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Published on: May 22, 2020
1 minute read
By: Dr Rajan Choudhary

Corona Virus In Young Patients And Kids

Kids seem to be relatively unaffected by COVID, but this does not mean they are invulnerable. As with adults, some children have pre-existing cardiac, respiratory, or metabolic conditions, and are therefore more vulnerable to the effects of COVID. Interestingly, children appear to have one more symptom when infected with coronavirus – COVID Toes.

I personally came across this phenomenon recently, with a young patient asymptomatic for COVID who presented with unusual symptoms of dark bruises on his toes. This had been present for just a few days. He did not have any pain, itching, swelling, no recent trauma, or injury to the feet. Circulation to his feet was normal, with no other rashes or skin changes, no other abnormal features in the history to note. It was certainly an odd presentation and certainly could have been an example of COVID toes.

This new phenomenon was noticed in April and has not gained as much notoriety because it is fairly rare compared to the major COVID symptoms, such as fever, cough, and lethargy. Doctors have described lesions on the feet of young people, usually purple-colored, around the tips of the toes. They have been compared to chilblains, painful swellings on feet, and toes that appear in the cold. Similarly to chilblains they do not cause any permanent damage and usually regress in days to weeks.

It's not clear why they occur or the mechanism behind the discoloration, because the presentation is rare and in healthy patients. We know COVID can cause systemic inflammation and can increase the risk of clot formation. It may be that localized inflammation is occurring in the toes, causing the vessels to clamp down and reduce blood flow to the area. This is similar to the mechanism for chilblains forming in the foot. Micro-clotting could also be partially responsible for this phenomenon.

COVID Toes is not the only skin symptoms related to COVID. In a paper published in the British Journal of Dermatology, researchers described five common skin presentations in 375 COVID patients. These were:

Asymmetrical chilblain like lesions in the hands and feet, found in younger patients lasting up to 2 weeks.
Small itchy blisters in the trunk and limbs, found in middle-aged patients before they present with symptoms, lasting about 10 days
Pink or white areas of raised skin, itchy, usually on the body
Raised bumps called macropapules, lasting about a week, seen in more severe infections.
Mottled, blotchy red-blue skin (known as livedo) seen in patients with severe illness.

So if you are currently suffering from COVID or have recently recovered from an infection, and suddenly notice odd colored toes, you too may have a case of COVID toes.

Dr Rajan Choudhary, UK, Chief Product Officer, Second Medic Inc

www.secondmedic.com

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Sleep Debt and Its Impact on the Body: Hidden Risks of Chronic Sleep Loss

Sleep is not a luxury; it is a biological necessity. Yet in today’s fast-paced world, many people consistently sacrifice sleep due to work demands, screen time and stress. Over time, insufficient sleep accumulates into what is known as sleep debt. Understanding sleep debt and its impact on the body is essential because chronic sleep loss silently affects nearly every organ system.

According to the World Health Organization and global sleep research, chronic sleep deprivation is associated with increased risk of cardiovascular disease, metabolic disorders and mental health conditions.

What Is Sleep Debt?

Sleep debt refers to the cumulative effect of not getting enough sleep.

For example:

if you need 8 hours but sleep 6 hours daily
you accumulate 2 hours of sleep debt per night

Over a week, that equals 14 hours of lost sleep.

This deficit places strain on the body.

Why Sleep Is Critical for Health

Sleep supports:

brain function
immune response
hormonal regulation
tissue repair
memory consolidation

Without adequate sleep, these processes become impaired.

Immediate Effects of Sleep Debt

Short-term consequences include:

daytime fatigue
poor concentration
mood swings
irritability
reduced reaction time

Even one night of poor sleep affects cognitive performance.

Sleep Debt and Hormonal Imbalance

Sleep regulates several key hormones.

Chronic sleep loss disrupts:

cortisol
insulin
leptin and ghrelin (hunger hormones)

This imbalance affects appetite, stress and metabolism.

Impact on Metabolic Health

Sleep debt increases:

insulin resistance
blood sugar fluctuations
abdominal fat accumulation

ICMR and NFHS-5 data show rising metabolic disorders in India, partly linked to lifestyle patterns including poor sleep.

Increased Risk of Obesity

When sleep is insufficient:

appetite hormones increase
cravings for high-calorie foods rise
impulse control weakens

Sleep deprivation promotes weight gain.

Sleep Debt and Immunity

The immune system relies heavily on sleep.

Chronic sleep loss:

reduces infection-fighting cells
increases inflammation
slows recovery from illness

Lancet research confirms that sleep deprivation weakens immune response.

Cardiovascular Consequences

Sleep debt increases risk of:

hypertension
heart disease
stroke

Poor sleep affects blood pressure regulation and vascular health.

Mental Health Impact

Sleep and mental health are deeply connected.

Sleep debt contributes to:

anxiety
depression
emotional instability

Chronic insomnia is both a cause and consequence of mental health disorders.

Cognitive Decline and Brain Health

Lack of sleep impairs:

memory
attention
decision-making

Over time, chronic sleep deprivation may increase risk of neurodegenerative disorders.

Sleep Debt and Inflammation

Chronic sleep loss elevates inflammatory markers.

Persistent inflammation contributes to:

metabolic syndrome
cardiovascular disease
autoimmune conditions

Preventing sleep debt reduces systemic inflammation.

Can Sleep Debt Be Recovered?

Short-term sleep debt can be partially recovered through:

consistent longer sleep
improved sleep hygiene

However, chronic sleep deprivation requires long-term behavioural changes.

Weekend “catch-up sleep” offers temporary relief but does not fully reverse long-standing sleep debt.

Warning Signs of Sleep Debt

Common indicators include:

reliance on caffeine
difficulty waking up
daytime drowsiness
poor focus
frequent illness

Persistent symptoms require lifestyle correction.

Practical Strategies to Reduce Sleep Debt

Maintain a Consistent Sleep Schedule

Go to bed and wake up at the same time daily.

Limit Screen Exposure Before Bed

Blue light suppresses melatonin production.

Create a Sleep-Friendly Environment

Dark, quiet and cool environments improve sleep quality.

Manage Stress

Relaxation techniques reduce cortisol levels and support sleep.

Avoid Heavy Meals and Caffeine at Night

These disrupt sleep cycles.

Role of Preventive Health Checkups

Screening helps detect:

hypertension
metabolic imbalance
stress-related conditions

Sleep quality assessment should be part of preventive care.

Long-Term Benefits of Adequate Sleep

Restorative sleep supports:

stable mood
strong immunity
healthy weight
improved productivity
reduced disease risk

Sleep is foundational to wellness.

Conclusion

Understanding sleep debt and its impact on the body highlights the critical role sleep plays in maintaining physical and mental health. Chronic sleep loss disrupts hormones, weakens immunity, increases metabolic risk and affects heart health. While occasional sleep loss may be manageable, consistent deprivation carries serious long-term consequences. Prioritising adequate, high-quality sleep is one of the most powerful steps toward protecting overall health and preventing chronic disease.

References

World Health Organization (WHO) – Sleep and Non-Communicable Diseases
Indian Council of Medical Research (ICMR) – Lifestyle Disorders and Sleep Patterns
National Family Health Survey (NFHS-5) – Adult Health Indicators
Lancet – Sleep Deprivation and Chronic Disease Research
NITI Aayog – Preventive Healthcare and Lifestyle Risk Factors

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