welcome to today's video and there's
some very interesting new information
come to light that I wasn't aware of and
it's come from the coverage symptom
tracker at the Kings College
zowie collaboration run by Professor Tim
Spector now we already know that the
classic features of cough in nineteen
are fever cough and loss of smell but
this study is saying that a rash should
be added to that as the fourth feature
now of course there are other clinical
features that can be present or not you
know that the headache the the muscle
pain the joint pain the undue fatigue
the sore throat the sometimes diarrhea
and vomiting these other features can be
there but the classic features that are
present most often are the fever the
cough and the loss of smell and now
they're saying that a rash it should be
added to that so interesting let's look
at that with what I was vaguely aware of
this from severe cases but this is
showing how prevalent this is in the
community so interesting new work from
Tim specters group here so a skin rash
should be considered as a fourth key
sign a fourth key sign after the fever
the cough and the the a nas Mia the loss
of smell now rashes have been reported
in China and Europe in hospitalized
patients in sick patients so we're aware
the the poor newest patients could get
this because that was reported from
hospital data but I wasn't aware that
this can be a more minor feature if you
like in the community and this is the
first study to systematically gather
data about skin rashes in milder cases
and in the wider population and as we'll
see in cases where skin rashes the only
fever but even those skin rash is the
only fever that still means the patient
has the infection therefore can still be
infectious so we could have been missing
some patients thinking their array
symptomatic my own actual fact we
missed the rash before now this is a
viral rashes here that this this doctor
is one of the consultant dermatologists
on the study and she's saying this many
infections can affect the skin
obviously these are systemic infections
your ear all over the skin can be
considered as the largest organ in the
body in terms of mass certainly so it's
not surprising that the skin is infected
in systemic infection so it's not
surprising we're seeing these rashes in
conferred 19 because it's a viral
infection however it's important that
people know that in some cases a rush
may be the first and only symptom of the
disease well I I don't I wasn't aware of
this so it can be the first symptom
previously we thought that loss of smell
can be the first symptom or the fever
could be the first symptom no this is
saying the rash can be the rush can be
the first symptom and sometimes the only
symptom of the disease so someone could
have had a rash in the past not realized
they had covered 19 I've gone round
about spreading the disease giving it to
people who became critically and
potentially died because we did not have
this index of suspicion this high index
of suspicion that a rash is a clinical
feature of cough in 19 or can be so this
consultant dermatologist is saying even
if you notice a new rash you should take
it seriously by self isolating and
getting tested as soon as possible so
the new rash should be considered
alongside fever cough and loss of smell
as a potential first feature of covered
19 disease so this is new interesting
and on a global scale could be
remarkably helpful that caught ailing
the spread of the infection now this
study is based on 336 thousand regular
app users regular users in fact I
haven't done mine today so I think I'll
probably just probably just do mine now
so here we have the coverage symptom
tracker app hopefully you can see that
covered symptom tracker app
that comes up report today of even if
you're feeling well so you report even
if you're feeling well or not this is me
last report was yesterday so our
reporting today that's actually asking
us for some extra information with each
sometimes does so I'll skip that because
I'm on this demonstration then asked you
if you've had a covered nineteen test so
I've never had a covered nineteen test
then I feel physically normal and that
is it that's it that as me reported in
for the day now sometimes they ask
additional questions and I will go back
and I will go back and answer those but
for most days for 919 days out of 20
that's all you do you just report in
like that it's not a geolocation it's
not all Welli and it's just collecting
really useful data so I'd really
encourage everyone to do that so this is
based on over third of a million now 8.8
of people reporting a positive swab test
had experienced a rash as part of their
symptoms so eight point eight percent of
people that turned out to be positive
when you asked them they had had a rash
at some point in the illness quite a
significant chunk so this means we could
have been missing eight point eight
percent of people with this as an early
feature who could have carried on
spreading the infection quite quite a
significant finding if you think of
eight point eight percent of the world's
population this is actually quite a
massive significant finding also a rash
reported in a further eight point two
percent of users with cough fever and a
NAS Mia so in other words people that it
looked clinically like they had covered
19 but didn't actually get tested but
had the cough the fever or the loss of
smell so clinically it looked like they
had covered 19 there was an other 8.2
cent also had a rash so that means that
I think a quick calculation there is
about 17% isn't it 16 yeah 17 percent so
17 percent of people with cough in 19 a
rash is part of the clinical features
according to this study but this is
highly likely to be valid because it's
based on over a third of a million users
that is a big study this is impressive
impressive data actually this is fairly
