Air Force physician and coauthors discuss loss of smell, taste in COVID-19

The sudden onset of difficulty with smell (anosmia) or taste (dysgeusia), with no other nasal congestion or other symptoms, warrants increased clinical caution during the COVID-19 pandemic, according to Col. (Dr.) Michael Xydakis, an ear, nose and throat surgeon in the Air Force Research Laboratory (AFRL), and a multinational team of medical professionals.

Xydakis, who works in AFRL’s 711th Human Performance Wing, and colleagues summarized their front-line observations and recommendations in a letter to the editor that was published online by The Lancet Infectious Diseases on April 15. Xydakis's coauthors included clinicians from Harvard University and the University of California San Francisco as well as Italy, Germany, France, and the United Kingdom.

“New onset anosmia likely serves as a reliable proxy marker of infection,” Xydakis said. “Diagnosing asymptomatic or mildly symptomatic carriers early and advising self-quarantine is essential to control the spread of this virus. By diagnosing patients infected by COVID-19 early in their disease process, we are essentially going after the kindling before it becomes a forest fire.”

Aimed at strengthening the COVID-19 diagnostic criteria for healthcare providers, the article offers recommendations to those treating, testing and diagnosing patients presenting with rapid onset difficulty with smell or taste.

“Most concerning,” Xydakis said, “is the recent and compelling evidence that viral shedding and transmission may occur in asymptomatic carriers or mildly symptomatic patients, and the current screening processes for detecting COVID-19 do not include testing taste or smell functions.”

Included in the one-page letter are recommendations for healthcare providers with patients who report a sudden loss of smell or taste, but do not have nasal congestion or other symptoms that accompany allergies or the common cold. Healthcare providers should have a high index of suspicion for COVID-19 in patients who present with new onset anosmia as the only symptom, he said.

“The clinical research that we are conducting in AFRL is intrinsically translational and, in a time of crisis, offers the shortest path for providing senior leadership with actionable, decision-quality, operational information” Xydakis said. “The same holds true for the national and international partnerships we build along the way.”

However, the authors cautioned that further study will be needed to establish the incidence and implications of anosmia and dysgeusia with regard to COVID-19, noting "the plural of an anecdote is not evidence."

Read more: https://afresearchlab.com/news/af-physician-advises-follow-your-nose-to-...

Read the letter in Lancet Infectious Diseases: https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30293-0/fulltext