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Olfaction and Taste

Alterations in Smell or Taste in Mildly Symptomatic Outpatients With SARS-CoV-2 Infection

Educational Objective
To understand how alterations in smell or taste can help identify patients infected with COVID-19

1 Credit CME

JAMA

Published Online: April 22, 2020

Research Letter

Article Information and Disclosures

Giacomo Spinato, MD¹;

Cristoforo Fabbris, MD¹;

Jerry Polesel, MD²;

Diego Cazzador, MD³;

Daniele Borsetto, MD⁴;

Claire Hopkins, MA(Oxon), DM⁴;

Paolo Boscolo-Rizzo, MD¹

Author Affiliations

¹Section of Otorhinolaryngology, University of Padova, Treviso, Italy
²Unit of Cancer Epidemiology, Aviano National Cancer Institute, IRCCS, Aviano, Italy
³Section of Otorhinolaryngology, University of Padova, Padova, Italy
⁴Guy’s and St Thomas’ Hospitals, London, United Kingdom

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Since December 2019, a pandemic of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally.¹ A spectrum of disease severity has been reported, with main symptoms that include fever, fatigue, dry cough, myalgia, and dyspnea. Previous strains of coronavirus have been demonstrated to invade the central nervous system through the olfactory neuroepithelium and propagate from within the olfactory bulb.² Furthermore, nasal epithelial cells display the highest expression of the SARS-CoV-2 receptor, angiotensin-converting enzyme 2, in the respiratory tree.³

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Article Information

Corresponding Author: Daniele Borsetto, MD, Guy’s Hospital, London SE1 9RT, United Kingdom (daniele.borsetto@gmail.com).

Accepted for Publication: April 14, 2020.

Published Online: April 22, 2020. doi:10.1001/jama.2020.6771

Author Contributions: Drs Spinato and Boscolo-Rizzo 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: Spinato, Borsetto, Hopkins, Boscolo-Rizzo.

Acquisition, analysis, or interpretation of data: Fabbris, Polesel, Cazzador, Borsetto, Hopkins, Boscolo-Rizzo.

Drafting of the manuscript: Spinato, Fabbris, Borsetto, Boscolo-Rizzo.

Critical revision of the manuscript for important intellectual content: Spinato, Polesel, Cazzador, Borsetto, Hopkins, Boscolo-Rizzo.

Statistical analysis: Polesel.

Administrative, technical, or material support: Fabbris, Borsetto.

Supervision: Spinato, Cazzador, Borsetto, Hopkins, Boscolo-Rizzo.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank Anna Menegaldo, MD, Daniele Frezza, MD, Francesca Mularoni, MD, Piergiorgio Gaudioso, MD, Silvia Marciani, MD, Samuele Frasconi, MD, Maria Ferraro, MD, Cecilia Berro, MD, and Chiara Varago, MD (University of Padova, Italy), for helping in the collection of patient data. We also thank Maria Cristina Da Mosto, MD, and Piero Nicolai, MD (University of Padova, Italy), Giancarlo Tirelli, MD (University of Trieste, Italy), Roberto Rigoli, MD (AULSS 2–Marca Trevigiana, Treviso, Italy), and Rupert Obholzer, MA(Oxon), MBBS(Lon) (Guy’s and St Thomas’ Hospitals, London, United Kingdom), for constructive criticism of the manuscript. None of these individuals received compensation for their contributions.

References

Wu Z , McGoogan JM . Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. Published online February 24, 2020. doi:10.1001/jama.2020.2648 PubMed Google Scholar

Dubé M , Le Coupanec A , Wong AHM , Rini JM , Desforges M , Talbot PJ . Axonal transport enables neuron-to-neuron propagation of human coronavirus OC43. J Virol. 2018;92(17):e00404-18. doi:10.1128/JVI.00404-18 PubMed Google Scholar

Sungnak W , Huang N , Bécavin C , Berg M , Network HLB . SARS-CoV-2 entry genes are most highly expressed in nasal goblet and ciliated cells within human airways. ArXiv200306122 Q-Bio. March 13, 2020. Accessed April 6, 2020. https://arxiv.org/abs/2003.06122

Giacomelli A , Pezzati L , Conti F , et al. Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study. Clin Infect Dis. 2020;ciaa330. Published online March 26, 2020. doi:10.1093/cid/ciaa330 PubMed Google Scholar

World Health Organization. Country and technical guidance—coronavirus disease (COVID-19). Accessed March 25, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/technical-guidance

Hopkins C , Gillett S , Slack R , Lund VJ , Browne JP . Psychometric validity of the 22-item Sinonasal Outcome Test. Clin Otolaryngol. 2009;34(5):447-454. doi:10.1111/j.1749-4486.2009.01995.x PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.