big data so this looks like it's pretty
well being missed since January now of
course some people had a rash who then
tested negative but that was five point
four percent so five point four percent
of people with a negative test result
also had a rash but of course that means
there's a big difference between five
point four and 17% well five point four
and eight point eight percent and with
these kind of numbers that is a very
significant difference that all the
statistical tests will come up with a
p-value of 0.02 0.03 of the rash on your
phone send it in to the group how hard
is it 17 percent of respondents tested
positive for the coronavirus reported a
rash in the first as the first symptom
of the disease so that's about what we
worked out wasn't it with Mya impromptu
adding up 17 percent of respondents
testing positive for coronavirus
reported a rash so of all the people
that tested positive they asked them all
and said look just just just think back
did you have a rash and 17% realized oh
yeah I did have a rash
17% reported a Rush's the first symptom
of the disease
so again on four one in five isn't it
you know has a rashes the first symptoms
of the disease twenty one percent of
those confirmed as being affected with
coronavirus the rush was their only
symptom Wow
so 21% of people confirmed as being
infected with covered 19 the rash was
the only symptom so this large
percentage of people would describe
previously described as being
asymptomatic and that they didn't feel
ill maybe they weren't asymptomatic
maybe they'd had a symptom which was a
rash
technically it's a sign but term a sign
is something you see a rash is something
the patient feels a symptom is something
the patient feels so technically a
society but nevermind
but anyway 21% of those confirmed as
being infected with Korean advice the
rash was their only symptom but of
course these people would be infectious
they could be spreading it on to other
people they would be part of the chain
of infection passing that on to someone
else
who could potentially get very sick may
be critical and who could potentially
die as a result of the infection quite
quite possible quite quite quite a
rational sequence of events so that's
really quite startling finding I'm still
kind of reeling at that 21 percent of
being 21 percent of people being
positive the rash was their only symptom
yep right useful stuff now that's kind
of the bottom line really of this video
that there is a bit of conclusion later
on so what I want to do now is tell you
a little bit about rashes and what they
mean and the relevance of Rush's to do
this study now in this study there was
basically three types of rash reported
three types of rush and the first were
hive type rashes or attic area now hives
or tea carrier actually literally means
nettle
that's really what it means and these
are raised red patches on the skin like
a nettle rash or red spots so sometimes
it's kind of an all-over red rash
sometimes it's little spots with white
bits in between and it's called earth
tech area and these are quite common as
well an allergic reactions I commonly
treat them with antihistamines it's kind
of a routine it's kind of a routine
treatment to treat these things if
they're persistent and annoying with
antihistamines so they're raised bumps
on the skin which come and go quite
quickly within a few hours and are
usually very itchy so I'm sure most of
you have had the nettle rush that's what
it's like earth to carry all hives these
raised red patches and when you feel
them the kind of lumpy because that
they're inflamed and the red can't
evolve any part of the body often starts
with itching on the palms or the soles
of the feet now that's interesting I
haven't heard that one before so itching
on the palms of the hands or the soles
of the feet and then the rash can appear
on other parts of the body can cause
swelling of the lips and eyelids and
again this is just classic of what we
would normally call a histamine type
reaction that we get it's in hay fever
don't you with Sissis what swelling of
the of the eyelids and salts or eyes the
swelling of the lips and the eyelids
again been reported many times in
covered 19:00 these rashes can present
quite early on in the infection very
often they go away but they can persist
that they can also last a long time
after the initial presentation so
sometimes they come and go other times
they hang around so that was a that was
that type of rush now the next type of
rash is that the prickly heat or the the
prickly heat or the chickenpox type rush
now this is a bit complicated here
because it's in kind of medical language
a wreath ro a wreath Roberto or anything
with a wreath Rouen means red
so like the erythrocytes are the red
blood cells so a wreath room at O
popular now popular means it's a solid
elevation like a little lump so it's a
solid little lump that's what a popular
is so the solid little lumps that are
red that's what us all Aretha motto
popular means so red and lumpy popular a
wreath row popular rush or it can be a
wreath row vesicular so again a wreath
Row means red and vesicular means that
the rash has got fluid associated with
it so there's little fluids but like
tiny little fluid e things if it becomes
bigger would call these blisters if it
was bigger and it says their chicken pot
chicken pox type rushes and this is true
so typically in the early stages of
chicken pox which of course you see all
the time in kids
it's a wreath row papular you get these
reddish hardest lumps on the surface of
the skin then over time it becomes the
become fluid field they've become a
wreath row vesicular so that means red
and raised lumpy that means red and
fluid inside like a little blister
that's all those terms mean so you can
get both of those areas of small itchy
bumps that can occur anywhere on the
body in covered 19 but particularly
