Growing Public Health Concern of COVID-19 Chronic Olfactory Dysfunction

As the world enters the second year of the COVID-19 pandemic, chronic (ie, >6 months) olfactory dysfunction (COD) has emerged as one of the symptoms of long-term COVID-19.¹ The loss of olfaction has been associated with decreased general quality of life, impaired food intake, inability to detect harmful gas and smoke, enhanced worries about personal hygiene, diminished social well-being, and the initiation of depressive symptoms.^2,3 To our knowledge, no study on long-term COVID-19 olfactory dysfunction (OD) has measured long-term recovery beyond 6 months. Therefore, the rate and trajectory of recovery for COVID-19 COD is not known. The purpose of this study was to estimate the scale of the public health concern of COVID-19 COD.

The data we used to estimate the number of daily new cases of COVID-19 were publicly available (https://covidtracking.com/data/national), and because of this, the institutional review board of Washington University in St. Louis waived approval and informed consent. The COVID Tracking Project provides national data for positive cases, which include confirmed and probable cases. A probable case is one that receives a positive test result via antigen without a positive polymerase chain reaction result or other approved nucleic acid amplification test, one with clinical evidence of COVID-19 infection with no confirmatory laboratory testing performed for SARS-CoV-2, or one with COVID-19 listed on the death certificate with no confirmatory laboratory testing performed for SARS-CoV-2. Positive COVID-19 cases that occurred between January 13, 2020, and March 7, 2021, are included in our estimate of COD.

A recent meta-analysis reported the incidence of acute COVID-19 OD as 52.7% (95% CI, 29.6%-75.2%).⁴ A prospective study reported the recovery rate from OD to be 95.3% (95% CI, 92.6%-98.0%).⁵ Based on these 2 studies and the number of daily cases, 3 estimates of the cumulative frequency of COVID-19 COD were created (Table). Analyses were conducted using R, version 3.6.3 (R Foundation).

During the COVID-19 pandemic, the mean (SD) number of daily cases was 68 468 (68 682). The incidence of COVID-19 peaked on January 8, 2021, with an estimated 295 121 US individuals receiving a diagnosis of confirmed COVID-19.

COD due to SARS-CoV-2 emerged in August 2020, 6 months after the pandemic began (Figure). There was a steady increase in the cumulative number of US individuals with COD through April 2021. Starting in May 2021, the analysis predicted a near exponential increase in the slope of the cumulative number of US individuals with COD through August. Based on intermediate estimates, the number of US individuals expected to develop COD by August 2021 was 712 268. Based on low estimates for each event, the number of US individuals who are expected to develop COD is 170 238, and based on the highest estimate, the number is 1 600 241.

This analysis of new daily cases of COVID-19, acute incidence of OD, and rates of recovery suggest that more than 700 000, and possibly as many as 1.6 million, US individuals experience COD because of SARS-CoV-2. To put this number in context, before the COVID-19 pandemic, the National Institute on Deafness and Other Communication Disorders estimated that, among US adults 40 years or older, measurable OD was found in up to 13.3 million adults.⁶ Notably, the age-specific prevalence of OD is 4.2% for individuals between age 40 to 49 years and 39.4% for individuals 80 years and older. The addition of 0.7 to 1.6 million new cases of COD represents a 5.3% to 12% relative increase. COVID-19 affects a younger demographic group than other causes of OD. Thus, the lifelong burden of OD will be much greater for the COVID-19 cohort than for patients in the older age groups. The true number of COD may be far higher than the results in this article indicate. The main limitation of this study is the inability to obtain the true number of cases, as state-reported positive cases likely underestimate the true number of positive cases. Furthermore, the estimates for the incidence of acute and chronic OD are derived from relatively healthier, ambulatory patients. The incidence of OD may be higher among patients who were hospitalized with SARS-CoV-2. These data suggest an emerging public health concern of OD and the urgent need for research that focuses on treating COVID-19 COD.

Accepted for Publication: September 29, 2021.

Published Online: November 18, 2021. doi:10.1001/jamaoto.2021.3379

Corresponding Author: Jay F. Piccirillo, MD, Clinical Outcomes Research Office, Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, 660 S Euclid Ave, Campus Box 8115, St Louis, MO 63110 (piccirij@wustl.edu).

Author Contributions: Mr Khan and Dr Kallogjeri had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Khan.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Khan.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: All authors.

Administrative, technical, or material support: Khan.

Supervision: Khan, Piccirillo.

Conflict of Interest Disclosures: Dr Kallogjeri reported stock in Potentia Metrics and personal fees from JAMA Otolaryngology–Head & Neck Surgery outside the submitted work. Dr Piccirillo reported receiving consulting fees from BIND-On-Demand Health Insurance. Research reported in this publication was supported by the National Center For Advancing Translational Sciences of the National Institutes of Health under award number TL1TR002344. No other disclosures were reported.

Disclaimer: Dr Kallogjeri is the Statistics Editor and Dr Piccirillo the Editor of JAMA Otolaryngology–Head & Neck Surgery, but they were not involved in any of the decisions regarding review of the manuscript or its acceptance. The content of this article is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.