{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T17:03:32Z","timestamp":1781715812799,"version":"3.54.5"},"reference-count":34,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAPMA"],"abstract":"<jats:p>COVID-19, caused by the SARS-CoV-2 virus, has become a global public health crisis with diverse clinical manifestations affecting multiple organ systems, including the integumentary system. One notable cutaneous manifestation, referred to as \u201cCOVID toes,\u201d involves the development of pernio-like chilblains, characterized by red-to-violet macules, plaques, or nodules, primarily on toes and fingers. This characteristic clinical feature gained significant attention due to its apparent association with COVID-19, especially during the early stages of the pandemic when individuals with mild or asymptomatic cases exhibited these symptoms. Concurrently, digital platforms such as Google Trends have emerged as tools for tracking public interest in health-related topics, offering insights into real-time patterns of disease awareness. Previous research has demonstrated that Google Trends data may correlate with the incidence of infectious diseases, suggesting that search interest can be a proxy for disease outbreaks. In this study, we sought to explore the potential relationship between public interest in COVID toes, as reflected in Google Trends, and the incidence and mortality rates of COVID-19. Specifically, we examined whether peaks in search interest for \u201cCOVID toes\u201d corresponded with surges in COVID-19 cases and deaths. By analyzing trends in search data, we aimed to assess the utility of digital platforms as an epidemiological tool for monitoring disease progression and public awareness. Our findings provide insights into the potential role of digital search data in forecasting outbreaks and highlight the interplay between public perception and the clinical burden of COVID-19, emphasizing the importance of real-time data in public health surveillance and response.<\/jats:p>","DOI":"10.3390\/japma116030038","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T15:11:22Z","timestamp":1781709082000},"page":"38","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Quantitative Assessment of the Correlation Between \u2018COVID Toes\u2019 Search Volume and COVID-19 Case Incidence and Mortality Dynamics: A Longitudinal Data-Driven Approach"],"prefix":"10.3390","volume":"116","author":[{"given":"Anna E.","family":"Kotula","sequence":"first","affiliation":[{"name":"Department of Microbiology, Immunology & Pathology, Des Moines University, West Des Moines, IA 50266, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rahul A.","family":"Pithadia","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Immunology & Pathology, Des Moines University, West Des Moines, IA 50266, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashley","family":"Wysong","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of Nebraska Medical Center, Omaha, NE 68198, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2598-7895","authenticated-orcid":false,"given":"Mark R.","family":"Wakefield","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA"},{"name":"Ellis Fischel Cancer Center, University of Missouri School of Medicine, Columbia, MO 65212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yujiang","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Microbiology, Immunology & Pathology, Des Moines University, West Des Moines, IA 50266, USA"},{"name":"Department of Surgery, University of Missouri School of Medicine, Columbia, MO 65212, USA"},{"name":"Ellis Fischel Cancer Center, University of Missouri School of Medicine, Columbia, MO 65212, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1001\/jamadermatol.2020.4324","article-title":"Clinical, Laboratory, and Interferon-Alpha Response Characteristics of Patients with Chilblain-like Lesions During the COVID-19 Pandemic","volume":"157","author":"Hubiche","year":"2021","journal-title":"JAMA Dermatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.neurol.2022.02.455","article-title":"The COVID-19 Pandemic, an Environmental Neurology Perspective","volume":"178","author":"Reis","year":"2022","journal-title":"Rev. Neurol."},{"key":"ref_3","first-page":"15","article-title":"COVID Toes: A Unique Cutaneous Indicator of COVID-19","volume":"9","author":"Dowdle","year":"2021","journal-title":"Southwest Respir. Crit. Care Chron."