Some medical specialists think that the sudden inability to smell or taste familiar odors and flavors could be an early sign of the novel coronavirus infection. This sign could be as innocuous-looking as feeling that food suddenly tastes bland, or that familiar strong smells aren't getting through. Yet, it could signal the need to isolate oneself because it is a little-known yet characteristic sign of COVID-19, the disease caused by the novel coronavirus that is racing around the world.
Dressed in full protective gear a healthcare worker collects a sample from a man sitting inside his car as part of the operations of a coronavirus mobile testing unit. Image Credit: JHDT Productions / Shutterstock
The loss of the faculty of smell and taste, called anosmia and ageusia, respectively, go together and may indicate the presence of the disease, even if no other typical symptoms are noted. The report came from UK ENT specialists who work on diseases of the ear, nose, and throat (ENT). They looked at reports of cases from ENT consultants the world over and concluded that adults anywhere in the world who suddenly cannot smell properly any more should go into self-isolation for seven days to stop further transmission of the disease and delay its spread within the community. They admit that they have insufficient data to strongly support this conclusion, yet they feel that the importance of this preliminary finding justifies its dissemination.
In an email, British Rhinological Society chief Claire Hopkins said, "We really want to raise awareness that this is a sign of infection and that anyone who develops loss of sense of smell should self-isolate. It could contribute to slowing transmission and save lives." Along with ENT UK president Nirmal Singh, Hopkins made a joint statement supporting the need for all professionals in the health sector to protect themselves with appropriate personal protective equipment if their patients report not being able to smell things. She reports that she herself sees roughly 12 patients a month now, in contrast to 1 earlier.
Evidence from all over
The statement was based on multiple international reports that show anosmia is an early and significant sign of coronavirus patients. For instance, a significant citation comes from South Korea, where testing has been carried out on a mass scale. Here, 30% of 2,000 patients who tested positive first presented with the loss of smell. All of these were mild cases. The statement says, "These patients might be some of the hitherto hidden carriers that have facilitated the rapid spread of COVID-19."
The British physicians are backed by American ENT specialists. The website of the American Academy of Otolaryngology now carries the information that many stories have come in indicating that anosmia or hyposmia (a reduced sense of smell) and ageusia are significant COVID-19 symptoms, often seen in patients who later turned out to be positive on virus tests, though they had no other symptoms.
The website advises that if the patient's anosmia or hyposmia cannot be satisfactorily accounted for by allergies or sinusitis, the physician should think immediately of testing for coronavirus. The condition should lead to the recommendation that the patient self-isolate as well.
In Italy's worse-affected areas too, doctors say they have found that anosmia and ageusia are telltale signs that an apparently healthy person is harboring the virus and is probably spreading it to others. Marco Metra, cardiology chief at Brescia's main hospital, which has 700 coronavirus patients out of a total of 1,200 patients, says, "Almost everybody who is hospitalized has this same story. The patient says, 'My wife has just lost her smell and taste, but otherwise she is well.' So she is likely infected, and she is spreading it."
German virologist Hendrik Streeck personally interviewed coronavirus patients in Germany's Heinsberg district, by house to house visiting. He reports an even higher percentage – about 66% - of the over 100 patients he met with mild coronavirus infection had loss of smell and taste lasting for several days. Others say these symptoms occur in about half of the patients and set in after the earliest respiratory symptoms. However, they can differentiate people who should be tested from those who don't need it.
A third specialist, Clemens Wendtner, added two details: the loss of smell is transient, usually lasting a few weeks at most, and it is independent of the severity of clinical illness and the presence of congestion. The symptoms cannot be relieved by nasal drops or sprays.
The association of anosmia with coronavirus infection was noted during an outbreak in New Rochelle, New York when many ENT doctors noted that patients who said they couldn't smell as well as before later turned out to be infected with the virus. One doctor, Rachel Kaye, who received this information from her colleagues in New Rochelle, says, "This raised a lot of alarms for me personally," because those patients "won't know to self-quarantine."
As a result, she says, many ENT doctors have already stopped making routine examinations and are wearing personal protective equipment, as is the case in her department.
The British statement also advises not ordering sinus endoscopies on anyone unless it is really essential because the virus is known to multiply in the nasal cavity and the oropharynx. If the patient undergoing the procedure sneezes or coughs, there is a high risk of viral spread to the physician performing the procedure.
Devotion and death
The advisory comes against a painful background: two ENT specialists in Britain are among those in critical condition due to novel coronavirus infection. While saying this, Hopkins also said that in Wuhan, China, the epicenter of the pandemic, reports had said that many ENT as well as eye specialists had been infected and had died of coronavirus infection.
In keeping with this grim picture, the American doctors also remind their members of the guidelines issued by the Centers for Disease Control and Prevention (CDC) that all clinical specialists make it a priority to make themselves free for urgent and emergency patients for the next few weeks, and to postpone elective or routine surgeries and examinations for this period.
The website also says, "There is evolving evidence that otolaryngologists are among the highest risk group when performing upper airway surgeries and examinations. A high rate of transmission of COVID-19 to otolaryngologists has been reported from China, Italy, and Iran, many resulting in death."