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Coronavirus patients lose their sense of smell. That's how it is



On a warm summer morning in New York City a few years ago, Jacob LaMendola, in his late 20s, smelled chocolate for the first time. As far as he can tell, it was the first time he smelled anything. Each.

"I cried because I knew what it was," he says. "It was chocolate."

LaMendola has anosmia or a total inability to recognize smells. On that memorable morning, the 32-year-old Brooklyn-based filmmaker was standing near a chocolate shop in Union Square when he was overcome with the certainty that he was finally and inexplicably experiencing this mysterious thing that other smells called – not just in his imagination but in his body.

"Something in my brain just understood it," he says. "It was amazing. I would go back there and see if I could smell it again, but it never happened."

LaMendola is fairly certain that he was born with this disease, although he only fully recognized it against the fifth class. Small clues added up. When classmates laughed at a child who farted in the cafeteria, he didn't understand the joke. When a friend in the Cologne camp put LaMendola's wrist and told him the smell would help him get girls, the suggestion made no sense.

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Jacob LaMendola, who always lived without a smile, made a film, Anosmia, about what it's like to navigate the world without smell.

Amanda Edwards / WireImage

For LaMendola, anosmia is a familiar, accepted part of world navigation ̵

1; generally "not a big deal," he says. But others find their lives dramatically excited when they suddenly lose the smell due to head injuries, nasal tumors, radiation, or viral infections. Increasing anecdotal evidence suggests that patients with COVID-19 belong to this latter category.

Although millions of people worldwide cannot smell, those who work in the field of olfactory disorders say that anosmia is nowhere near as well known and understood as vision and hearing loss, and in some cases is overlooked or ignored by medical professionals. However, the condition receives increased attention under .

In Germany, at least two out of three confirmed COVID-19 patients suffer from anosmia. This emerges from a joint statement by Claire Hopkins of the British Rhinological Society and Nirmal Kumar, President of ENT UK, a professional organization for the ear, nose and ear surgeons. In South Korea, 30% of the patients who tested positive had anosmia as the main symptom in otherwise mild cases.

The increase in COVID-19 patients reporting transient odor loss is so significant that in some countries like France, patients with sudden odor loss are diagnosed with COVID-19 without being tested. AbScent, a UK organization that aims to raise public awareness of odor loss, is now releasing the following message at the top of its website: "AbScent recommends that you quarantine immediately if you experience sudden odor loss for at least seven days." "[19659002] Scientists in Italy, Iran and Iceland are already preparing studies on this phenomenon, and researchers from the Weizmann Institute of Science in Israel and the Edith Wolfson Medical Center have even developed the online platform SmellTracker, which visitors can use to measure their odor perception uses common household goods such as toothpaste and vinegar to detect early signs of COVID-19, and the tool has identified potential coronavirus cases that were later confirmed, the researchers report.

But what is it like not to smell freshly cut grass? to be able to brew coffee, hand lotion, a skunk, that distinct new car smell? A study by the University of East Anglia in the UK, published in Clinical Otolaryngology at the end of last year, found that odor loss can interfere with almost every aspect of life, from practical to emotional.

"I have lost many of the emotional highlights of life experience – less joy, less excitement," says Duncan Boak, whose sense of smell disappeared in 2005 due to a head injury. Boak founded Fifth Sense, a British charity for people with olfactory and taste disorders. It is part of the Global Consortium on Chemosensory Research, which examines the relationships between COVID-19 and odor loss.

Anosmia has the most obvious effect on taste, with some describing a cloudiness as dramatic as changing from life in color to life in black and white. Anosmia can cause insecurity about personal hygiene and fear that potential dangers such as smoke or gas leaks cannot be identified.

"It affects people's ability to feel safe within their own four walls," says Dr. Zara Patel, associate professor of ENT and director of endoscopic skull base surgery at Stanford University Medical Center, who has treated many patients with this disease.

It can also reduce sexual intimacy and question personal relationships.

"People will tell me that they long to be able to smell their husbands or wives the way they used to," says Patel, "or they just wish they could smell their child . "

In a short documentary by LaMendola entitled Anosmia, a father with the disease wistfully introduces how his son smells: "I think he smells sweet and like a child. I wish I knew."

When a virus catches the smell

The concept of the smell can be difficult to describe even for those who have no smell problems. It is esoteric and personal, combined with memories of people, places and experiences that evoke joy, sadness and longing.

Despite all the secrets, the smell has a scientific effect. If you take a breath, a scent molecule stimulates nerve cells high up in your nose. The cells send an electrical signal to the olfactory bulb, a structure at the base of your forebrain that extends to the roof of the nasal cavity. The light bulb then passes the signal on to other areas of the brain for further processing.

Sometimes part of this system does not work properly, which leads to anosmia or hyposmia, a reduced sense of smell.

