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Abstract
In response to the coronavirus disease 2019 (COVID-19) pandemic, countries have implemented various strategies to reduce and slow the spread of the disease in the general population. For countries that have implemented restrictions on its population in a stepwise manner, monitoring of COVID-19 prevalence is of importance to guide the decision on when to impose new, or when to abolish old, restrictions. We are here determining whether measures of odor intensity in a large sample can serve as one such measure. Online measures of how intense common household odors are perceived and symptoms of COVID-19 were collected from 2440 Swedes. Average odor intensity ratings were then compared to predicted COVID-19 population prevalence over time in the Swedish population and were found to closely track each other (r = −0.83). Moreover, we found that there was a large difference in rated intensity between individuals with and without COVID-19 symptoms and the number of symptoms was related to odor intensity ratings. Finally, we found that individuals progressing from reporting no symptoms to subsequently reporting COVID-19 symptoms demonstrated a large drop in olfactory performance. These data suggest that measures of odor intensity, if obtained in a large and representative sample, can be used as an indicator of COVID-19 disease in the general population. Importantly, this simple measure could easily be implemented in countries without widespread access to COVID-19 testing or implemented as a fast early response before widespread testing can be facilitated.
Highlights
The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has, since its first discovery at the end of the year 2019, rapidly spread across countries (Zhu et al 2020)
Odor intensity ratings of common household odors track the estimated prevalence of COVID-19 in the population and the shift in intensity aligned with predicted peak SARS-CoV-2 contagion
We can demonstrate that odor dysfunction is associated with symptoms of COVID19 and that, when an individual progresses from indicating no COVID-19 symptoms to listing COVID-19 symptoms, there is a significant drop in odor intensity as soon as the testing session
Summary
The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has, since its first discovery at the end of the year 2019, rapidly spread across countries (Zhu et al 2020). Reports based on a retrospective review of medical records have generally reported lower prevalence numbers, whereas the majority of publications using self-reported olfactory problems have indicated prevalence numbers around 60% (ranging from 30% to 88%; cf Pellegrino et al forthcoming) This large variation between studies can be attributed to both difference in how olfactory dysfunction was assessed and defined and to what sample (clinical or general population) was recruited to the various studies. The Swedish Public Health Authority recently identified olfactory dysfunction as the most prevalent symptom in the Swedish COVID-19 population estimate. The overwhelming majority of odors stimulate both the olfactory and the so-called trigeminal nerve and produce a feeling of nasal irritation in addition to the odor percept (Lundström et al 2012) It is not known if the trigeminal nerve is affected by the SARS-CoV-2 virus, and a potential home-made test needs to account for this possibility. In a larger sample, odor intensity ratings over time would follow the prevalence of COVID-19 in the general population and, be of potential use as a predictor
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