVID-related inflammation and immune response. «Some of the neurotoxins that are reactions to immune activation can go to the brain, through the blood-brain barrier, and can induce this damage,» says Dr. Vilma Gabbay, a co-director of the Psychiatry Research Institute at Montefiore Einstein in the Bronx.
A skin rash that looks like hives or chicken pox could be a sign of COVID-19. One skin rash is a «lacy, purple, bruise-like rash that occurs on critically ill patients,» says Dr. Joanna Harp, a dermatologist at Weill Cornell Medicine. «It usually occurs on the hands and feet and may extend onto the arms and legs. This rash may indicate clotting in the blood vessels of the skin. We are learning that COVID-19 disease seems to be associated with a higher risk of blood clotting in many organs including the skin, the larger blood vessels in the legs and lungs, and even in the brain causing strokes… As of now, we don’t really know if these rashes are actually from the virus itself or possibly represent mild allergic reactions to medications.»
«Many viral infections can affect the skin, so it’s not surprising that we are seeing these rashes in COVID-19,» says Dr. Veronique Bataille, consultant dermatologist at St. Thomas’ Hospital and King’s College London. «However, it is important that people know that in some cases, a rash may be the first or only symptom of the disease. So if you notice a new rash, you should take it seriously by self-isolating and getting tested as soon as possible.» «These findings highlight the importance of keeping an eye on any new changes in your skin, such as lumps, bumps or rashes,» says consultant dermatologist Dr Justine Kluk. «Early reporting of COVID-associated rashes by members of the public and recognition of their significance by frontline healthcare practitioners – such as GPs, NHS 111 and hospital staff – may increase the detection of coronavirus infections and help to stop the spread.»
Follow the public health fundamentals and help end this pandemic, no matter where you live—get vaccinated or boosted ASAP; if you live in an area with low vaccination rates, wear an N95 face mask, don’t travel, social distance, avoid large crowds, don’t go indoors with people you’re not sheltering with (especially in bars), practice good hand hygiene, and to protect your life and the lives of others, don’t visit any of these 35 Places You’re Most Likely to Catch COVID.