Although COVID-19 cases are beginning to trend downward in the U.S., millions are still battling the virus — and struggling to sift through their symptoms in the process. In recent months, the Centers for Disease Control and Prevention has added new symptoms to its information page, including loss of smell/taste and congestion. But now anecdotal reports have floated a new one, which has earned the moniker “COVID tongue.”
The reports, many posted on Facebook, describe symptoms such as a swollen tongue, one with a scalloped appearance, or a “furry surface” of the tongue. Still, COVID-19 experts say it’s too soon to link them. So what’s really happening? Here’s what you need to know.
Some patients on social media say they’ve experienced tongue reactions
In the COVID-19 Facebook group Survivor Corps, a grassroots organization of COVID-19 patients, many have shared oral symptoms that they say coincided with their testing positive for the coronavirus. Carol Van Der Spuy, a marketing manager in Cape Town, South Africa, said she noticed the symptoms when she tested positive for COVID-19 a second time. “I had big patches on [my tongue] which were a different color,” she says. “It almost looks like it has been ‘burned clean.’”
New Yorker Martha Barrera says she developed symptoms two weeks after getting COVID-19 in March. “My tongue swelled up,” she tells Yahoo Life. “It was painful and so sensitive and I could not tolerate anything cold or hot. It also was white ... didn’t matter how many times I brushed, the color was different. Doctor didn’t know what to do, so he prescribed thrush medication for three weeks. Ten months later, my tongue swells up out of the blue. I still have issues.”
There has been little research to suggest that the symptoms are linked to COVID-19
Two small studies have analyzed COVID-19 and oral symptoms, neither of them conclusive. One comes from researchers at La Paz hospital in Madrid, who reviewed the records of more than 600 COVID-19 patients and found 25 percent of them had some type of tongue reaction. “We found changes in the tongue that until then had not been linked to Covid,” said Dr. Almudena Nuño González in a press release. “The tongue is enlarged, it appears swollen, the teeth marks can be seen and ... with small indentations in the back where the taste buds are flattened.”
Another report was published in The Egyptian Journal of Otolaryngology in mid-January but contained less detail about the potential symptoms. In it, researchers simply said that the symptoms should not be overlooked. “It is crucial for ENT [ear, nose and throat] physicians to have high index of suspicion to identify those COVID 19 patients with atypical presentations,” the authors write.
Experts in the U.S. say they haven’t seen the reaction
According to multiple experts who spoke with Yahoo Life, there is not enough evidence at this point to connect the tongue symptoms to COVID-19. Experts at Mount Sinai Health System’s Center for Post-COVID Care — the first recovery center for survivors in the U.S. — haven’t seen a “single case” involving COVID tongue among the “thousands of patients” being treated.
Doctors at the Ohio State University Wexner Medical Center agreed, saying tongue reactions are also not a condition they’re treating. “I can’t say I’ve come across anything like this, and it’s not something that we’ve discussed as a group,” says Dr. Jeffrey Horowitz, professor of medicine and division director of pulmonary, critical care and sleep medicine.
An otolaryngologist says the symptoms could be unrelated
Dr. Nina Shapiro, director of pediatric ear, nose and throat at the UCLA Mattel Children’s Hospital and a professor at the David Geffen School of Medicine at UCLA, says none of the symptoms described in the studies are uncommon, meaning they could be occurring for other reasons. “Do some of these people have [these symptoms] anyway, and because they’re getting so closely followed, they’re finding it?” she asks. “That’s hard to know.”
She notes that oral symptoms can be caused by things like the common cold or other illnesses, as well as be reactions to certain medications that weaken the immune system, such as steroids. Dexamethasone, a corticosteroid, has been identified as an “effective” treatment for COVID-19.
The symptoms themselves are less mysterious than they seem
Shapiro breaks down exactly what is happening in the strange descriptions from the studies. “Some of these pictures [in the studies] resemble what’s called ‘geographic tongue,’ which makes the tongue look like a map with little islands and whitish discoloration,” she says. “It’s been associated with colds and other kinds of illnesses, but it’s not a worrisome condition in and of itself.” The Mayo Clinic describes geographic tongue as “an inflammatory but harmless condition affecting the surface of your tongue.”
Sores or other wounds on the tongue may be a sign of another infection, she says. “Lesions of the tongue such as ulcers can be associated with viral illness,” she says. “It could be due to a secondary viral infection, such as herpes, or other sorts of viruses that grow in the mouth and the throat such as Coxsackievirus. So there certainly could be a viral association.”
A woolly-looking tongue, Shapiro says, is likely candida. “The furry tongue, where it almost looks like a little shag carpet, is typically just a fungal infection,” she says. “If your immune system is weakened for any reason — which could just be from stress itself or from some of the treatments they’re using — then you can develop secondary infections such as candida of the mouth.”
And what about the scalloped appearance? Also nothing to worry about. “Some irregularity to the borders of the tongue could be from a lot of things,” she says. “A lot of the patients described [in the studies] had pneumonia so they may have been intubated or on oxygen and severely dehydrated or congested.”
Overall, Shapiro says, oral issues are typically secondary and not the “primary problem.” They’re also likely unrelated to loss of smell and taste, which stem from the olfactory nerves. So aside from antifungal medications or other targeted drugs, she says, the best way to address them is to get rid of the underlying infection. “They should resolve as the illness resolves.”
For the latest coronavirus news and updates, follow along at https://news.yahoo.com/coronavirus. According to experts, people over 60 and those who are immunocompromised continue to be the most at risk. If you have questions, please reference the CDC’s and WHO’s resource guides.
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