Why Losing Your Sense of Smell With Covid-19 Is So Traumatizing
Most people recover their sense of smell after Covid-19. But months on, some are still nose blind with distressing effects.
Eight weeks after giving birth to her daughter in late December, Kelly De-Gol displayed mild symptoms of Covid-19, accompanied by a complete loss of smell. Though she wasn’t officially tested at the time, as smell loss was a relatively unknown symptom, she later tested positive for Covid-19 antibodies.
Despite having recovered from all other symptoms in March, she still struggles months on to recognize her baby’s scent: The olfactory experiences that come with motherhood — from a newborn’s hair to the stench of vomit after feeding — have been mostly dulled.
“Cuddles were instantly less intimate. I didn’t know when she was dirty in her nappy as I was completely nose blind. This upset me on several occasions,” said De-Gol, 40, who lives in the U.K. “Every time I hold her, I sniff her hair as hard as I can, longing to smell her,” said the mother of five.
Anosmia, the technical term for smell loss, is now a recognized symptom associated with Covid-19, though by no means a diagnosis. A study found that almost 90% of those affected either recover or improve their sense of smell within a month. However, there’s a minority like De-Gol in whom the condition persists and in whom another pattern can emerge after months: anosmia becomes parosmia — the abnormality of smell.
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“Loss of smell and taste continued for months with little improvement. Then one day, out of the blue, tap water tasted really chemical to me,” said De-Gol, who developed parosmia but added that she still experiences some loss of smell. “This was in July, and rapidly, everyday things became distorted in a vile way. My husband’s aftershave is horrendous. I can’t go out to eat or drink. I hold my nose to drink even water.”
“What we’re seeing [months after loss of smell] is that many [Covid-19] patients develop parosmia,” said Claire Hopkins, MD, an ENT surgeon and president of the British Rhinological Society. “Even those who regained their sense of smell find they’ve developed parosmia, while others get it before they’ve noticed improvement.”
“Loss of smell and taste continued for months with little improvement. Then one day, out of the blue, tap water tasted really chemical to me.”
“Parosmia is a very distorted smell,” she continued. “Some might describe it as being musky, acrid, often very sour; and it’s triggered by odored, particular things like coffee, onions, toothpaste. And patients find that really distressing because something like cleaning their teeth is unpleasant.”
But Hopkins added, based on research in other post-viral loss, this is usually an indication of the recovery stage. “In most people, we expect it to be transient, but it can go on for months, sometimes years [as seen in other infections]. Parosmia is relatively common in post-viral loss, but it seems to be very bothersome with Covid-19.”
Hopkins stressed there’s still little data on Covid-19-related smell disorders and emphasized that researchers are extrapolating from data on previous post-viral loss and current Covid-19 literature, including growing anecdotal evidence. But the early, emerging theory is that for those with short-term anosmia, the virus only affected the cells supporting the olfactory neurons. However, in slower recovery, the virus has affected the olfactory neurons themselves, which take longer to regenerate and in which the recovery stage may be associated with parosmia.
But again, she said, “We still aren’t absolutely sure of the mechanisms with loss of smell.”
According to olfaction experts, the field has historically been underrated in medicine, but the pandemic has ignited an interest. For starters, recognizing anosmia as a symptom of Covid-19 could slow down transmission from those who are otherwise asymptomatic.
But there’s also the question of life after Covid-19 and what can be learned from survivors who endure its lingering effects, including those living with smell conditions. And while anosmia and parosmia may not kill, they can still threaten survival.
Lucy Packman contracted Covid-19 in March and found anosmia has impaired her instinct to detect danger. “I find that when preparing food, I often have to ask someone to keep an eye out for the smell of burning,” said the 18-year-old university student. “Because I can’t smell when things are cooked, there’s been numerous occasions where I’ve burnt something or left the grill on.”
What’s been hardest, though, is living without all the joys associated with food. “It’s mentally tough knowing the foods you used to love now simply taste like sewage. I no longer crave food or enjoy eating. It’s a chore.”
“[I don’t know] whether something is off, whether I’m off.”
In fact, past research on the social and mental impact on those suffering with long-term smell disorders from other infections or accidents is significant. Many report feelings of isolation, depression, and anxiety as well as eating problems. For Sarah Harrison, 50, losing her sense of smell since a Covid-19 infection in March has been harder than she thought. “I think I’m a bit depressed about it, if I’m honest. I moan about it too much, which is unusual for me. I can usually put a positive spin on most things, but I’m struggling with this,” said Harrison seven months on, who lives in the U.K.
“I feel vulnerable and afraid, like my defenses have gone,” she said. “I no longer enjoy my food. I miss smelling the air. The washing. [I don’t know] whether something is off, whether I’m off.”
Harrison, like thousands of others, has turned to online groups for support and answers on how to cope and whether it’ll go away. While there’s no specific treatment, smell training is often recommended for therapy by medical professionals. This involves repeatedly sniffing certain smells throughout the day to stimulate the senses. Some evidence suggests smell training can be effective, but it isn’t a cure.
Those with parosmia have found that focusing on “safe foods,” such as plain pasta, potatoes, or raw carrots, can help to mitigate unpleasant tastes. Harrison said she’s learning to hone in on flavors her taste buds pick up. “So I’m drawn to more salty foods, hot spices, sugary things, and sours.”
“In terms of therapy, time to recover and smell training are really important, but there aren’t many drug therapies that you can give to speed up that process,” said Claire Hopkins, the ENT surgeon. “It’s unlikely that we’re able to give a tablet that’s going to bring [people’s] sense of smell back. We try to help out in other ways: working with charities, getting information out to GPs about the importance of starting smell training. They need advice and support, rather than necessarily prescriptions.”
“To lose your sense of smell is to lose access to your sense of self.”
Since the pandemic, charities like the U.K.-based Fifth Sense and AbScent, both part of the Global Consortium for Chemosensory Research, have been looking into links between coronavirus and smell loss and reported a surge in people reaching out to them about Covid-19-related anosmia.
AbScent, in particular, currently has over 8,000 members worldwide in its Facebook group. “In a short period, our group is eight times the size it was in March,” said founder Chrissi Kelly, who had anosmia in 2012 and experienced the bereavement that came with it.
“To lose your sense of smell is to lose access to your sense of self,” she said. “Any living creature lives because they have senses with which to decode what’s going on in the environment, to find food, avoid danger, find a mate. [Anosmia] changes your perception of the world, and it changes your personality.”
For those with long term Covid-19-related smell disorders, online communities have been vital — not just for support but for validation that what they’re experiencing is significant, even if not well understood. “I cried when I found it,” said De-Gol of the AbScent Facebook group. “I was not going mad. I’m not the only one. What I’m experiencing is ‘normal.’ We’re strangers but united by the unfortunate position we have all found ourselves in.”