Self-reported loss of smell without nasal obstruction to identify COVID-19. The multicenter Coranosmia cohort study

doi:10.1016/j.jinf.2020.07.005

Observational Study

. 2020 Oct;81(4):614-620.

doi: 10.1016/j.jinf.2020.07.005. Epub 2020 Jul 7.

Self-reported loss of smell without nasal obstruction to identify COVID-19. The multicenter Coranosmia cohort study

Dominique Salmon Ceron¹, Sophie Bartier², Charlotte Hautefort³, Yann Nguyen⁴, Jérôme Nevoux⁵, Anne-Laure Hamel³, Yohan Camhi⁶, Florence Canouï-Poitrine⁷, Benjamin Verillaud³, Dorsaf Slama⁸, Stephanie Haim-Boukobza⁹, Elise Sourdeau¹⁰, Delphine Cantin¹⁰, Alain Corré¹¹, Agnes Bryn¹², Nicolas Etienne⁸, Flore Rozenberg¹³, Richard Layese⁷, Jean-François Papon¹⁴, Emilie Bequignon²; APHP COVID-19 research collaboration

Affiliations

¹ Department of Infectious Diseases and Immunology, Hotel Dieu Hospital, Paris Public Hospitals (APHP), 1 Place du Parvis de Notre-Dame, Paris 75004, France; University of Paris, School of Medicine, Paris 75005, France. Electronic address: dominique.salmon@aphp.fr.
² Department of Oto-rhino-laryngology, Head and Neck Surgery, Intercommunal Hospital of Créteil, Créteil 94000, France; University Paris-Est Créteil (UPEC), School of Medicine, Créteil 94000, France; INSERM U955, IMRB- CEpiA team, 94000 Créteil, France Paris Public Hospitals Henri Mondor Hospital (APHP), Créteil 94000, France; Department of Oto-rhino-laryngology, Henri Mondor Hospital of Créteil, Paris Public Hospitals, Créteil 94000, France; Centre National de la Recherche Scientifique CNRS, ERL 7000, Créteil 94000, France.
³ Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, Lariboisière Hospital (APHP), Paris 75010, France; University Paris Diderot, School of Medicine, Paris 75010, France.
⁴ Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, AP-HP Sorbonne University Hospital Pitié Salpêtrière Hospital (AP-HP), Paris 75006, France; Sorbonne University, Paris 75013, France.
⁵ Groupe Hospitalier Paris-Saclay, Hôpital Bicêtre, Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals. Le Kremlin-Bicêtre 94270, France; Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre F-94275, France.
⁶ Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, AP-HP Sorbonne University Hospital Pitié Salpêtrière Hospital (AP-HP), Paris 75006, France.
⁷ University Paris-Est Créteil (UPEC), School of Medicine, Créteil 94000, France; INSERM U955, IMRB- CEpiA team, 94000 Créteil, France Paris Public Hospitals Henri Mondor Hospital (APHP), Créteil 94000, France; Clinical Research Unit: (URC-Mondor), Department of Public Health, Henri Mondor Hospital Paris Public Hospitals (AP-HP), Créteil 94000, France.
⁸ Department of Infectious Diseases and Immunology, Hotel Dieu Hospital, Paris Public Hospitals (APHP), 1 Place du Parvis de Notre-Dame, Paris 75004, France.
⁹ Cerba Laboratory, Saint-Ouen L'Aumône, France.
¹⁰ Emergency Department, Hotel Dieu Hospital, Paris Public Hospitals (APHP), Paris 75004, France.
¹¹ Department of Oto-rhino-laryngology Head and Neck Surgery, Hopital Rothschild Foundation, Paris, France.
¹² University of Paris, School of Medicine, Paris 75005, France; General Medical Practioner, Paris, France.
¹³ University of Paris, School of Medicine, Paris 75005, France; Virology Department, Cochin Hospital, Paris Public Hospitals (APHP), Paris 75004, France.
¹⁴ INSERM U955, IMRB- CEpiA team, 94000 Créteil, France Paris Public Hospitals Henri Mondor Hospital (APHP), Créteil 94000, France; Centre National de la Recherche Scientifique CNRS, ERL 7000, Créteil 94000, France; Groupe Hospitalier Paris-Saclay, Hôpital Bicêtre, Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals. Le Kremlin-Bicêtre 94270, France; Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre F-94275, France.

