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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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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Daniele Borsetto, MD, Guy’s Hospital, London SE1 9RT, United Kingdom (firstname.lastname@example.org).
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.
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