Elizabeth Simins had all the typical symptoms of Covid after testing positive for the virus June 25.
For about a week, Simins, 34, of Portland, Oregon, felt dizzy, fluish and out of breath. She had palpitations if she exerted herself. Those symptoms, thankfully, were temporary. But just when she thought she was in the clear, she lit a scented candle and noticed something else — she couldn’t smell it.
For five days, everything smelled the same to her, a woodsy autumnal smell uncharacteristic of July in Oregon. Even now, her sense of smell is not as keen as it was before she got sick.
She’s not alone: While far fewer patients reported loss of the sense of smell during the first omicron wave compared to earlier waves, the Covid peculiar symptom seems to be making a comeback.
Doctors note that what they’re seeing during the current rise in cases — fueled by the hyperinfectious BA.5 omicron subvariant — is still based on anecdotal evidence.
But health care providers like Valentina Parma, a psychologist at the Monell Chemical Senses Center in Philadelphia, who works with Covid patients, are noticing more patients reporting loss of smell.
“What I am seeing in my corner of the world is a spike,” she said. “There seems to be more requests than earlier this year but still significantly less than with delta.”
Until now, each variant and subvariant of concern has appeared to carry a lesser risk of loss of smell than the last. A study published in May found that the alpha variant — the first variant of concern — was half as likely to odd smell than the original version of the coronavirus. During the delta wave, the odds people would experience an impaired sense of smell fell to 44%. During the winter omicron wave, it fell further, to 17%.
Dr. Lauren Roland, a rhinologist at Washington University in St. Louis, Missouri, said it’s too soon to say for sure if BA.5 is causing more cases of anosmia — complete loss of smell — than the original omicron variant.
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“These patients usually don’t come in until several months after they’ve lost their smell and we don’t get a lot of information until after the wave,” she said.
Dr. Lora Bankova, an allergist and immunologist at Brigham and Women’s Hospital in Boston, has also, anecdotally, seen more patients reported loss of smell.
“I have talked to people overall about losing their taste and smell lately and it seems that there is an uptick, but the data isn’t there yet,” she said.
Parma noted that loss of smell is probably underreported among Covid patients.
“When we ask people if they lose their taste and smell, we have a cohort of people who say yes, those are the ones who lost their full sense of smell,” she said. “But when you administer a smell test, we’re seeing about 25% of people have an impaired sense of smell, which is not a small number.”
The science of smell loss
Throughout the pandemic, scientists have explored many theories as to how the coronavirus leads to loss of smell. Recently, most seem to be converging around one main idea: the virus appears to damage cells that support the olfactory neurons, making it harder to send information about smell to the brain.
“For different variants, I think what we are going to find is that different variants affect those cells differently, and the amount of destruction or long-term inflammation will also be different,” Roland said.
It may also depend on who is infected. “Now that we are two years in, we have very variable reinfection and vaccination rates,” she said. “Some people have been vaccinated with different vaccines, some have been boosted, some have had Covid multiple times.”
The virus itself is also mutating faster than researchers can study it, meaning concrete data on how the BA.5 subvariant impacts smell is not yet known.
When will smell come back?
While many Covid patients regain their ability to smell within three months, some recover more slowly, Bankova said. If people are still having trouble with smell after six months, she said, they usually see little improvement until they hit the one-year mark, when they tend to improve. But that isn’t the case for everyone.
“I certainly have patients in my clinic who lost their sense of smell during the initial wave in 2020 and still don’t have it back,” she said.
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A small study that included 100 people who had a mild case of Covid early on in the pandemic found that almost half of those who lost their smell were still having issues in 2021. This includes both total smell loss and dysosmia, or a distorted sense of smell. For example, a cup of coffee now smells like sewage. Both can take a huge toll.
“You are reminded multiple times a day that your world has changed in a way that is unpredictable,” Parma said.
According to Bankova, there is a silver lining for people struggling with long-term loss of smell. As the problem persists, it’s garnering the attention of researchers who may hold answers for better methods of treatment.
“The good news is that things are always evolving and we’re continuing to learn more and more about this problem as we get more information,” she said.
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