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

Itamar Getzler

Keywords: COVID-19, Herpes, Herpesviridae, SARS-COV-2

Background:

Since COVID-19 outbreak, numerous reports concerning COVID-19 skin manifestations have emerged. A debate has ensued, with lacking evidence to support whether these skin manifestations are unique, or represent a form of re-activation with Herpesviridae viruses.

Research questions:

The goal of this research was to compare the incidence of herpetic skin lesions between COVID-19 group, Vaccinated group, and their respective control, considering Herpesviridae carrier status.

Method:

Maccabi Health Services’ database was digitally scanned, and a cohort of both verified COVID-19 and SARS-COV-2 vaccinated patients were extracted in respect to the study timeframe. Random control cohorts were pulled from the database to be matched to the cohorts. All patient records of the cohort were then analyzed to find occurrences of clinically diagnosed herpetic lesions during and before the study timeframe.

Results:

105,000 patients were recruited to each cohort. For the COVID-19 cohort, we’ve demonstrated nonsignificant difference between both groups for developing herpetic skin lesions. A logistic regression demonstrated that the Interaction of COVID-19 with History of Herpes is statistically significant with an odds ratio of 0.51 (p=<0.001). For the ‘Vaccination’ cohort, the data shows statistically significant differences between groups in herpetic frequencies, but contrary to the COVID-19 disease, the interaction of the vaccine with the ‘history of herpes’ is not significant with an odds ratio of 0.74 (p=<0.070).

Conclusions:

We can infer that COVID-19 has a low or non-significant impact on the development of clinically diagnosed herpetic lesions within one month of diagnosis. This result diminishes the idea of COVID-19 contributing to unique skin lesions. However, because of the meaningful interaction of the COVID-19 disease with the History of herpes variable, we can suggest that COVID-19 has a role in reactivation of latent Herpesviridae infections. The SARS-COV-2 vaccine can increase the odds of developing herpetic infection almost 2-fold relative to those who did not get the vaccine.

Points for discussion:

Results of the study proposal presented on the EGPRN's 93rd meeting.