Lechner, Matt

Lund, Valerie J.

Patel, Zara M.

Philpott, Carl

University of East Anglia digital repository

Letter to the editor  Loss of sense of smell and taste - screening for SARS-CoV-2 infection in healthcare personnel  Matt Lechner1,2, Zara M. Patel3, Carl Philpott4,5 & Valerie J. Lund6 1 Whipps Cross University Hospital, Barts Health NHS Trust, UK 2 UCL Cancer Institute, University College London, London, UK  3 Department of Otolaryngology-Head and Neck Surgery, Stanford University, Palo Alto, CA, US.   4 ENT Department, James Paget University Hospital NHS Foundation Trust, Gorleston, UK. 5 Norwich Medical School, University of East Anglia, Norwich, UK 6 Royal National Throat, Nose and Ear Hospital, UCLH Foundation Trust, London, UK  We read the recent articles by Elizier et al.1 in JAMA Otolaryngology-Head and Neck Surgery and Mao et. al.2 in JAMA Neurology, respectively, with great interest. Elizier et al. describe the highly interesting case of a woman in her 40s who presents with an olfactory loss secondary to SARS-CoV-2 infection and Mao et al. describe neurological manifestations of hospitalized patients with SARS-Cov-2 infection in China. They found that around 5% experience a loss of their sense of smell and taste. As the Covid-19 pandemic is hitting both the US and Europe hard at the moment, symptoms of anosmia and ageusia, 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 CDC has just added this to the symptoms related to Covid-19, but individual institutions may or may not be testing based on this symptom3. In our clinics in the UK, a number of health care personnel at the forefront of patient care during the Covid-19 pandemic have presented with loss of smell and taste. Upon testing, they were found positive for SARS-CoV-2 infection by qPCR-based swab testing. The debate is ongoing 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 significant nasal congestion or a runny nose4 and also favors a neurotropic and neuroinvasive pathogenesis which may be site-specific to the olfactory system as has been shown for other coronaviruses previously4, however, the short time to recovery exhibited in some of these patients leaves the etiology unclear.  In conclusion, hyposmia and hypogeusia 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 health care personnel at the forefront of patient care during the Covid-19 pandemic. (373 words) References: 1. Eliezer M, Hautefort C, Hamel AL, et al. Sudden and Complete Olfactory Loss Function as a Possible Symptom of COVID-19. JAMA Otolaryngol Head Neck Surg. 2020. 2. Mao L, Jin H, Wang M, et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurol. 2020. 3. CDC. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. 2020. Accessed 4/21/2020. 4. Xydakis MS, Dehgani-Mobaraki P, Holbrook EH, et al. Smell and taste dysfunction in patients with COVID-19. Lancet Infect Dis. 2020.  

Olfactory loss of function as a possible symptom of COVID-19

https://ueaeprints.uea.ac.uk/id/eprint/74855/7/Accepted_Manuscript.pdf

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

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