More Than Smell—COVID-19 Is Associated With Severe Impairment of Smell, Taste, and Chemesthesis
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Abstract
Recent anecdotal and scientific reports have provided evidence of a link between COVID-19 and chemosensory impairments, such as anosmia. However, these reports have downplayed or failed to distinguish potential effects on taste, ignored chemesthesis, and generally lacked quantitative measurements. Here, we report the development, implementation, and initial results of a multilingual, international questionnaire to assess self-reported quantity and quality of perception in 3 distinct chemosensory modalities (smell, taste, and chemesthesis) before and during COVID-19. In the first 11 days after questionnaire launch, 4039 participants (2913 women, 1118 men, and 8 others, aged 19–79) reported a COVID-19 diagnosis either via laboratory tests or clinical assessment. Importantly, smell, taste, and chemesthetic function were each significantly reduced compared to their status before the disease. Difference scores (maximum possible change ±100) revealed a mean reduction of smell (−79.7 ± 28.7, mean ± standard deviation), taste (−69.0 ± 32.6), and chemesthetic (−37.3 ± 36.2) function during COVID-19. Qualitative changes in olfactory ability (parosmia and phantosmia) were relatively rare and correlated with smell loss. Importantly, perceived nasal obstruction did not account for smell loss. Furthermore, chemosensory impairments were similar between participants in the laboratory test and clinical assessment groups. These results show that COVID-19-associated chemosensory impairment is not limited to smell but also affects taste and chemesthesis. The multimodal impact of COVID-19 and the lack of perceived nasal obstruction suggest that severe acute respiratory syndrome coronavirus strain 2 (SARS-CoV-2) infection may disrupt sensory-neural mechanisms.
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SciScore for 10.1101/2020.05.04.20090902: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
Experimental Models: Organisms/Strains Sentences Resources Of those included in the final sample, 2913 were women, 1118 were men, 3 were other and 5 preferred not to say. , 1118suggested: NoneSoftware and Algorithms Sentences Resources Statistical analysis: All analyses were performed in R (Team R Core Development, 2013) via RStudio. RStudiosuggested: (RStudio, RRID:SCR_000432)The code will be also available on GitHub at https://github.com/GCCR/GCCR001, and will include a Jupyter notebook replicating the core analyses in Python. Pythonsuggested: (IPython, RRID:SCR_001658)To characterize the relationship between perceived nasal blockage … SciScore for 10.1101/2020.05.04.20090902: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
NIH rigor criteria are not applicable to paper type.Table 2: Resources
Experimental Models: Organisms/Strains Sentences Resources Of those included in the final sample, 2913 were women, 1118 were men, 3 were other and 5 preferred not to say. , 1118suggested: NoneSoftware and Algorithms Sentences Resources Statistical analysis: All analyses were performed in R (Team R Core Development, 2013) via RStudio. RStudiosuggested: (RStudio, RRID:SCR_000432)The code will be also available on GitHub at https://github.com/GCCR/GCCR001, and will include a Jupyter notebook replicating the core analyses in Python. Pythonsuggested: (IPython, RRID:SCR_001658)To characterize the relationship between perceived nasal blockage and chemosensory change, we used a principal component analysis (PCA) using prcomp from the R default stats package and we plotted the results with functions from the FactoMineR package (Lê et al., 2008). FactoMineRsuggested: (FactoMineR, RRID:SCR_014602)Results from OddPub: Thank you for sharing your code and data.
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:It is a limitation of this initial snapshot, however, that participants from different countries are not evenly represented. Cultural biases or country-specific manifestations of COVID-19 could potentially impact these results and will be explored by GCCR in future studies. Though our comprehensive self-report survey cannot replace in-person testing in a controlled clinical or laboratory setting, the gold standard for assessing alterations in chemosensory function, it efficiently and effectively addresses an emerging public health crisis with global scope of coverage. Thus, the model shown in this study of remote smell and taste assessment utilizing the internet may represent one way of reducing delays in assessment until aggressive physical distancing ends (Patel, 2020; Workman et al., 2020). The mean change in ability to smell was substantial. Prior to onset of COVID-19, the mean rating for the ability to smell was over 90 on a 100-point VAS, yet during the disease, the mean rating dropped below 20. These data do not allow us to differentiate between individuals with partial (hyposmia) versus total loss (anosmia), and participants themselves may be unable to precisely characterize their degree of loss in the absence of objective olfactory testing (Hoffman et al., 2016; Loetsch and Hummel, 2019; Welge-Lüssen et al., 2005). Still, we can conservatively conclude that a major drop in the ability to smell is a hallmark of COVID-19. If the prevalence of COVID-19-associated smell ...
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Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
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