Abstract
Sudden loss of smell and/or taste has been identified as an early symptom of SARS-CoV-2 2019 (COVID-19) infection, and presents an effective target for prompt self-isolation and reducing community spread. The current study sought to develop and test a novel, rapid, self-administered test to objectively measure smell and taste losses associated with COVID-19, and administered self-report questionnaires to characterise symptoms associated with COVID-19 in Singapore. Participants (N = 99) completed questionnaires to record recent changes in smell and taste ability. This was followed by the ‘Singapore Smell and Taste Test’ (SSTT), a personal, objective testing kit for daily self-assessment of smell and taste function at their place of residence. Seventy-two recruited participants were confirmed as COVID-19 positive at baseline, of which 58 completed the SSTT at home. Of these, 36.2% had objectively measured smell and/or taste loss. The SSTT measures of smell and taste function were positively associated with participants’ self-reported smell and taste acuity, and rated smell intensity of 6 common household items. This study presents the first application of the SSTT as a rapid, cost-effective, objective tool to self-monitor smell and taste function in a residential setting, and ensures comparability across individuals through the use of standardised stimuli. The SSTT has potential for future application in populations with limited access to formal COVID-19 testing as a self-administered objective method to monitor sudden changes in smell and taste, and to prompt early self-isolation, in order to reduce community transmission of COVID-19.
Highlights
IntroductionSudden loss of smell (anosmia) and/or taste (ageusia) are globally recognised as key symptoms of Severe Acute Respiratory Syn drome Coronavirus 2 infection (SARS-CoV-2) (causing the disease known as COVID-19) (American Academy of Otolaryngology-Head and Neck Surgery, 2020; ENT UK, 2020b, 2020a; European Rhinologic So ciety, 2020; French Society of ENT (SFORL), 2020; Gane et al, 2020; Menni et al, 2020; Pellegrino et al, 2020), alongside fever, dry cough, fatigue and breathing difficulties (World Health Organisation, 2020).Many global public health bodies, including the Singapore Ministry of Health (2020), recommend that individuals at risk monitor their sense of smell and taste, and self-isolate and present for formal diagnostic testing should they experience any sudden changes (American Academy of Otolaryngology-Head and Neck Surgery, 2020; Centers for Disease Control and Prevention, 2020; ENT UK, 2020b, 2020a; Public Health England, 2020; World Health Organisation, 2020).Data from self-report questionnaires collected across many countries and clinical populations demonstrate an association between sudden onset smell and/or taste loss and SARS-CoV-2 infection (Bagheri et al., Abbreviations: COVID-19, Coronavirus disease 2019; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2; PCR, Polymerase Chain Reaction; SSTT, The Singapore Smell and Taste Test; SSTQ, The Singapore Smell and Taste Questionnaire; SNOT-22, 22-item Sino-Nasal Outcome test; visual analogue scale (VAS), Visual Analogue Scale.2020; Klopfenstein et al, 2020; Lechien, Chiesa-Estomba, De Siati, et al, 2020; Lechien, Chiesa-Estomba, Hans, et al, 2020; Parma et al, 2020; Yan et al, 2020)
Data from self-report questionnaires collected across many countries and clinical populations demonstrate an association between sudden onset smell and/or taste loss and SARS-CoV-2 infection
Many participants did not complete the daily home test procedure for 28 days. We attribute this to a lack of direct in-person contact with participants and no follow-up requirements with the remotely administered protocol, the lack of financial incentives for participants to complete the full protocol remotely, and that many stopped completing the daily testing procedure once they had recovered from COVID-19, which usually occurs in the first 10–14 days postinfection
Summary
Sudden loss of smell (anosmia) and/or taste (ageusia) are globally recognised as key symptoms of Severe Acute Respiratory Syn drome Coronavirus 2 infection (SARS-CoV-2) (causing the disease known as COVID-19) (American Academy of Otolaryngology-Head and Neck Surgery, 2020; ENT UK, 2020b, 2020a; European Rhinologic So ciety, 2020; French Society of ENT (SFORL), 2020; Gane et al, 2020; Menni et al, 2020; Pellegrino et al, 2020), alongside fever, dry cough, fatigue and breathing difficulties (World Health Organisation, 2020).Many global public health bodies, including the Singapore Ministry of Health (2020), recommend that individuals at risk monitor their sense of smell and taste, and self-isolate and present for formal diagnostic testing should they experience any sudden changes (American Academy of Otolaryngology-Head and Neck Surgery, 2020; Centers for Disease Control and Prevention, 2020; ENT UK, 2020b, 2020a; Public Health England, 2020; World Health Organisation, 2020).Data from self-report questionnaires collected across many countries and clinical populations demonstrate an association between sudden onset smell and/or taste loss and SARS-CoV-2 infection (Bagheri et al., Abbreviations: COVID-19, Coronavirus disease 2019; SARS-CoV-2, Severe Acute Respiratory Syndrome Coronavirus 2; PCR, Polymerase Chain Reaction; SSTT, The Singapore Smell and Taste Test; SSTQ, The Singapore Smell and Taste Questionnaire; SNOT-22, 22-item Sino-Nasal Outcome test; VAS, Visual Analogue Scale.2020; Klopfenstein et al, 2020; Lechien, Chiesa-Estomba, De Siati, et al, 2020; Lechien, Chiesa-Estomba, Hans, et al, 2020; Parma et al, 2020; Yan et al, 2020). Sudden loss of smell (anosmia) and/or taste (ageusia) are globally recognised as key symptoms of Severe Acute Respiratory Syn drome Coronavirus 2 infection (SARS-CoV-2) (causing the disease known as COVID-19) (American Academy of Otolaryngology-Head and Neck Surgery, 2020; ENT UK, 2020b, 2020a; European Rhinologic So ciety, 2020; French Society of ENT (SFORL), 2020; Gane et al, 2020; Menni et al, 2020; Pellegrino et al, 2020), alongside fever, dry cough, fatigue and breathing difficulties (World Health Organisation, 2020). Self-report measures of smell and taste often rely on in dividuals noticing these changes, which may result in under-reporting and not accurately reflect the prevalence of these symptoms This is likely because the relationship between self-reported and objectively measured sensory function is typically low (Landis et al, 2003). A recent meta-analysis highlighted the need for objective sensory testing with standardised stimuli to identify and track COVID-19-related changes (Hannum et al, 2020)
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