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. 2025 Sep 2;8(9):e2533815.
doi: 10.1001/jamanetworkopen.2025.33815.

Olfactory Dysfunction After SARS-CoV-2 Infection in the RECOVER Adult Cohort

Leora I Horwitz  1   2 , Jacqueline H Becker  3 , Weixing Huang  4 , Teresa Akintonwa  5 , Maxwell M Hornig-Rohan  5 , Gabrielle Maranga  1 , Dara R Adams  6 , Mark W Albers  7 , Mirna Ayache  8 , Jasmine Berry  9 , Hassan Brim  10 , Tanner W Bryan  11 , Alexander W Charney  12 , Robert A Clark  13 , Melissa M Cortez  14 , Brian D'Anza  15 , Hannah Davis  16 , Sarah E Donohue  17 , Nathaniel Erdmann  18 , Valerie Flaherman  19 , Tamara G Fong  20 , Jennifer A Frontera  21 , Mark P Goldberg  22 , Jason D Goldman  23   24 , Michelle S Harkins  25 , Sally L Hodder  26 , Vanessa L Jacoby  27 , Prasanna Jagannathan  28 , Xiaolin Jia  28 , John Daniel Kelly  29 , Jerry A Krishnan  30 , Andre Kumar  28 , Adeyinka O Laiyemo  10 , Emily B Levitan  31 , Jeffrey N Martin  32 , Kathryn M McCaffrey  33 , Grace A McComsey  34 , Torri D Metz  35 , Ganesh Murthy  36 , Helen Nguyen  33 , Megumi Okumura  37   38   39 , Samuel Parry  40 , Sairam Parthasarathy  41 , Thomas F Patterson  42 , Michael J Peluso  43 , Christina Sorochinsky  4 , Tiffany Walker  44 , Samantha L Wiegand  45 , Zanthia Wiley  46 , Juan Wisnivesky  47 , Hassan Ashktorab  10 , Andrea Foulkes  4   48   49 , Joyce K Lee-Iannotti  36 ; Researching COVID to Enhance Recovery Consortium
Collaborators, Affiliations

Olfactory Dysfunction After SARS-CoV-2 Infection in the RECOVER Adult Cohort

Leora I Horwitz et al. JAMA Netw Open. .

Abstract

Importance: Olfactory dysfunction is common after SARS-CoV-2 infection and has been associated with cognitive loss in other conditions. Formal testing is needed to characterize the presence, severity, and patterns of olfactory dysfunction.

Objective: To characterize long-term olfactory dysfunction after SARS-CoV-2 infection.

Design, setting, and participants: This prospective cohort study included adults enrolled in the Researching COVID to Enhance Recovery (RECOVER)-Adult study. All those with and a random sample of those without self-reported change or loss in smell or taste were offered olfactory testing, performed at 83 sites in 35 US states and territories. Participants included 2956 enrollees with prior infection (1393 with and 1563 without self-reported change or loss) and 569 without prior infection (9 with and 560 without self-reported change or loss in taste) who underwent olfactory testing a mean (SD) of 671.6 (417.8) days after the index date. Data were collected from October 29, 2021, to June 6, 2025.

Exposure: SARS-CoV-2 infection.

Main outcomes and measures: Olfactory function, as defined by age- and sex-standardized performance on the University of Pennsylvania Smell Identification Test (UPSIT), a well-validated test comprising 40 unique odors.

Results: The study included 3525 participants with a mean (SD) age of 47.6 (15.2) years; of 3520 with data available, 2548 (72.4%) were female or intersex. Among 1393 infected participants with self-reported change or loss, 1111 (79.8%) had hyposmia on the UPSIT, including 321 (23.0%) with severe microsmia or anosmia. Among 1563 infected participants without self-reported change or loss, 1031 (66.0%) had hyposmia, including 128 (8.2%) with severe microsmia or anosmia. Participants with prior infection and self-reported change or loss scored at the 16th age- and sex-standardized UPSIT percentile, compared with the 23rd and 28th percentiles for those without self-reported change or loss with and without prior known infection, respectively. Younger women had scores corresponding to lower mean age- and sex-standardized percentiles. Among participants who self-reported change or loss in smell, those with abnormal UPSIT scores more often reported cognitive problems (742 of 1111 [66.8%]) than those with normal UPSIT scores (179 of 282 [63.5%]).

Conclusions and relevance: In this cohort study of RECOVER-Adult participants, self-reported change or loss in smell or taste was an accurate signal of verified hyposmia, but a high rate of hyposmia among those with no reported change or loss was also observed. Formal smell testing may be considered in those with prior SARS-CoV-2 infection to diagnose occult hyposmia and counsel patients about risks.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Albers reported being a cofounder and shareholder of Aromha Inc outside the submitted work. Dr Flaherman reported receiving grant support from the National Institutes of Health (NIH) during the conduct of the study. Dr Goldman reported receiving grant support from Gilead Sciences Inc, personal fees from Gilead Sciences Inc, Invivyd Inc, and Merck & Co Inc, and performing contracted research for Helix and Gilead Sciences Inc outside the submitted work. Dr Hodder reported receiving grant support from the NIH for the Clinical & Translational Science Institute and several clinical trials during the conduct of the study and serving on the scientific advisory board for HIV for Gilead Sciences Inc outside the submitted work. Dr Jacoby reported receiving grant support from the NIH during the conduct of the study. Dr Krishnan reported receiving personal fees from AstraZeneca, MedImmune LLC, Verona Pharma, and Inogen and grant support from BioVie Inc outside the submitted work. Dr Levitan reported receiving grant support from Amgen Inc and serving on the data safely monitoring board for University of Pittsburgh outside the submitted work. Dr Metz reported receiving grant support from Pfizer Inc as a site principal investigator (PI) for a study of administration of Paxlovid in pregnancy for mild to moderate COVID-19, Moderna as a site PI for a study of an respiratory syncytial virus (RSV) vaccine during pregnancy, and Pfizer Inc as a site PI for a study of an RSV vaccine in pregnancy outside the submitted work. Dr Nguyen reported grants from NIH during the conduct of the study. Dr Parthasarathy reported receiving consulting fees from AbbVie Inc, Jazz Pharmaceuticals plc, and Apria Healthcare Inc outside the submitted work. Dr Peluso reported receiving personal fees from Gilead Sciences Inc, BioVie Inc, Apellis Pharmaceuticals Inc, and BioNTech SE and nonfinancial support from Aerium Therapeutics and Shionogi Inc outside the submitted work. Dr Wisnivesky reported receiving personal fees from Banook, Sanofi SA, PPD Inc, and the American Medical Association and grant support from Sanofi SA, Boehringer Ingelheim, Regeneron Pharmaceuticals Inc, and Axcella outside the submitted work. Dr Ashktorab reported receiving grant support from Howard University during the conduct of the study. Dr Foulkes reported receiving grant support from the NIH during the conduct of the study and personal fees from Roundtable outside the submitted work. No other disclosures were reported.

Figures

Figure.
Figure.. Flow Diagram of Participants Included in Analysis
Self-report yes or no indicates self-reported change in or loss of smell or taste. RECOVER indicates Researching COVID to Enhance Recovery; UPSIT, University of Pennsylvania Smell Identification Test.
See this image and copyright information in PMC

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