{"id":20367,"date":"2020-05-18T17:45:21","date_gmt":"2020-05-18T16:45:21","guid":{"rendered":"https:\/\/research.reading.ac.uk\/research-blog\/?p=20367"},"modified":"2023-04-24T14:01:35","modified_gmt":"2023-04-24T13:01:35","slug":"sudden-loss-of-smell-why-it-is-a-reason-to-self-isolate","status":"publish","type":"post","link":"https:\/\/research.reading.ac.uk\/research-blog\/2020\/05\/18\/sudden-loss-of-smell-why-it-is-a-reason-to-self-isolate\/","title":{"rendered":"Sudden loss of smell \u2013 why it is a reason to self-isolate"},"content":{"rendered":"

From the early days of the COVID-19 pandemic, many people with symptoms of infection said they’d lost their sense of smell. Professor Jane Parker from the University’s Flavour Centre and colleagues from East Anglia and Oxford Universities,\u00a0 explain how increasing evidence has led to so-called ‘anosmia’ being added to the UK Government’s list of COVID-19 symptoms.<\/strong><\/p>\n

\"\"
Image by Engin Akyurt, Pixebay<\/figcaption><\/figure>\n

Waking up and not being able to smell the coffee could be a sign of COVID-19. The\u00a0World Health Organization recently announced<\/a>\u00a0that a sudden loss of sense of smell (anosmia) should be added to the symptoms of COVID-19. The UK government\u00a0has just done that<\/a>, stating: \u201cFrom today, all individuals should self-isolate if they develop a new continuous cough or fever or anosmia.\u201d<\/p>\n

The inclusion of sudden anosmia is important as it may be an early \u2013 and sometimes the only \u2013 symptom of COVID-19 infection. It is also a symptom, like fever, that we can detect ourselves without a laboratory test. The indications are that if we were all to respond to this cue by self-isolating, we could reduce the spread of the virus.<\/p>\n

An early clue that a loss of smell might be related to COVID-19 came in early March 2020 from a\u00a0Facebook post<\/a>\u00a0about an ear, nose and throat (ENT) doctor who suddenly lost his sense of smell. What followed was a gradual accumulation of evidence linking anosmia to COVID-19.<\/p>\n

Membership of closed Facebook groups dedicated to those experiencing smell loss grew exponentially, Google searches for \u201canosmia\u201d\u00a0increased, and high-profile cases were reported in the\u00a0news<\/a>. ENT doctors saw an increase in patients reporting anosmia and started to publish case studies based on the experience of their\u00a0patients\u00a0\u2013 many of them healthcare professionals. One, a neurosurgeon, reported anosmia with no other symptoms. Two days later he tested positive for COVID-19.<\/p>\n

The\u00a0sudden onset of anosmia<\/a>\u00a0was described as a new finding that may distinguish COVID-19 from the common cold or flu. An\u00a0early statement\u00a0was issued by ENT-UK and the British Rhinology Society calling for anosmia to be recognised as a marker of the virus. However, while the case studies and anecdotes are compelling, they lack the large datasets of a scientific study.<\/p>\n

The first large dataset came from Iran. It was a home-based study of 10,000 people showing a correlation between anosmia and\u00a0COVID-19<\/a>. Results from the second large dataset were published by a team based at King\u2019s College London. Their\u00a0COVID Symptom Study<\/a>\u00a0app\u00a0showed that 65%<\/a>\u00a0of those who tested positive for the disease also had a loss of smell and taste, and this symptom was by far the best predictor of COVID-19. And\u00a0preliminary results from the first survey<\/a>\u00a0of the\u00a0Global Consortium for Chemosensory Research (GCCR)<\/a>\u00a0showed that those reporting COVID-19 symptoms had an average drop of 80% in their ability to smell.<\/p>\n

These surveys add weight to the anecdotal evidence, but they have limitations. The main one being that they are based on people self-reporting symptoms \u2013 that is, their ability to smell was not clinically assessed.<\/p>\n

On the other hand, studies based in hospitals and ENT clinics provide valuable evidence where the COVID-19 status and case histories can be determined with more certainty. The first came out of\u00a0China<\/a>, where researchers reported a modest 5% of patients had an impaired sense of smell. Studies in\u00a0France<\/a>\u00a0(417 patients), in\u00a0Italy<\/a>\u00a0(202) and in the\u00a0US<\/a>\u00a0(102), on patients all testing positive for COVID-19, found a loss of smell in 86%, 64% and 68% of cases, respectively.<\/p>\n

Results from clinical studies appear at the rate of one every few days and the conclusions overwhelmingly support the claim that anosmia is associated with COVID-19. The most revealing of these was another study from\u00a0Iran<\/a>\u00a0that measured sense of smell using a recognised scratch and sniff test. In this case, 59 out of 60 COVID-19 patients had a decrease in their sense of smell.\u00a0Three<\/a>\u00a0systematic\u00a0reviews<\/a>\u00a0of the\u00a0recent evidence<\/a>\u00a0have concluded that there is a strong link between COVID-19 and anosmia.<\/p>\n

Early warning sign<\/h2>\n

It is important to understand the timings of smell loss in relation to other symptoms. Several studies report the onset of anosmia before other symptoms, or as the\u00a0only<\/em>\u00a0symptom. Indeed, a\u00a0US study<\/a>\u00a0found anosmia appearing as the first symptom in 27% of their responses. A\u00a0Chinese group<\/a>\u00a0showed you can still be infectious, even if anosmia is your only symptom, but this is an area when more data is required fast. The relationship between anosmia and infectiousness is still unclear, but it is certainly an early warning sign that other symptoms may follow.<\/p>\n

Considering the\u00a0combined strength<\/a>\u00a0of all the above, there is little doubt that sudden loss of smell is related to COVID-19. But we still need a strict evidence-based approach involving objective smell testing and evidence of the mechanisms involved, some of which is\u00a0emerging<\/a>. In the meantime, we would all be well advised to treat a sudden loss of the sense of smell as an indication we should self-isolate.<\/p>\n

More data is needed, and you can help. If you have experienced a sudden loss of smell or taste during the pandemic, fill in both the\u00a0UK<\/a>\u00a0and\u00a0global<\/a>\u00a0GCCR surveys. These simple online surveys take less than ten minutes each. Our focus is on understanding the mechanisms involved in both smell and taste disorders.<\/em><\/p>\n

This article was first published in The Conversation on 18 May 2020.<\/a><\/p>\n

Jane Parker, <\/span><\/a>Associate Professor, Flavour Chemistry, University of Reading<\/p>\n

Carl Philpott, <\/a><\/span>Professor of Rhinology and Olfactology, University of East Anglia<\/p>\n

Tristram Wyatt, <\/span><\/a>Senior Research Fellow, University of Oxford<\/p>\n","protected":false},"excerpt":{"rendered":"

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