Post-viral anosmia is a major cause of odor loss in adults, according to the British Rhinological Society, and accounts for up to 40% of cases. It is not yet known how many COVID-19 patients have experienced it or whether it will lead to permanent impairment. Currently, scientists can only rely on anecdotes and extrapolate the odor loss associated with colds and flu.

"The majority should see a recovery in days to weeks, a smaller subgroup from weeks to months … and the smallest group will only see partial recovery or permanent anosmia or hyposmia," said Steven Munger, director of the University of Florida smell and taste center.

There are a number of hypotheses why some COVID-19 patients lose their sense of smell. The preferred theory, Munger says, is that the virus targets non-neural cells such as glandular cells in the olfactory epithelium, the nasal tissue involved in the smell.

"This could potentially lead to processes such as inflammation that interfere with the general ability to recognize smells or to send this smell information to the brain efficiently," he explains. It is a theory that Harvard scientists are advancing in a new study that was submitted to the bioRxiv repository on March 28 and has not yet been reviewed by experts.

LaMendola, who has lived all his life without smell, would never have thought that the condition was a threat. Until the coronavirus crisis. "I thought I might not know early on that I was sick," he says. "I was a little worried that I wouldn't know immediately."

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Dr. Jeb Justice, co-director of the University of Florida Smell and Taste Center, is consulting with a patient. He holds part of a nasal endoscope in his hand, a tool that examines the inside of the nose, including the tissue that holds the key cells for the smell.

Mindy Miller / University of Florida

Brain Retraining

Several factors determine the extent to which odor can return, says Stanford University Patel, including the cause of the loss, the age of the patient, and the speed looking for care.

"The sooner you can come to a specialist like me to get treatment, the better chance we can help you," she says.

The treatment with the highest level of success, says Patel, is a so-called olfactory training that resembles physiotherapy at home, which aims to restore the brain's ability to smell. A doctor like Patel recommends sniffing certain scents – usually twice a day for up to six months, about 15 seconds per smell. The scents vary by patient, but Patel usually starts with rose, carnation, lemon, and eucalyptus.

"It is important that people concentrate on remembering this smell," she says. "This seems to be a very important part of this training process because the olfactory cortex is right next to the memory center in the brain and this can be very helpful in restoring the right way back to the cortex."

Anyone who has smelled the ocean and been brought to the summer of childhood on the beach or felt an overwhelming wave of fatherly love for smelling his late father's sweater knows how strong the connection between smell and memory can be. Disconnecting this connection can be particularly worrying for people with anosmia.

"Campfire night, Christmas smells, perfumes and people – all gone," said Carl Philpott of Norwich Medical School, a researcher at the University of East Anglia, in a research summary. "People who have lost their sense of smell miss all these memories that can produce smells."

Smell-related memories are one of the pieces that LaMendola misses the most, although he can only imagine how they feel. "When someone talks about smelling something that reminds them of a memory," he says, "it is the special part of it that I have never experienced."

Hope Amidst Losses

Previous research has shown that people who have lost their sense of smell report a high rate of depression, anxiety, isolation, and interpersonal difficulties. "It had a huge impact on partner relationships," said Boak, founder of Fifth Sense. "There is a gap that is difficult to bridge, a separation."

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Duncan Boak, founder of the British charity Fifth Sense, said it was powerful to meet others with anosmia.

Duncan Boak

For the study by the University of East Anglia, scientists interviewed 71 participants between the ages of 31 and 80 who turned to the olfactory and taste clinic at James Paget University Hospital in the UK. The researchers conducted their study in collaboration with the Fifth Sense charity and found that the far-reaching effects of the odor loss were compounded by a lack of knowledge about the disorder among doctors.

Dawn Millard, whose 15-year-old daughter Abi was born without a sense of smell, remembers years when she felt alone and misunderstood as she struggled to find doctors who could diagnose and help her child. Dawn began to suspect something was wrong early on when Abi didn't respond to intoxicating or terrible smells as a toddler.

"Doctors didn't know what to do," recalls Millard, who lives in Dorset, England. "An otolaryngologist told me:" If you had to lose any sense, it would be one. "A shocking comment for a child who lacks one of the senses … Nobody seemed to understand us or be serious Finally, she discovered Fifth Sense, to whom she attributes that she and her daughter finally feel heard and supported. Abi, who had an operation that temporarily gave her a 10% sense of smell, raised money for the charity and told her story at Fifth Sense's fifth anniversary conference.

"I will do as much as I can to help someone with this disease," she says.

Boak found his own comfort when he maneuvered the world without a meaning that he once took for granted. One of them cooks – although he doesn't appreciate much taste, he experiments with taste and texture. "I really focused on getting the most out of my remaining sensory skills," he says.

It also has its purpose in educating the world on a condition that it believes too few have heard of. And connection by knowing others who suffer from it.

"One of the most powerful things for me when I started the charity was to meet and share and learn with other people who have odor disorders," says Boak. "This is so important to deal with a loss that most people don't understand."


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