PMID: 32650110
PMCID: PMC7338860
DOI: 10.1016/j.jinf.2020.07.005

Observational Study

Self-reported loss of smell without nasal obstruction to identify COVID-19. The multicenter Coranosmia cohort study

Dominique Salmon Ceron et al. J Infect. 2020 Oct.

. 2020 Oct;81(4):614-620.

doi: 10.1016/j.jinf.2020.07.005. Epub 2020 Jul 7.

Authors

Affiliations

¹ Department of Infectious Diseases and Immunology, Hotel Dieu Hospital, Paris Public Hospitals (APHP), 1 Place du Parvis de Notre-Dame, Paris 75004, France; University of Paris, School of Medicine, Paris 75005, France. Electronic address: dominique.salmon@aphp.fr.
² Department of Oto-rhino-laryngology, Head and Neck Surgery, Intercommunal Hospital of Créteil, Créteil 94000, France; University Paris-Est Créteil (UPEC), School of Medicine, Créteil 94000, France; INSERM U955, IMRB- CEpiA team, 94000 Créteil, France Paris Public Hospitals Henri Mondor Hospital (APHP), Créteil 94000, France; Department of Oto-rhino-laryngology, Henri Mondor Hospital of Créteil, Paris Public Hospitals, Créteil 94000, France; Centre National de la Recherche Scientifique CNRS, ERL 7000, Créteil 94000, France.
³ Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, Lariboisière Hospital (APHP), Paris 75010, France; University Paris Diderot, School of Medicine, Paris 75010, France.
⁴ Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, AP-HP Sorbonne University Hospital Pitié Salpêtrière Hospital (AP-HP), Paris 75006, France; Sorbonne University, Paris 75013, France.
⁵ Groupe Hospitalier Paris-Saclay, Hôpital Bicêtre, Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals. Le Kremlin-Bicêtre 94270, France; Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre F-94275, France.
⁶ Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, AP-HP Sorbonne University Hospital Pitié Salpêtrière Hospital (AP-HP), Paris 75006, France.
⁷ University Paris-Est Créteil (UPEC), School of Medicine, Créteil 94000, France; INSERM U955, IMRB- CEpiA team, 94000 Créteil, France Paris Public Hospitals Henri Mondor Hospital (APHP), Créteil 94000, France; Clinical Research Unit: (URC-Mondor), Department of Public Health, Henri Mondor Hospital Paris Public Hospitals (AP-HP), Créteil 94000, France.
⁸ Department of Infectious Diseases and Immunology, Hotel Dieu Hospital, Paris Public Hospitals (APHP), 1 Place du Parvis de Notre-Dame, Paris 75004, France.
⁹ Cerba Laboratory, Saint-Ouen L'Aumône, France.
¹⁰ Emergency Department, Hotel Dieu Hospital, Paris Public Hospitals (APHP), Paris 75004, France.
¹¹ Department of Oto-rhino-laryngology Head and Neck Surgery, Hopital Rothschild Foundation, Paris, France.
¹² University of Paris, School of Medicine, Paris 75005, France; General Medical Practioner, Paris, France.
¹³ University of Paris, School of Medicine, Paris 75005, France; Virology Department, Cochin Hospital, Paris Public Hospitals (APHP), Paris 75004, France.
¹⁴ INSERM U955, IMRB- CEpiA team, 94000 Créteil, France Paris Public Hospitals Henri Mondor Hospital (APHP), Créteil 94000, France; Centre National de la Recherche Scientifique CNRS, ERL 7000, Créteil 94000, France; Groupe Hospitalier Paris-Saclay, Hôpital Bicêtre, Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals. Le Kremlin-Bicêtre 94270, France; Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre F-94275, France.

PMID: 32650110
PMCID: PMC7338860
DOI: 10.1016/j.jinf.2020.07.005

Abstract

Objectives: To determine the frequency of SARS-CoV-2 positive samples in a subset of patients consulting for primarily isolated acute (<7 days) loss of smell and to assess the diagnostic accuracy of olfactory/gustatory dysfunction for COVID-19 diagnosis in the overall population tested for COVID-19 in the same period.

Methods: Prospective multicentric cohort study in four olfactory ENT units and a screening center for COVID-19.

