Anosmia in COVID-19: What Care Providers Need to Know

A familiar image during the past year is a patient with COVID-19 on a ventilator in an intensive care unit, cared for by nurses swathed in protective equipment. Becoming more familiar now is the image of the “long hauler,” no longer an inpatient but struggling with COVID’s residuals weeks or months after the initial infection (Siegelman, 2020). Among the troubling residual symptoms reported by survivors is anosmia: loss of the sense of smell. In contrast to studies of the past, in which smell was ranked as the least important sense, and less valuable to some people than their technological devices (Jarvis, 2021), the COVID survivors who cannot smell are finding it profoundly dismaying, disorienting, and disruptive. It can even be life-threatening, as evidenced by the story of a family whose members had lost their sense of smell because of COVID and escaped their burning house only because one uninfected child smelled the smoke (Jarvis, 2021).

Since March 2020, British rhinologist Claire Hopkins has emphasized that anosmia can be an early symptom of COVID-19, with sudden onset and no other symptoms, alerting primary care providers across the globe about this predictor of coronavirus infection (cited in Meng et al., 2020). The pathogenesis of anosmia is not yet well understood, but its incidence in COVID patients ranges from 33.9% to 68%, with higher incidence in females (Meng et al., 2020). In research conducted to date, formal olfactory testing is less common than reliance on patient self-reports. Anosmia may or may not be associated with dysgeusia (impairment of taste).

Last spring, a multidisciplinary and international consortium of scientists began to collect narratives from COVID survivors about their lived experience of anosmia, receiving responses from 40,000 people in just a few weeks (Global Consortium for Chemosensory Research, cited in Jarvis, 2021). Invaluable to the scientists were the vivid descriptors of experiences written in the text boxes of the GCCR survey. Many survey respondents wrote pages about how they felt “adrift—disconnected from a world that felt wrong, uncanny, confusing” because they could not smell (Jarvis, 2021, p. 24). As time went on, and the researchers continued to track study participants’ experiences, they found that three-quarters of the COVID survivors did recover their sense of smell, within a few weeks or months, while others recovered more slowly or not at all (Jarvis, 2021).

A Facebook support group (AbScent) has attracted thousands of anosmic people who received consensual validation and support for their feelings of depression, anger, and anxiety—and a distressing new symptom that surfaced when the sense of smell returned: smells that were faulty and even bizarre (called parosmia). Examples of unpleasant odors included “food smelled like gasoline or cigarettes…poo now smelled better than coffee” (Jarvis, 2021, p. 25).

Psychiatric nurses and other care providers must empathically validate the distress of anosmic COVID survivors. They can be referred to support groups such as AbScent and prescribed psychotropic medications such as antidepressants if indicated. Many sufferers have encountered lack of sympathy for their condition (e.g., doctors “shrugging,” saying there was no treatment, and friends telling them this was “no big deal”) (Jarvis, 2021, p. 46). Care providers should continue to track the forthcoming publications emanating from the international GCCR consortium, which is developing coronavirus screening tests based on the ability to smell, and exploring smell training modalities for post-COVID anosmics.

Pre-COVID literature on smell training does exist, as summarized in a meta-analysis that found a significant, positive effect of smell training, based on studies of participants with post-infectious and post-traumatic olfactory loss and all types of olfactory diseases (Sorokowska et al., 2017). Olfactory training involves asking people to sniff four different odors twice a day for 4-6 months, presumably to increase the growth of olfactory receptor neurons (Sorokowski et al.) The patient selects items representing flowery, spicy, resinous, and fruity categories. Although it is too early to evaluate efficacy of smell training for post-COVID anosmia, there is nothing in the literature to suggest harmful effects of such simple daily exercises.

Although we have focused here on anosmia as a sequela of COVID-19, loss of smell is already known as a possible indicator of conditions such as Alzheimer’s, Parkinson’s, and schizophrenia. Therefore, it is imperative for all psychiatric-mental health clinicians to become more informed about anosmia and vigilant about assessing it. As always, manuscripts submitted to Issues in Mental Health Nursing by clinicians and researchers will be welcome contributions to the sparse literature on anosmia.