Onset, duration and unresolved symptoms, including smell and taste changes, in mild COVID-19 infection: a cohort study in Israeli patients

Klein, Hadar; Asseo, Kim; Karni, Noam; Benjamini, Yuval; Nir-Paz, Ran; Muszkat, Mordechai; Israel, Sarah; Niv, Masha Y.

doi:10.1016/j.cmi.2021.02.008

Cited by 81 publications

(87 citation statements)

References 28 publications

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“… 1 Nearly 15–20 per cent of the afflicted population have reported persistent olfactory dysfunction. 2 Yet, this is starkly different from the findings of a six-month psychophysical olfactory assessment study, in which 60 per cent of the cohort were found to have persistent olfactory dysfunction, whilst only 18 per cent of this group self-reported on altered smell. 3 Parallel to that, the prevalence of, as well as recovery from, olfactory dysfunction in Covid-19 patients may be underreported, as most study findings are based on self-reports.…”

Section: Introductioncontrasting

confidence: 66%

Impact of olfactory dysfunction on quality of life in coronavirus disease 2019 patients: a systematic review

Saniasiaya

Prepageran

2021

J. Laryngol. Otol.

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Objective To outline the impact on quality of life in coronavirus disease 2019 patients with olfactory dysfunction. Methods Five databases were searched for articles referring to the impact on quality of life in coronavirus disease 2019 patients with olfactory dysfunction. The search was conducted for the period from November 2019 to April 2021. The search was conducted over one month (May 2021). Results Four studies that met the objective were included. Altogether, there were 1045 patients. Various questionnaires were used to assess quality of life. Overall, the quality of life deficit affected 67.7 per cent of patients. Quality of life domains investigated include overall quality of life (four studies), food and taste dysfunction (two studies), mental health (two studies), cognitive function (one study), functional outcome (one study) and safety domains (one study). Conclusion Quality of life deficit was reported to be 67.7 per cent among coronavirus disease 2019 patients with olfactory dysfunction. The high prevalence of persistent olfactory dysfunction prompts more serious research, as the long-standing consequences of olfactory dysfunction are detrimental.

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Section: Introductioncontrasting

confidence: 66%

Impact of olfactory dysfunction on quality of life in coronavirus disease 2019 patients: a systematic review

Saniasiaya

Prepageran

2021

J. Laryngol. Otol.

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“…[1][2][3][4][5] Estimates of symptom prevalence and persistence vary substantially, arguably due to heterogeneous study designs and syndrome definitions. [6][7][8][9] It has been suggested that Long COVID describes a group of disparate conditions, including post-viral syndromes, long-term tissue or organ damage and ongoing inflammation. 3,7,10,11 Occurrence of Long COVID appears to be associated with the severity of acute COVID-19 symptoms; for example, high prevalence of persistent symptoms has been reported among people hospitalised with COVID-19.…”

Section: Introductionmentioning

confidence: 99%

Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people

Whitaker

Elliott

Chadeau‐Hyam

et al. 2021

Preprint

124

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Introduction Long COVID, describing the long-term sequelae after SARS-CoV-2 infection, remains a poorly defined syndrome. There is uncertainty about its predisposing factors and the extent of the resultant public health burden, with estimates of prevalence and duration varying widely. Methods Within rounds 3-5 of the REACT-2 study, 508,707 people in the community in England were asked about a prior history of COVID-19 and the presence and duration of 29 different symptoms. We used uni- and multivariable models to identify predictors of persistence of symptoms (12 weeks or more). We estimated the prevalence of symptom persistence at 12 weeks, and used unsupervised learning to cluster individuals by symptoms experienced. Results Among the 508,707 participants, the weighted prevalence of self-reported COVID-19 was 19.2% (95% CI: 19.1,19.3). 37.7% of 76,155 symptomatic people post COVID-19 experienced at least one symptom, while 14.8% experienced three or more symptoms, lasting 12 weeks or more. This gives a weighted population prevalence of persistent symptoms of 5.75% (5.68, 5.81) for one and 2.22% (2.1, 2.26) for three or more symptoms. Almost a third of people 8,771/28,713 (30.5%) with at least one symptom lasting 12 weeks or more reported having had severe COVID-19 symptoms ('significant effect on my daily life') at the time of their illness, giving a weighted prevalence overall for this group of 1.72% (1.69,1.76). The prevalence of persistent symptoms was higher in women than men (OR: 1.51 [1.46,1.55]) and, conditional on reporting symptoms, risk of persistent symptoms increased linearly with age by 3.5 percentage points per decade of life. Obesity, smoking or vaping, hospitalisation , and deprivation were also associated with a higher probability of persistent symptoms, while Asian ethnicity was associated with a lower probability. Two stable clusters were identified based on symptoms that persisted for 12 weeks or more: in the largest cluster, tiredness predominated, while in the second there was a high prevalence of respiratory and related symptoms. Interpretation A substantial proportion of people with symptomatic COVID-19 go on to have persistent symptoms for 12 weeks or more, which is age-dependent. Clinicians need to be aware of the differing manifestations of Long COVID which may require tailored therapeutic approaches. Managing the long-term sequelae of SARS-CoV-2 infection in the population will remain a major challenge for health services in the next stage of the pandemic.