},{"key":"ref_4","unstructured":"(2025, April 09). COVID Toes: What Are They and What Do They Mean. Available online: https:\/\/mydoctor.kaiserpermanente.org\/mas\/news\/covid-toes-what-are-they-and-what-do-they-mean-1758928."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e2111369","DOI":"10.1001\/jamanetworkopen.2021.11369","article-title":"Bilateral Chilblain-like Lesions of the Toes Characterized by Microvascular Remodeling in Adolescents During the COVID-19 Pandemic","volume":"4","author":"Discepolo","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Escand\u00f3n, K., Rasmussen, A.L., Bogoch, I.I., Murray, E.J., Escand\u00f3n, K., Popescu, S.V., and Kindrachuk, J. (2021). COVID-19 False Dichotomies and a Comprehensive Review of the Evidence Regarding Public Health, COVID-19 Symptomatology, SARS-CoV-2 Transmission, Mask Wearing, and Reinfection. BMC Infect. Dis., 21.","DOI":"10.1186\/s12879-021-06357-4"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1143","DOI":"10.1111\/pde.14805","article-title":"\u201cCOVID Toes\u201d: A Meta-Analysis of Case and Observational Studies on Clinical, Histopathological, and Laboratory Findings","volume":"38","author":"Rocha","year":"2021","journal-title":"Pediatr. Dermatol."},{"key":"ref_8","unstructured":"Rochman, S. (2025, April 09). \u2018COVID Toes\u2019 Were Likely Not Caused by COVID-19, in Most Cases. Available online: https:\/\/divisionofresearch.kaiserpermanente.org\/covid-toes-not-caused-by-covid\/."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"486","DOI":"10.12968\/jowc.2020.29.9.486","article-title":"COVID Toes and Other Cutaneous Manifestations of COVID-19","volume":"29","author":"Dua","year":"2020","journal-title":"J. Wound Care"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1053\/j.seminoncol.2020.05.012","article-title":"Going Viral: A Brief History of Chilblain-like Skin Lesions (\u201cCOVID Toes\u201d) amidst the COVID-19 Pandemic","volume":"47","author":"Massey","year":"2020","journal-title":"Semin. Oncol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1002\/path.5642","article-title":"COVID-19: Immunopathology, Pathophysiological Mechanisms, and Treatment Options","volume":"254","author":"Binkhorst","year":"2021","journal-title":"J. Pathol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1186\/s13052-022-01296-5","article-title":"Chilblain-like Lesions Onset during SARS-CoV-2 Infection in a COVID-19-Vaccinated Adolescent: Case Report and Review of Literature","volume":"48","author":"Paparella","year":"2022","journal-title":"Ital. J. Pediatr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.jdin.2022.06.012","article-title":"\u201cCOVID Toes\u201d: A True Viral Phenomenon or a Diagnosis without a Leg to Stand On?","volume":"9","author":"Gao","year":"2022","journal-title":"JAAD Int."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Wang, D., Guerra, A., Wittke, F., Lang, J.C., Bakker, K., Lee, A.W., Finelli, L., and Chen, Y.-H. (2023). Real-Time Monitoring of Infectious Disease Outbreaks with a Combination of Google Trends Search Results and the Moving Epidemic Method: A Respiratory Syncytial Virus Case Study. Trop. Med. Infect. Dis., 8.","DOI":"10.3390\/tropicalmed8020075"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Saegner, T., and Austys, D. (2022). Forecasting and Surveillance of COVID-19 Spread Using Google Trends: Literature Review. Int. J. Env. Res. Public Health, 19.","DOI":"10.3390\/ijerph191912394"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1055\/s-0041-1726513","article-title":"The Clinical Information Systems Response to the COVID-19 Pandemic","volume":"30","author":"Reeves","year":"2021","journal-title":"Yearb. Med. Inf."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Gholamzadeh, M., Asadi Gharabaghi, M., and Abtahi, H. (2025). Public Interest in Online Searching of Asthma Information: Insights from a Google Trends Analysis. BMC Pulm. Med., 25.","DOI":"10.1186\/s12890-025-03545-9"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1177\/00333549231163531","article-title":"Tracking COVID-19 in the United States with Surveillance of Aggregate Cases and Deaths","volume":"138","author":"Khan","year":"2023","journal-title":"Public Health Rep."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1016\/j.sapharm.2023.03.010","article-title":"Information Seeking during the COVID-19 Pandemic: Application of the Risk Information Seeking and Processing Model","volume":"19","author":"Park","year":"2023","journal-title":"Res. Soc. Adm. Pharm."