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Sociodemographic Characteristics and Comorbidities of Patients With Long COVID and Persistent Olfactory Dysfunction

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Key Points

Question  What are the sociodemographic and clinical characteristics of patients with long COVID and persistent olfactory dysfunction?

Findings  In this cross-sectional study of 219 patients with long COVID and neurologic symptoms, 64% had olfactory dysfunction, with the highest prevalence among women, adults, and outpatients. Patients with olfactory dysfunction may develop severe olfactory loss (hyposmia or anosmia) that may persist for more than 1 year after the onset of symptoms.

Meaning  This study suggests that olfactory dysfunction in patients with long COVID may become permanent.


Importance  Determining the characteristics, type, and severity of olfactory dysfunction in patients with long COVID is important for the prognosis and potential treatment of the affected population.

Objective  To describe the sociodemographic and clinical features of patients with long COVID who develop persistent olfactory dysfunction.

Design, Setting, and Participants  This cross-sectional study, conducted at a rehabilitation center at a public university in the Amazon region of Brazil between September 9, 2020, and October 20, 2021, comprised 219 patients with long COVID and self-reported neurologic symptoms. Of these 219 patients, 139 received a diagnosis of chronic olfactory dysfunction, as confirmed by the Connecticut Chemosensory Clinical Research Center (CCCRC) test.

Exposure  Clinical diagnosis of long COVID.

Main Outcomes and Measures  Electronic case report forms were prepared for the collection of sociodemographic and clinical data. Patients’ sense of smell was evaluated via a CCCRC test, and the association of olfactory dysfunction with aspects of daily life was recorded using a questionnaire.

Results  Of the 219 patients included in the study, 164 (74.9%) were women, 194 (88.6%) were between 18 and 59 years of age (mean [SD] age, 43.2 [12.9] years), 206 (94.1%) had more than 9 years of education, and 115 (52.5%) had a monthly income of up to US $192.00. In the study group, 139 patients (63.5%) had some degree of olfactory dysfunction, whereas 80 patients (36.5%) had normosmia. Patients with olfactory dysfunction had a significantly longer duration of long COVID symptoms than those in the normosmia group (mean [SD], 242.7 [101.9] vs 221.0 [97.5] days; P = .01). Among patients with anosmia, there was a significant association between olfactory dysfunction and daily activities, especially in terms of impairment in hazard detection (21 of 31 patients [67.7%]), personal hygiene (21 of 31 patients [67.7%]), and food intake (21 of 31 patients [67.7%]). Univariable logistic regression analyses found that ageusia symptoms were associated with the occurrence of olfactory dysfunction (odds ratio [OR], 11.14 [95% CI, 4.76-26.07]; P < .001), whereas headache (OR, 0.41 [95% CI, 0.22-0.76]; P < .001) and sleep disorders (OR, 0.48 [95% CI, 0.26-0.92]; P = .02) showed an inverse association with the occurrence of olfactory dysfunction.

Conclusions and Relevance  Olfactory dysfunction is one of the most important long-term neurologic symptoms of COVID-19, with the highest prevalence seen among women, adults, and outpatients. Patients with olfactory dysfunction may experience persistent severe hyposmia or anosmia more than 1 year from the onset of symptoms, suggesting the possibility of the condition becoming a permanent sequela.

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Article Information

Accepted for Publication: July 15, 2022.

Published: September 8, 2022. doi:10.1001/jamanetworkopen.2022.30637

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2022 Mendes Paranhos AC et al. JAMA Network Open.

Corresponding Author: Luiz Fábio Magno Falcão, PhD, Biological and Health Center, Pará State University, 2623, Perebebui St, Belém, PA, Brazil (fabiofalcao@uepa.br).

Author Contributions: Dr Magno Falcão had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Souza, Simões Quaresma, and Magno Falcão share senior authorship.

Concept and design: Mendes Paranhos, Nazareth Dias, Vieira Hennemann Koury, Cerasi, Souza, Simões Quaresma, Magno Falcão.

Acquisition, analysis, or interpretation of data: Mendes Paranhos, Nazareth Dias, Machado da Silva, Vieira Hennemann Koury, de Jesus Sousa, Cerasi, Souza, Magno Falcão.

Drafting of the manuscript: Mendes Paranhos, Nazareth Dias, Machado da Silva, Cerasi, Souza, Simões Quaresma, Magno Falcão.

Critical revision of the manuscript for important intellectual content: Mendes Paranhos, Nazareth Dias, Vieira Hennemann Koury, de Jesus Sousa, Cerasi, Souza, Magno Falcão.

Statistical analysis: Mendes Paranhos, Nazareth Dias, Vieira Hennemann Koury, Souza, Magno Falcão.

Obtained funding: Simões Quaresma.

Administrative, technical, or material support: Vieira Hennemann Koury, Cerasi.

Supervision: Souza, Simões Quaresma.

Conflict of Interest Disclosures: None reported.

Funding/Support: This study was supported by Fundação Amazônia de Amparo a Estudos e Pesquisa (FAPESPA 006/2020), Secretaria de Estado de Ciência, Tecnologia e Educação Técnica e Tecnológica (SECTET 09/2021), and Coordination for the improvement of Higher Education Personnel (CAPES PDPG AMAZÔNIA LEGAL).

Role of the Funder/Sponsor: The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: The authors thank all of the patients who agreed to voluntarily participate in this study and the pharmacology laboratory of Cosmopolita College for the development of Connecticut Chemosensory Clinical Research Center test solutions used in the data collection.

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