26 November, 2020

Anosmia Uncovered: Is the loss of sense of smell COVID-19 – related?

On December 31, 2019, a cluster of cases with pneumonia of unknown cause was detected in Wuhan, China. Later on, it was attributed to a novel coronavirus that is now known as “COVID-19.”

The COVID-19 outbreak was started by a novel coronavirus which was named by the World Health Organization (WHO) as SARS-CoV-2. The affliction of the virus can lead to pneumonia, respiratory failure, septic shock, and death. Its main symptoms include fever, cough, sore throat, body aches, difficulty in breathing, headaches, nausea and diarrhoea.

ANOSMIA AS A NEW SYMPTOM OF COVID 19: SNIFFING OUT THE TRUTH

Just recently, Dr Nirmal Kumar of Ear, Nose and Throat surgery of the United Kingdom (ENTUK) and Dr Claire Hopkins of the British Rhinological Society proposed anosmia or loss of smell and taste to be included as a major symptom for COVID-19. A study in Germany found that among 200 COVID-19 positive patients, two out of three reported anosmia.

ENT specialists stated that during the pandemic, the leading cause of loss of smell in adults is post-viral anosmia accounting to 60% of the cases. The smell blindness may occur at any time and usually has a sudden onset. Uncommonly, there were also a few reports of patients with anosmia without any accompanying symptoms. According to Dr Kumar, adolescents and young adults, in particular, may present anosmia without demonstrating commonly recognized symptoms.

A systematic review containing 19 studies concluded that the sinonasal cavity might be the major site of infection. The SARS-CoV-2 virus initially concentrates on the nose and upper airway where it obstructs olfactory function. Viral shedding also appears to be highest in the nose, which impairs the spread of infection and will result in a less severe and sudden onset response, milder symptoms, and barring other risk factors.

What is notable is that it appears that anosmia may be a predictor that a SARS-CoV-2 infection will not be as severe and less likely require hospitalization.  If it is the first symptom, it could help to recognize the illness early and prompt self-isolation to limit its spread. Given the urgency and lethality of the pandemic, this holds potential as a diagnostic screening tool to limit patients going to hospitals and asking them to self-isolate instead.

WHAT IT FEELS TO HAVE ANOSMIA AND HOW TO MANAGE IT

Everyone knows that sudden loss of smell is one of the first symptoms that appear suddenly in COVID-19 patients. For anyone who newly develops this symptom, there is, in addition, anxiety regarding the likelihood of recovery and worry about the underlying cause.  Think about having to make a cup of coffee in the morning, sniffing it, only to find out that it did not smell anything!

Aside from this, there is a loss-of-taste situation, but it is not entirely true. Food will just be plain and unappetizing due to the loss of smell. Others have also described dysosmia where some pleasant smells may appear as unpleasant. It is crucial to immediately seek care, especially if these symptoms are prolonged.

Take into consideration the experience of a British rhinologist and how he handled anosmia while the pandemic is ongoing. According to him, he experienced two days of what he assumed was mild symptoms of COVID-19: head and body aches, fever, and fatigue. As a resilient doctor, he put himself on isolation and medication until the symptoms subsided. But it was only after the flu-like symptoms abated that he realized his sense of smell and taste were lost. Troubled by his disorientation, he consulted Dr Hopkins of the British Rhinological Society. He was advised that he should continue self-quarantine in two weeks and try olfactory training.

Olfactory training can be done inside the house to stimulate the nerves and encourage recovery. It involves sniffing a set of odorants (commonly lemon, rose, cloves, and eucalyptus) for 20 seconds each at least twice a day. Studies have demonstrated improved olfaction in patients after olfactory training. Usually, the sense of smell improves in a span of two weeks to two months. Otherwise, it is still better to consult with your ENT doctor/rhinologist for advice.

ENSURING SAFETY

The greatest risk to those who have anosmia is caused by fires, cookers, and boilers. Natural gas is basically imperceptible by the eye, and people used to smell gas when it is leaking to avoid trouble. It may pose a danger to those with anosmia by just opening the gas stove or oven.

In case a person is experiencing anosmia, it is always wise to ask someone to check the gas appliances for safety. People with olfactory disorders also face problems when it comes to storing food.  Without smell to act as an indicator of when something is starting to turn bad, there is the risk of sickness or food poisoning. Try labelling containers from the date it was opened, If in doubt, throw it out immediately. Lastly, although personal hygiene is not strictly a health concern, it is worth bearing in mind that one can’t smell yourself or other people. Hence, it is a must to maintain good personal hygiene all the time.

Always remember that by isolating oneself, it limits the spread of the diseases. It may be a difficult time right now to lose the sense of smell, but with proper monitoring and treatment, recovery is assured.

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