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confidence: 99%

“…Most individuals (>75-80%) reporting taste and smell impairments due to COVID-19 tend to recover these senses within a few months, but smell impairment is still reported by 25-40% of patients after one or two months 5,14 at 6 months 15,16 . Given the common confusion between taste, smell and flavor, data on taste recovery are less clear, though suggested to recover somewhat faster than smell 16 . Separately, some individuals recover from acute smell loss, only to subsequently report other olfactory dysfunction, such as parosmia (smell distortions) and phantosmia (phantom smells or olfactory hallucinations) 17,18 .…”

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confidence: 99%

Increasing incidence of parosmia and phantosmia in patients recovering from COVID-19 smell loss

Ohla

Veldhuizen

Green

et al. 2021

Preprint

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Importance: Sudden smell loss is a specific early symptom of COVID-19, with an estimated prevalence of ~40% to 75%. Smell impairment affects physical and mental health, and dietary behavior. Thus, it is critical to understand the rate and time course of smell recovery. Objective: To characterize smell function and recovery up to 11 months post COVID-19 infection. Settings, Participants: This longitudinal survey of individuals suffering COVID-19-related smell loss assessed disease symptoms and gustatory and olfactory function. Participants (n=12,313) who completed an initial respiratory symptoms, chemosensory function, and COVID-19 diagnosis survey (S1) between April and September 2020 and completed a follow-up survey (S2) between September 2020 and February 2021; 27.5% participants responded (n=3,386), with 1,468 being diagnosed with COVID-19 and suffering co-occurring smell and taste loss at the beginning of their illness. Main Outcomes & Measures: Primary outcomes are ratings of smell and taste function on a visual analog scale, and self-report of parosmia (smell distortions) and phantosmia (unexplained smells). Secondary outcomes include a checklist of other COVID-19 symptoms. Results: On follow-up (median time since COVID-19 onset ~200 days), ~60% of women and ~48% of men reported less than 80% of their pre-illness smell ability. Taste typically recovered faster than smell, and taste loss rarely persisted if smell recovered. Prevalence of parosmia and phantosmia was ~10% of participants in S1 and increased substantially in S2: ~47% for parosmia and ~25% for phantosmia. Persistent smell impairment was associated with more symptoms overall, suggesting it may be a key marker of long-COVID. During COVID-19 illness, the ability to smell was slightly lower among those who did not recover their pre-illness ability to smell at S2. Conclusions and Relevance: While smell loss improves for many individuals who lost it due to COVID-19, the prevalence of parosmia and phantosmia increases substantially over time. Olfactory dysfunction is also associated with wider COVID-19 symptoms and may persist for many months after COVID-19 onset. Taste loss in the absence of smell loss is rare. Persistent qualitative smell symptoms are emerging as common long-term sequelae; more research into treatment options is strongly warranted given that conservative estimates suggest millions of individuals may experience parosmia following COVID-19. Healthcare providers worldwide need to be prepared to treat post COVID-19 secondary effects on physical and mental health.

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Onset, duration and unresolved symptoms, including smell and taste changes, in mild COVID-19 infection: a cohort study in Israeli patients

Cited by 81 publications

References 28 publications

Impact of olfactory dysfunction on quality of life in coronavirus disease 2019 patients: a systematic review

Impact of olfactory dysfunction on quality of life in coronavirus disease 2019 patients: a systematic review

Persistent symptoms following SARS-CoV-2 infection in a random community sample of 508,707 people

Increasing incidence of parosmia and phantosmia in patients recovering from COVID-19 smell loss

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