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"010403","DOI":"10.7189\/jogh.10.010403","article-title":"Using Google Trends to Assess the Impact of Global Public Health Days on Online Health Information Seeking Behaviour in Central and South America","volume":"10","author":"Havelka","year":"2020","journal-title":"J. Glob. Health"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2499","DOI":"10.1111\/jdv.16774","article-title":"Cutaneous Manifestations of SARS-CoV-2 Infection: A Clinical Update","volume":"34","author":"Gisondi","year":"2020","journal-title":"J. Eur. Acad. Dermatol. Venereol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1016\/j.anai.2020.11.021","article-title":"Zoonotic Coronavirus Epidemics","volume":"126","author":"Fung","year":"2021","journal-title":"Ann. Allergy Asthma Immunol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1016\/j.jaad.2020.05.145","article-title":"Chilblain-like Acral Lesions during the COVID-19 Pandemic (\u201cCOVID Toes\u201d): Histologic, Immunofluorescence, and Immunohistochemical Study of 17 Cases","volume":"83","author":"Kanitakis","year":"2020","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"2750","DOI":"10.1093\/ckj\/sfad222","article-title":"Dobrava Hantavirus and Coinciding SARS-CoV-2 Infection Mimicking Thrombotic Microangiopathy and Responding to a Single Dose of Eculizumab","volume":"16","author":"Aberger","year":"2023","journal-title":"Clin. Kidney J."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e714","DOI":"10.1002\/mco2.714","article-title":"The Interaction of Innate Immune and Adaptive Immune System","volume":"5","author":"Wang","year":"2024","journal-title":"MedComm"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1266","DOI":"10.1111\/cup.14059","article-title":"Skin Manifestations as Potential Symptoms of Diffuse Vascular Injury in Critical COVID-19 Patients","volume":"48","author":"Rezai","year":"2021","journal-title":"J. Cutan. Pathol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1016\/j.ijid.2020.04.033","article-title":"Association of the COVID-19 Pandemic with Internet Search Volumes: A Google TrendsTM Analysis","volume":"95","author":"Effenberger","year":"2020","journal-title":"Int. J. Infect. Dis."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e366","DOI":"10.1093\/pubmed\/fdab349","article-title":"Digital Contact-Tracing in France: Uptake by COVID-19 Risk Factor and by Exposure Risk","volume":"44","author":"Guillon","year":"2022","journal-title":"J. Public Health"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"e42446","DOI":"10.2196\/42446","article-title":"Enhancing the Predictive Power of Google Trends Data Through Network Analysis: Infodemiology Study of COVID-19","volume":"9","author":"Chu","year":"2023","journal-title":"JMIR Public Health Surveill."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1016\/j.jaad.2020.05.109","article-title":"Pernio-like Skin Lesions Associated with COVID-19: A Case Series of 318 Patients from 8 Countries","volume":"83","author":"Freeman","year":"2020","journal-title":"J. Am. Acad. Dermatol."},{"key":"ref_31","unstructured":"(2025, April 21). What Are COVID Toes? A Case Study. Available online: https:\/\/www.nursingcenter.com\/journalarticle?Article_ID=5706248&Journal_ID=448075&Issue_ID=5705678."},{"key":"ref_32","unstructured":"(2025, April 21). COVID Toe: Symptoms, Duration and Treatments. Available online: https:\/\/ada.com\/covid\/covid-19-toes-symptoms\/."},{"key":"ref_33","unstructured":"(2025, April 21). COVID Toe: A Dermatological Manifestation of COVID-19. Available online: https:\/\/researchoutreach.org\/articles\/covid-toe-dermatological-manifestation-covid-19\/."},{"key":"ref_34","first-page":"78","article-title":"SYMPTOMATOLOGY AND TREATMENT OF COVID-19 AFFECTING SKIN APPENDAGES: A NARRATIVE REVIEW BEYOND COVID-TOES","volume":"331","author":"Wollina","year":"2022","journal-title":"Georgian Med. News"}],"container-title":["Journal of the American Podiatric Medical Association"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1930-8264\/116\/3\/38\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T16:05:40Z","timestamp":1781712340000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1930-8264\/116\/3\/38"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,17]]},"references-count":34,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["japma116030038"],"URL":"https:\/\/doi.org\/10.3390\/japma116030038","relation":{},"ISSN":["1930-8264"],"issn-type":[{"value":"1930-8264","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,17]]}}}