Push to include anosmia as recognised COVID-19 symptom

Evelyn Lewin

24/03/2020 2:11:15 PM

Experts believe there is a potential to reduce transmission if patients with new onset anosmia are told to self-isolate due to this symptom alone.

GP and patient
Peak international ENT bodies are pushing to include anosmia as a recognised symptom of COVID-19.

According to the Department of Health, the recognised symptoms of COVID-19 (coronavirus) currently include fever, cough, sore throat, fatigue and shortness of breath.
However, there is a push by peak international ear, nose and throat (ENT) bodies to include a further symptom to that list: anosmia (loss of sense of smell).
Further symptoms they believe may warrant consideration of COVID-19 include:

  • hyposmia – reduced sense of smell
  • dysgeusia – distorted sense of taste
  • hypogeusia – reduced sense of taste.
The ENT UK and British Rhinological Society tweeted about this issue on 21 March.
They stated that evidence from South Korea, China and Italy suggests ‘significant numbers’ of patients with COVID-19 have developed anosmia or hyposmia.
‘In Germany, it is reported that more than two thirds of cases have anosmia,’ they wrote in the tweet.
‘In South Korea, where testing has been more widespread, 30% of patients testing positive have had anosmia as their major presenting symptom in otherwise mild cases.’
They report that cases of isolated anosmia are also on the rise in Iran, the US, France and northern Italy.
‘These patients may be some of the hitherto hidden carriers that have facilitated the rapid spread of COVID-19. Unfortunately, they do not meet current criteria for testing or self-isolation,’ they wrote.
The ENT UK and British Rhinological Society are consequently calling on patients with new onset of these symptoms to isolate.
‘There is a potential to reduce COVID-19 transmission by requesting that individuals with new onset of anosmia self-isolate,’ they wrote.
‘If anosmia was added to the current symptom criteria used to trigger quarantine, and any adult with anosmia but no other symptoms was asked to self-isolate for seven days, we might potentially be able to reduce the number of otherwise asymptomatic individuals who continue to act as vectors.’
Mr Stephen Kleid is an ENT and head and neck surgeon at Peter MacCallum Cancer Centre, and Masada and Epworth Freemasons hospitals in Melbourne.
He told newsGP he agrees with the current push to include anosmia as a key symptom.
‘One of the early symptoms [of COVID-19] that seems to be evident is significant anosmia,’ he said.
Mr Kleid is keen to note, however, that the symptoms of anosmia and altered sense of taste may also occur in the context of other respiratory tract infections.
‘You often get that with a cold anyway,’ he said. ‘That’s the confusing thing; it’s a non-specific feature.’
Despite this caveat, Mr Kleid believes anosmia should be added to the current criteria that may prompt testing for COVID-19.
‘Loss of sense of smell should be part of it,’ he said.
‘If it’s acute onset loss of sense of smell, then I think they should be treated as a coronavirus patient until proven otherwise.’
In an ideal world, Mr Kleid believes everybody should be tested today for COVID-19. Then, in a few days, it would be clear who should be isolated.
‘That’s obviously not going to happen,’ he said.
But anosmia should be added to the list of symptoms that may indicate the need for swab testing, Mr Kleid said.
He does acknowledge the potential downside of this process.
‘It will create a heightened degree of panic,’ he said. ‘But maybe we’ll pick up a few more patients … and we’ll know who to isolate from there.’
Mr Kleid said some patients may experience anosmia as the only symptom of COVID-19, while for others it may be an early symptom.
Flinders University professor and ENT specialist Simon Carney is the immediate past-president of the Australia and New Zealand Rhinologic Society. He agrees that patients presenting with symptoms relating to changes or loss of smell should be considered as having COVID-19.
‘It is these silent carriers who may remain undetected by current screening procedures, which may explain why the disease has progressed so rapidly in so many countries around the world,’ he said.
‘In the UK, ENT surgeons are pushing to have anosmia highlighted as an important symptom that may signify a patient may be an asymptomatic carrier.’
The American Academy of Otolaryngology-Head and Neck Surgery has also released a statement noting that anosmia and dysgeusia are ‘significant symptoms’ associated with COVID-19.
They state anosmia in particular has been seen in patients with no other symptoms who ultimately test positive for coronavirus.
‘We propose that these symptoms be added to the list of screening tools for possible COVID-19 infection,’ they wrote in a statement.
‘Anosmia, hyposmia, and dysgeusia, in the absence of other respiratory disease such as allergic rhinitis, acute rhinosinusitis, or chronic rhinosinusitis, should alert physicians to the possibility of COVID-19 infection and warrant serious consideration for self-isolation and testing of these individuals.’
Professor Carney said Australia should utilise these findings to try to lower the rate of infection by including anosmia as a recognised symptom of COVID-19.
‘Australia is in a position to take advantage of these findings overseas to try and flatten the curve while we still can,’ he said.
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Dr Abid Ali Munir Ahmed Jamadar   28/03/2020 2:54:35 PM

I agree with the suggestion as I almost missed a COVID-19 patient. His ONLY complain was anosmia and loss of taste - Ageusia. Being so fixated on URTI symptomatology we can easily overlook this aspect of COVID-19 presentation.