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Comment & Response
July 16, 2020

Olfactory Loss of Function as a Possible Symptom of COVID-19

Author Affiliations
  • 1Barts Health NHS Trust, London, United Kingdom
  • 2UCL Cancer Institute, University College London, London, United Kingdom
  • 3Department of Otolaryngology–Head and Neck Surgery, Stanford University, Palo Alto, California
  • 4ENT Department, James Paget University Hospital NHS Foundation Trust, Gorleston, United Kingdom
  • 5Norwich Medical School, University of East Anglia, Norwich, United Kingdom
  • 6Royal National Throat, Nose and Ear Hospital, UCLH Foundation Trust, London, United Kingdom
JAMA Otolaryngol Head Neck Surg. 2020;146(9):872-873. doi:10.1001/jamaoto.2020.1589

To the Editor We read the recent articles by Eliezier et al1 in JAMA Otolaryngology–Head and Neck Surgery and Mao et al2 in JAMA Neurology, respectively, with great interest. Eliezier et al1 describe the important case of a woman in her 40s who presented with an olfactory loss secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, and Mao et al2 describe neurologic manifestations of hospitalized patients with SARS-Cov-2 infection in China. They found that around 5% had a loss of their sense of smell and taste. As the coronavirus 2019 (COVID-19) pandemic is hitting both the US and Europe hard at the moment, symptoms of loss of sense of smell and taste, even in the absence of the other common symptoms of SARS-CoV-2 infection, need to be added to the list of primary screening symptoms for SARS-CoV-2 infection and should indicate the need for urgent COVID-19 testing and self-isolation. The US Centers for Disease Control has just added this to the symptoms related to COVID-19, but individual institutions may or may not be testing based on this symptom.3 In clinics in the UK, a number of health care professionals at the forefront of patient care during the COVID-19 pandemic have presented with loss of smell and taste. On testing, they were found positive for SARS-CoV-2 infection by quantitative polymerase chain reaction–based swab testing.4 The debate is ongoing regarding to what extent the loss of smell and taste in SARS-CoV-2 infection is caused by nasal congestion and edema in the upper portion of the nasal cavity or whether and how it is mediated by direct damage to olfactory neuroepithelial cells as a result of the infection. Experience by colleagues suggests that nasal SARS-CoV-2 infection does not appear to exhibit considerable nasal congestion or a runny nose5 and also favors a neurotropic and neuroinvasive pathogenesis, which may be site-specific to the olfactory system as has been shown for other coronaviruses previously5; however, the short time to recovery exhibited in some of these patients leaves the etiology unclear.

Loss of sense of smell and taste need to be added to the list of primary screening symptoms for SARS-CoV-2 infection in all countries and should indicate the need for urgent COVID-19 testing and self-isolation. Awareness and early recognition of these symptoms is particularly important for clinicians at the forefront of patient care during the COVID-19 pandemic.

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Article Information

Corresponding Author: Matt Lechner, MD, University College London Cancer Institute, 72 Huntley Street, London, WC1E 6DD, United Kingdom (m.lechner@ucl.ac.uk).

Published Online: July 16, 2020. doi:10.1001/jamaoto.2020.1589

Conflict of Interest Disclosures: Dr Philpott reported grants from the National Institute for Health Research, Rosetrees, Sir Jules Thorn Trust, Royal College of Surgeons, Bernice Bibby Trust, and personal fees from Sanofi-Genzyme outside the submitted work; and being a Trustee of the charity Fifth Sense that supports those afflicted with Smell and Taste Disorders. No other disclosures were reported.

Eliezer  M, Hautefort  C, Hamel  AL,  et al.  Sudden and complete olfactory loss of function as a possible symptom of COVID-19.   JAMA Otolaryngol Head Neck Surg. Published online April 8, 2020. doi:10.1001/jamaoto.2020.0832PubMedGoogle Scholar
Mao  L, Jin  H, Wang  M,  et al.  Neurologic manifestations of hospitalized patients with Coronavirus Disease 2019 in Wuhan, China.   JAMA Neurol. 2020.PubMedGoogle Scholar
Lechner  M, Chandrasekharan  D, Jumani  K,  et al.  Anosmia as a presenting symptom of SARS-CoV-2 infection in healthcare workers—a systematic review of the literature, case series, and recommendations for clinical assessment and management.   Rhinology. Published online May 9, 2020. doi:10.4193/Rhin20.189PubMedGoogle Scholar
Xydakis  MS, Dehgani-Mobaraki  P, Holbrook  EH,  et al.  Smell and taste dysfunction in patients with COVID-19.   Lancet Infect Dis. 2020;S1473-3099(20)30293-0. doi:10.1016/S1473-3099(20)30293-0PubMedGoogle Scholar