As the medical community continues its race to understand COVID-19, the first comprehensive research paper on skin manifestations of the virus has been published in the medical journal Advances in Wound Care. Its unlikely authors are a second-year medical student at Indiana University School of Medicine and his older sister, a young doctor in her second year of residency.
Harjas Singh, a member of the IU School of Medicine Class of 2023, and his sister, Harleen Kaur, MD, a resident in internal medicine at IU School of Medicine, used time off from the clinical and laboratory settings during the summer of 2020 to delve into the effect of SARS-CoV-2 (the virus that causes COVID-19) on skin. While most medical scientists were focused on respiratory symptoms, Singh and Kaur were determined to document skin manifestations reported from around the globe.
The initial charge came from Chandan Sen, PhD, Distinguished Professor, J. Stanley Battersby Chair and Professor of Surgery, and associate dean of research at IU School of Medicine, who directs the IU Health Comprehensive Wound Center and the Indiana Center for Regenerative Medicine and Engineering (ICRME) at IU School of Medicine. Because of his international recognition and award-winning research in the field of regenerative medicine, Singh had selected Sen as his desired mentor for the Indiana University Medical Student Program for Research and Scholarship (IMPRS) summer session.
Initially disappointed that COVID-19 restrictions would prevent him from working in Sen’s lab, Singh, nonetheless, was honored Sen entrusted him to conduct work important to the scientific community’s understanding of the novel coronavirus.
For Sen, he merely expected his eager mentee to pull together the existing literature on COVID-19 skin manifestations—which he underestimated to be a dozen or so papers. What Singh and Kaur ultimately produced went far beyond Sen’s expectations.
“This brother-sister team actually surprised me in more ways than I could imagine,” said Sen. “Summer was gloomy, but this was a silver lining. They ended up writing what I thought was a masterful document.”
In total, Singh and Kaur analyzed 56 papers, mainly from European nations, along with some from Asia. They put together a series of tables with images, detailing various types of rashes and lesions observed in COVID-19 patients.
“At that time, there weren’t any full reviews. The tables we created were very thorough and might be beneficial to scientists,” Singh said.
Sen was convinced the comprehensiveness of the team’s work would add value to the medical community’s understanding of COVID-19. So much so that he helped Singh submit the paper for publication in Advances in Wound Care, a publication of the Wound Healing Society, for which Sen is editor-in-chief.
The paper was peer-reviewed by top experts around the country. After making their suggested revisions, “Cutaneous Manifestations of COVID-19: A Systemic Review” was accepted for publication on September 16, 2020.
“It was so well written and was so timely,” Sen said. “Having access to this information is very helpful to dermatologists and other clinicians.”
While Singh and Kaur were working on their research, Sen was busy pivoting his lab to study an electroceutical fabric’s ability to kill coronaviruses on contact—research that has made national media headlines and is now in the FDA’s “breakthrough technology” approval process. Yet Sen made time for regular Zoom calls with his mentee. He also assigned a junior scientist in his lab, Kanhaiya Singh, PhD, assistant research professor of surgery (no relation to Harjas Singh), to help mentor this eager medical student through the research process.
“Dr. Singh did take me under his wing. He would Zoom with me two or three times a week,” Singh said.
“It was wonderful to be under such amazing mentors,” added Kaur, who came on board a couple weeks into the project after being infected by her brother’s enthusiasm.
It was a bit of a role reversal from when Kaur’s enthusiasm for a career in medicine inspired her younger brother to apply for medical school.
“Medicine is an absolute privilege to be able to practice each day,” said Kaur, a first-generation doctor who studied rural medicine at IU School of Medicine-Terre Haute. “While it may be tough and there may be happy days or sad days, at the end of it all, I can't think of anywhere else I would be. One patient's smile, one patient now being able to embrace their family, one patient now healthy and able to walk out of the hospital, makes each day worth it all.”
Singh has followed in his sister’s footsteps, beginning his medical studies as an undergraduate student in the Rural Health Program at Indiana State University, a partnership with IU School of Medicine, and is now studying at IU School of Medicine-Terre Haute.
Children of immigrants from Punjab, India, Kaur and Singh were fortunate to have parents who supported and encouraged their aspirations not only to become physicians but lifelong learners. The siblings share insatiable curiosity and the desire to contribute to scientific knowledge in medicine.
“It continues to amaze me how much more knowledge there is to gain. The more you know, the more you realize you don't know,” Kaur said. “It's humbling. But we are blessed with great mentors every which way we go.”
During her clinical rotations in the hospital, Kaur had been more focused on the life-threatening respiratory symptoms of COVID-19, but she was eager to address the gap in medical knowledge related to skin manifestations—something her own dermatologist had asked if she’d seen in any of the hospitalized patients she had treated.
The research team discovered that skin has the same “receptors” for COVID-19 as do lungs, Sen said.
“When you start looking at it, several secrets start unfolding,” said the seasoned research scientist. “This is the first paper synthesizing all articles on skin manifestations and treating them critically. It will be heavily cited and well received by the medical community.”
And, it was the first research publication experience for both siblings.
“There was a time constraint to get the information out about COVID, and it got pretty stressful at times, but it helped knowing Harleen was there,” said Singh. “She has more clinical experience, so she helped me with data collection and analyzing the photos and the research articles I was finding.”
Kaur is quick to point back at Singh as the real driver of the project and the one who is rightly listed as the paper’s principal author.
Both say they are humbled and honored to contribute to the medical community’s understanding of COVID-19 during the global pandemic.
“To now be part of the scientific community that helps further the advancement of knowledge is beyond words,” Kaur said.