Thread by @evolutionarypsy

Anniversary of me taking this pic of my kid’s food and sending it to my medical friends “what the hell is this?”

In another few weeks it would look like this, and the second kid came to me with similar but milder toe findings, and we all figured out we’d probably had COVID about 8 weeks after the fact. 🤷🏻‍♀️ #covidtoes

Subsequent derm papers showed actual virus particles in the small vessels in the feet of similar patients, also patterns of type 1 interferonopathy vasculitis.

#covidtoes in healthy kids => probably a sign of a big innate immune response to the virus. khanacademy.org/test-prep/mcat…

They are also seen in more seriously ill patients (usually adults) along with other dermatological findings. Haven’t read as much about these but it’s likely they are part of the hyper inflammatory state of the very ill.

There’s still some controversy because many of the kids with COVID toes have negative serology and never had positive tests (my own kids have never been tested). But because both got the findings at the same time the dermatologist said it was almost undoubtedly infectious.

Also we all had a febrile viral URI at the same time in February

Here’s a paper summarizing the situation with #covidtoes including the controversy. ncbi.nlm.nih.gov/pmc/articles/P…

I suspect that #covidtoes may require a combination of cold feet rewarming too fast plus an inflammatory current or post-viral state which is why more weren’t seen in the summer time but I could be wrong and it might all be a rash of chilblains in kids during lockdown.

The paper I linked doesn’t really discuss that two-factor cause, but I just tell parents of kids who get Covid to keep their feet warm. Socks on the cold New England winter and spring floors can’t hurt.

Just saw the typo in the first tweet obviously that is the kid’s foot not her food. We don’t eat human feet. 😃

Come to think of it this is the first winter I’ve not had at least some minor chilblains in 13 years, and the first winter since the kids were born that I haven’t had any colds. I wonder if the two-factor conditions were always in place for chilblains (careless rewarming + virus)

Another weird population based-finding was a drop in the incidence of preterm birth during the spring of 2020. This was found in Denmark, Ireland, and the northeast US ncbi.nlm.nih.gov/pmc/articles/P… (despite the fact that COVID causes preterm birth)

Like the #covidtoes finding, was this due to more staying at home and resting for pregnant women, or was it due to the social distancing that dropped all other respiratory virus infections nearby to zero? Or is there some other reason?

There are ways to test these hypotheses (a quick scan of pubmed didn’t show me anything to back any of them up other than yes flu and hospitalization with respiratory illness increase preterm birth). Imagine a world without need for so many NICU beds though...be worth knowing

People reading my work over the years probably know I have an outsize suspicion that exposure to infections is a part of what predisposes us to a lot of other chronic illness.

By using masks during flu season and upgrading ventilation and HVAC systems would we decrease heart attacks, preterm birth, psychiatric disease, and other chronic illness? (Here flu increases risk of MI 2-3x for example) ncbi.nlm.nih.gov/pmc/articles/P…

I think these issues are multi factorial of course, preventing cardiovascular disease altogether will not happen by eliminating flu, RSV, parainfluenza, etc, but it’s worth thinking about and testing.

But doesn’t practice make perfect don’t we have more autoimmune disease if we clean too much re the “hygiene hypothesis” => immunity is never that simple, autoimmune disease likely much more related to lack of exposure to parasites & mycobacteria than respiratory infections

I personally don’t see any good reason for people to get flu, seasonal colds, or RSV and similar. It’s all downside with higher risk of other illnesses.

New paper with *associations* between COVID infection and new neurological/psychiatric disease

https://twitter.com/TheLancet/status/1379555514955235334