Results: i) Among a subset of 55 patients consulting for primarily recent loss of smell, we found that 51 (92.7%) had a COVID-19 positive test (median viral load of 28.8 cycle threshold). Loss of smell was mostly total (anosmia), rarely associated with nasal obstruction but associated with a taste disorder in 80%. Olfactory dysfunction occurred suddenly, either as first complaint or preceded by mild symptoms occurring a median of 3 days. The majority of patients (72.9%) partially recovered the sense of smell within 15 days. ii) In a population of 1824 patients tested for COVID-19, the positive predictive value and the specificity of loss of smell and/or taste were 78.5% and 90.3% respectively (sensitivity (40.8%), negative predictive value (63.6%)).

Conclusions: Self-reported loss of smell had a high predictive positive value to identify COVID-19. Making this sign well known publicly could help to adopt isolation measures and inform potential contacts.

Keywords: Anosmia; COVID-19; Dysguageusia; Loss of smell; Positive predictive value; SARS-CoV-2; Viral load.

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Conflict of interest statement

Declaration of Competing Interest All the authors have read and agreed with the paper's content. No authors have financial or personal conflicts. Neither the work nor any part of its essential substance, tables or figures have been or will be published or submitted to another scientific journal or are being considered for publication elsewhere.

Figures

**Fig. 1**
Frequency of rhinologic symptoms in the study population (n = 55 patients) Values are percentage of patients. COVID-19: Coronavirus Disease 2019.

See this image and copyright information in PMC

Comment in

Magnetic resonance imaging of COVID-19 anosmic patients reveals abnormalities of the olfactory bulb: Preliminary prospective study.
Chetrit A, Lechien JR, Ammar A, Chekkoury-Idrissi Y, Distinguin L, Circiu M, Saussez S, Ballester MC, Vasse M, Berradja N, Hans S, Carlier R, Edjlali M. Chetrit A, et al. J Infect. 2020 Nov;81(5):816-846. doi: 10.1016/j.jinf.2020.07.028. Epub 2020 Jul 30. J Infect. 2020. PMID: 32739489 Free PMC article.

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References

1. Paules C.I., Marston H.D., Fauci A.S. Coronavirus infections-more than just the common cold. JAMA. 2020 - PubMed
1. Hopkins C., Surda P., Kumar N. Presentation of new onset anosmia during the COVID-19 pandemic. Rhinology. 2020 - PubMed
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[1] Paules C.I., Marston H.D., Fauci A.S. Coronavirus infections-more than just the common cold. JAMA. 2020 - PubMed

[2] Paules C.I., Marston H.D., Fauci A.S. Coronavirus infections-more than just the common cold. JAMA. 2020 - PubMed

[3] Hopkins C., Surda P., Kumar N. Presentation of new onset anosmia during the COVID-19 pandemic. Rhinology. 2020 - PubMed

[4] Hopkins C., Surda P., Kumar N. Presentation of new onset anosmia during the COVID-19 pandemic. Rhinology. 2020 - PubMed

[5] Yu X., Sun S., Shi Y., Wang H., Zhao R., Sheng J. SARS-CoV-2 viral load in sputum correlates with risk of COVID-19 progression. Crit Care Lond Engl. 2020;24:170. - PMC - PubMed

[6] Yu X., Sun S., Shi Y., Wang H., Zhao R., Sheng J. SARS-CoV-2 viral load in sputum correlates with risk of COVID-19 progression. Crit Care Lond Engl. 2020;24:170. - PMC - PubMed

[7] Lechien J.R., Chiesa-Estomba C.M., De Siati D.R. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol - Head Neck Surg. 2020 - PMC - PubMed

[8] Lechien J.R., Chiesa-Estomba C.M., De Siati D.R. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Oto-Rhino-Laryngol Off J Eur Fed Oto-Rhino-Laryngol Soc EUFOS Affil Ger Soc Oto-Rhino-Laryngol - Head Neck Surg. 2020 - PMC - PubMed

[9] Bénézit F., Le Turnier P., Declerck C. Utility of hyposmia and hypogeusia for the diagnosis of COVID-19. Lancet Infect Dis. 2020 - PMC - PubMed

[10] Bénézit F., Le Turnier P., Declerck C. Utility of hyposmia and hypogeusia for the diagnosis of COVID-19. Lancet Infect Dis. 2020 - PMC - PubMed

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Self-reported loss of smell without nasal obstruction to identify COVID-19. The multicenter Coranosmia cohort study

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Self-reported loss of smell without nasal obstruction to identify COVID-19. The multicenter Coranosmia cohort study

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