these rashes occur on the elbows and
knees backs of the hands and feet now
I've never quite worked out why
particular rashes appear on particular
parts of the body but that's where the
comments are elbows knees back to the
hands and feet and this rash can persist
for days or weeks interesting so a
longer a longer living longer lasting
rash so that's the second sort and the
third presentation in covered 19 is
called covered fingers and toes and
these are like kill blends now
chillblains are really quite common
typically they're caused by exposure
to the cold now not everyone gets them
so one person might get exposed to a
certain amount of cold and have cold
feet another person might be exposed to
a certain amount of cold and get that
one person doesn't get them one person
does get them but what it is it's a
painful inflammation of the small blood
vessels on exposure to cold and it can
lead to blistering so you tend to get
red fingers inflamed fingers more but
most times I've seen it on the toast
caused feet tend to get the coldest so
you get these you get these red inflamed
toes typically it's itchy
typically it's painful and they can
blister chillblains so some people are
particularly prone to and of course it's
important for those people to keep their
feet warm
so chilblains again see this all the
time
reddish or purplish lumps on the fingers
or toes which we see a common finding
now typically chilblains most of the
patients that have complained to me
about chilblains
they say it's itchy but in covered 19
it's saying maybe saw so they may be
quite painful sorts or chilblains but
they're saying usually not itching so a
little unusual if it's not usually
actually but there you go that's well
that's what the finding is this type of
rash is most specific to covered 19 so
in other words the earth to carry or
rash and this these sorts of a wreaths
wrote popular and re-throw vesicular
rashes can occur in other conditions but
the chilblains rash is the most specific
- covered 19 so in a sense this is the
most useful diagnostic rash and we've
known about this for a while again most
most commonly I've heard about it in
patients that are severely ill because
they're the ones that have come to the
attention of the researchers but this
covered fingers and toes
so it's inflammation of the red blood
vessels in the fingers and toes
making fingers and toes red and and
making them not so much it G but butts
or more common in younger people and
tends to present later on in the illness
so where is the dirty carrier rash or
the prickly heat type rush tended to be
early features this tends to be a late
of
so they're the three types of rashes and
they're just a little bit about what
this means one of the other consultant
dermatologists doctor cluck involved in
this study
she says this these findings highlight
the importance of keeping an eye on any
new changes in your skin such as lumps
bumps or rashes let's just put it much
simpler than Meyerson shape lumps bumps
or rashes though the reporting of
coverage associated rashes by members of
the public and recognition of their
significance by frontline health care
practitioners is important so in other
words the public needs to be aware of
this as a potential clinical feature of
covered 19 and anyone assessing these
patients needs to be aware that a rash
on its own even without any other
symptoms at all
as we saw 21% of people who tested
positive the rash was the only clinical
feature so worldwide this is of just
massive importance massive importance
may increase the detection of corona
virus infection and stop the spread
absolutely otherwise people might not
know they've had it because they might
not realize the rashes covered 19 so
that was another one of the consultant
dermatologists involved in the study and
research and finally this doctor here is
that is the president of the British
Association of dermatologists so these
are these are big cheese is now in
dermatology and she's saying this
documenting the skin symptoms associated
with covered 19 is an important piece of
the puzzle in building and understand
building our understanding of the
disease
so obviously the the boffins here I've
got more thoughts on this it's helping
them to understand the disease
altogether as well as helping us to
recognize it early and isolate people
she goes on to say this is actually
speaking for the British Association of
dermatologists here skin symptoms may
play
crucial role in detecting infection in
people who are otherwise asymptomatic
21% otherwise asymptomatic so skin
symptoms may play a crucial role in
detecting the infection in people who
are otherwise asymptomatic this on a
global scale has got the potential to
prevent tens of millions of infections
this is um everything of 21% of the
people in a country who could be
infectious but who we can isolate then
that means to me that we could be
reducing the drivers of transmission by
21 percent simply by recognising these
rashes and isolating people with these
rushes and we get 21% less spread of
infection it is massively important
we're delighted to be working with the
team at King's College London to make an
image library of covered 19 skin
manifestations now I'm not sure where I
stand with copyright but I have included
a link at the top of this way you can
look all the pictures for yourself so
that they're there available
this will help healthcare professionals
guide their decision-making in clinical
settings of course and alert members of
the public and may have a role in
educating the public about skin symptoms
which would warrant self isolation so
there we go I think that's a remarkably
important study very important study
excellent useful information people with
mild or no symptoms can have the skin
rush and therefore can identify
themselves or be identified as people
that are infected with Kovic 19