A COVID-19 Conundrum – Can the reported skin manifestations of COVID-19 be explained by re-activation of herpes virus?

Itamar Getzler

Keywords: COVID19; COVID-19; Herpes; Herpetic lesion; Herpesviridae; Zoster; Skin Manifestations

Background:
Over the past year, numerous reports concerning COVID-19 skin manifestations have started to emerge. A debate has ensued, with lacking evidence to support whether these skin manifestations are unique, or rather represent a form of re-activation or superinfection with Herpesviridae viruses. The primary goal of this research is to examine the differences in frequencies and\or the time to develop herpetic lesions between COVID-19 patients, vaccinated individuals, and a control group. This, to supply evidence and a possible solution to the COVID-19 skin manifestations debate. Secondary goals include characterizing the skin lesions in the COVID19 group compared with the control group in respect of recent literature and examine possible vaccine side-effects.

Research questions:
The working hypothesis is that there is no difference in the frequency or the average time to develop lesions between the COVID-19 group and the other groups, among patients with no known history of herpes infection (i.e. first documented lesion). The parallel hypothesis is that there is a difference in the average time to develop lesions between the COVID19 group and the other groups among patients with known history of herpes infection. An additional hypothesis is that there might be occurrences of herpes re-activation within the vaccinated group.

Method:
Patient files mentioning a herpetic lesion between December-20 to March-21 would be extracted from Maccabi Health Services database. These patients would be grouped by the association of the lesion to the COVID-19 disease (Infected, Vaccinated, Control). These groups would then be statistically matched to reduce bias, using common criteria such as age, sex, immunocompetence, and known risk factors for severe COVID19 disease as published by the CDC. A statistical analysis of the data would be applied on the matched groups, focusing on survival analysis.

Results:
Work in progress...

Conclusions:
This study could provide evidence and a possible solution to the COVID-19 skin manifestations debate.

Points for discussion:
What are the arguments and evidence supporting unique skin manifestations of COVID-19?

What are the arguments and evidence supporting reactivation of herpesviridae during COVID-19 illness?