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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

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
1.
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.2020.2648PubMedGoogle Scholar
2.
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.00404-18PubMedGoogle Scholar
3.
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
4.
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/ciaa330PubMedGoogle Scholar
5.
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
6.
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.xPubMedGoogle ScholarCrossref
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