Becker's Hospital Review

50 CMO / CARE DELIVERY When will smell, taste come back? 5 COVID-19 questions answered By Gabrielle Masson T emporary loss of smell, known as anosmia, is a commonly reported indicator of COVID-19. Losing your sense of smell and taste can be jarring and emotional, and adjusting to the seemingly muted world can be difficult at first. However, research looks promising for COVID-19 patients with anosmia, though scientists say there's still a lot unknown. Here's what we know about anosmia related to COVID-19 as of Jan. 11: How does it happen? e novel coronavirus likely changes the sense of smell in patients not by directly infecting neurons, but by affecting the func- tion of supporting cells, said Sandeep Robert Datta, MD, PhD, associate professor of neu- robiology at Boston-based Harvard Medical School. Dr. Datta co-authored a study pub- lished last July in Science Advances, and its findings identify the olfactory cell types in the upper nasal cavity as most vulnerable to SARS-CoV-2 infection. Justin Turner, MD, PhD, associate pro- fessor of Otolaryngology-Head and Neck Surgery and medical director of Nashville, Tenn.-based Vanderbilt University Medical Center's Smell and Taste Center, said May 21 that the primary cause of smell loss ap- pears to be from an inflammatory reaction inside the nose that can lead to a loss of the olfactory neurons. Who loses their smell? Smell loss can be one of the first or only signs of disease and may precede symptoms such as cough and fever, Dr. Turner said, citing spring 2020 data from VUMC's Smell and Taste Center. A study published Jan. 5 in the Journal of Internal Medicine found that 86 percent of patients with mild COVID-19 cases experi- enced anosmia, compared with 4 percent to 7 percent of those with moderate to severe cases. e research analyzed data from 2,581 patients in France, Belgium and Italy. Will COVID-19 patients get their sense of smell back? Of 2,581 COVID-19 patients studied, 95 per- cent of patients regained their sense of smell within six months, according to the Jan. 5 study in the Journal of Internal Medicine. For most patients, COVID-19 infection is unlikely to permanently damage olfactory neural circuits and lead to persistent anos- mia, Dr. Datta said, adding, "Once the infec- tion clears, olfactory neurons don't appear to need to be replaced or rebuilt from scratch. But we need more data and a better under- standing of the underlying mechanisms to confirm this conclusion." If so, when do COVID-19 patients get their sense of smell back? e average time of olfactory dysfunction re- ported by patients was 21.6 days, according to the study in Journal of Internal Medicine. Nearly a quarter of the 2,581 COVID-19 pa- tients studied didn't regain smell and taste within 60 days of infection. Are there any long-term physical or psychological risks? "If you have a gas leak, you can't necessarily smell it," Nina Shapiro, MD, a pediatric head and neck surgeon at University of California, Los Angeles School of Medicine, told NBC News. "And if people lose their appetites be- cause food tastes like cardboard or even rot- ting meat, they might develop vitamin defi- ciencies. What's more, people might not know when food is, indeed, spoiled or burning." "Anosmia seems like a curious phenomenon, but it can be devastating for the small frac- tion of people in whom it's persistent," Dr. Datta said. "It can have serious psychological consequences and could be a major public health problem if we have a growing popula- tion with permanent loss of smell." n 76% of hospitalized COVID-19 patients have symptoms for 6 months, study finds By Mackenzie Bean M any hospitalized COVID-19 patients may experi- ence symptoms for up to six months, according to a study published Jan. 8 in The Lancet. The study involved 1,733 COVID-19 patients discharged from a hospital in Wuhan, China, between Jan. 7 and May 29, 2020. Researchers conducted a follow-up survey with patients on their condition and lingering symptoms between June 16 and Sept. 2, 2020. Four study findings: 1. Seventy-six percent of patients still had at least one symptom after six months. 2. Women were more likely to have lingering symptoms than men in the study. 3. The most common lingering symptoms were fatigue or muscle weakness (63 percent) and sleep difficulties (26 percent). 4. Nearly a quarter of patients reported anxiety or depres- sion during the follow-up period. "Our analysis indicates that most patients continue to live with at least some of the effects of the virus after leaving hospital and highlights a need for post-dis- charge care, particularly for those who experience se- vere infections," lead author Bin Cao, MD, vice president and director of respiratory and critical care medicine at the China-Japan Friendship Hospital in Beijing, said in a statement cited by CNN. n

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