“We really want to raise awareness that this is a sign of infection and that anyone who develops loss of sense of smell should self-isolate,” said Prof. Claire Hopkins, president of the British Rhinological Society, according to the New York Times. “It could contribute to slowing transmission and save lives.”

Ear, nose and throat specialists and eye doctors were infected and dying in large numbers in earlier reports from Wuhan, China, the epicentre of the coronavirus outbreak, according to Hopkins.

Reports from multiple countries have indicated that significant numbers of coronavirus patients experienced anosmia, the loss of sense of smell, and ageusia, an accompanying diminished sense of taste, according to the Times.

Can viruses get into your nerves?

Viruses and bacteria are constantly bombarding the lining of the nose. Luckily our defence mechanisms prevent most pathogens penetrating into the deeper layers of tissue. Yet some pathogens can penetrate the nasal lining and are known to enter the olfactory nerve, which is responsible for the sense of smell. Pathogens can also enter the trigeminal nerve, which is responsible for controlling biting and chewing, and for sensation in the face. If viruses or bacteria do enter the nerves, the consequences can be serious. Perhaps the most striking example is Bell’s palsy, where part of the face is temporarily paralysed, and which may sometimes be caused by a viral infection of the facial nerve.

How does an infection affect the sense of smell?

This killing of the olfactory nerve cells is likely to be the main reason people lose their sense of smell after an infection. Once 20-30% of the olfactory nerve cells have died, people will report they have lost their sense of smell. If a person has lost 30% of their olfactory nerve cells, they won’t be able to detect enough odour molecules to activate the threshold level for smelling when they breathe normally. However, if they sniff harder they will probably be able to smell enough to recognise an odour. Our research with bacteria has shown that olfactory nerve damage can occur within 24 hours of initial exposure, and (unpublished) results with other viruses show they can act even more quickly. In this way, loss of sense of smell can indeed be an early indicator of a potential pathogen onslaught within the nasal system.

Why is taste affected as well?

What we usually think of as “taste” when we enjoy a delicious meal is actually the combination of smell and taste. When people lose their sense of smell, the major contribution to the enjoyment of food is lost. This is why people may report they have also lost their sense of taste – which strictly speaking depends on the tongue and tastebuds – when they have lost only their sense of smell.

Why do only some people with COVID-19 lose their smell?

Our bodies and immune systems are very diverse, due to genetics and circumstances. Not all people will be susceptible to particular pathogens or affected in the same way. Our research in mice has clearly demonstrated not only that different strains of mice are susceptible to different bacteria but also that different nerve routes can be affected. While we do not yet know if SARS-CoV-2 does harm the olfactory nerve, a similar process could explain why some people report a loss of smell and some don’t.

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