As Otolaryngologists we have seen an increase in patients who have lost their sense of smell (Anosmia) during this COVID-19 pandemic. We are two ENTs here to answer your questions about all Coronavirus related ENT issues, including when it is a go...

How often is your mom calling you saying she is worried and you should have studied law?

Haha, well my mom is Chinese so she only believes that one profession exists.

ohmigod... i needed that

Haha. Funny story. When my mom was growing up her dad took her to a drive up fast food restaurant and a roller skate waitress took their order. When she skated away, my mother told my grandfather she wanted to be a roller-waitress when she grew up. My grandfather (who was a 1st generation Chinese immigrant Physician) replied, “Ingrid, you can do anything you want once you get your M.D.”

True story. Hope you enjoy it.

Good grief, funny but sad.

Different times...

Is there a preferred substance that is used to determine if anosmia is present? Would it be a faint or strong scent?

Also, is it weird that the word "anosmia" is "a nose" missing in action (mia)?

Haha that is a great observation. Cannot believe we have never heard that before.

Is the anosmia permanent?

We don't have enough data to know for sure but early reports are showing that it CAN come back. That doesn't mean it will for sure and some of our colleagues in Other countries have said they have remained without smell or taste since onset months ago. There are a lot of causes of anosmia though so it would be wise to workup for other things unless you know you were COVID positive via testing.

I’m starting to get a sore throat, dull headache, occasional cough and post nasal drip. I see conflicting reports that some of these are symptoms. Would it be best to just wait and see since it is allergy season also?

Yes these are symptoms but do not mean you have it for sure. Dr. Rami made a great handout you can find here if you want to know more. If you are able to quarantine then please just stay home and away from immunocompromised people for 14 days from symptoms if possible.

I believe I have COVID19 (tests in my area are only for very very sick people and healthcare workers, which is wise, but I've had the symptoms-dry cough, fever, headache, difficulty breathing / "floor" in my lungs, shortness of breath, and ongoing lung pain for 7+ days, quarantined for 10).

On the day I was sickest, I woke up and my bedroom smelled like bread yeast (kind of hard to describe, but a lot like dough that was rising). My husband couldn't smell it at all. Is it possible I can smell the disease? It was super weird.

Yes, unfortunately we are only able to test those that are elderly, very sick, or caring for those directly that are also in those boats. Just stay isolated and it should pass. Sounds like you are improving now. That cough sounds NASTY! If your husband gets similar symptoms make sure he stays quarantined as well. Here is some info on when to exit quarantine.

Are those that are asymptomatic actually showing ZERO symptoms or are they having incredibly light symptoms to the point of disregard? Its hard to imagine that an average individual thats contracted COVID-19 can show no symptoms and be completely fine and on the other hand these incredibly healthy athlete's are being put on ventilators. Thank you!

There is way more to our genetic composition and immune system then we know. The body and the immune system in general are incredibly variable. Yes it is possible to have the virus and never know. Just like in many homes a spouse can be very sick and the other never gets it. That is why this virus is so dangerous. The spread is so fast and it is incredibly virulent.

Hi doctors,

Type I diabetic on a pump here in his mid 30s. A1C rides at a steady 5% due to micromanaging the condition and an ultra low carb intake.

My question is: What is it about the corona virus that immediately places me into the high-risk/immuno- compromised, etc. population? Is it just that blood glucose management is made more difficult when you become ill, or are there other factors that just don't get discussed beyond the warnings that I'm seeing everywhere about us diabetics?

This is a great question that I am underqualified to answer. It sounds like you do a great job managing your glucose. In general those with DM have relative immunosupression but as you know not all diabetics are created equal. I think your observation about how your body responds if you do get infected is likely the best answer I could give. In reality the physiology is likely much more complex. I presume it comes down to mitochondrial response and immune response and that DM has suppression of immune response. Whatever the reason is I would suggest you quarantine well and subsribe to Netflix if you don't already have it. Might I suggest Tiger King?

My best friend lost her sense of smell and taste due to covid-19 but says she is gaining in back day by day will she continue to improve or she will never get her full sense of smell and taste back?

She might! Tell her to help she can try to do sensory retraining. Just get essential oils and smell them daily and look at the label after she smells. Sound silly but it works!

Are you noticing a difference between certain blood groups handling the virus better than others?

To be honest we aren't in the emergency room so don't have as much access to that. I have seen reports that this is true but I don't think the data is sufficient to know for sure. As a medical community any trend is being closely watched right now but don't forget that everything being published does not have rigorous study behind it. Take what you read with a grain of salt and be smart.

Hey docs!

10 days ago I had an awful headache that felt like a sinus headache (but with no nasal congestion, sneezing, or post nasal drip). Bad enough it caused me to vomit. 3 days later I felt a tiny bit of a heavy chest and was slightly winded walking up one flight of stairs. The next day...anosmia!

An MD friend of mine (at Johns Hopkins) told me my symptoms are in line with probable covid-19 and I’ve been isolating since then. The headache has remained, but it definitely isn’t sinus.

I’ve been counting the headache as my onset of symptoms, but does that make sense with the reports of anosmia? I’ve had a lifetime of sinus issues, including being roto-rootered (polyp removal), so I wasn’t too concerned with the headache (at first) since pollen levels are ridiculous where I live.

Thanks for answering our questions!

Hi there! And sorry you are not feeling well! I think to be on the safe side it's best to self-quarantine and operate as it there is a covid-19 infection. In fact, one thing we are worried about is that other types of pre-existing inflammation in the nose (like sinusitis and nasal polyps) might make it easier for the virus to seat an infection.

But, also treat the concurrent sinusitis as it could be due to allergies or a variety of other reasons. Check out this list of all the other causes of anosmia, as we may be able to get your smell back!

Thanks for answering.

I have zero symptoms of sinusitis other than the headache that “felt” like a sinus headache. Tylenol and Sudafed (usually a godsend) didn’t touch it at all. And just for reference, the polyp removal was 15 years ago.

I’ll definitely stay isolated and check out your link.

Thanks again :)

It is also possible you have a return of your nasal polyps (crazy coincidence!). I'd suggest getting it all checked out after this craziness has ended!

I live in Florida. My wife and I back in Dec-Jan had a really nasty cough that took weeks to go away. I ended up kicking it and was left with a terrible sinus headache that took another few weeks.

We both think we had the virus before it was televised. It was the strangest cough for both of us.

Is this possible? We never visited China.

Yes it is possible that you had the virus but if it was back then it likely passed. Most patients will never know they had it. We don't have any good blood tests to know you have antibiodies though so please stay inside and stay safe!!

What are the main differences that you have found between Coronavirus and a cold/the flu?

It is very difficult to tell the difference right now especially because everyone is so scared. Gastric symptoms are less likely during COVID-19 infections and while body aches and fluctuating fevers can happen in both they seem to be more prominent in influenza. The good news is that most people will pass through all of these symptoms whether it is COVID or Influenza. The key is supportive care, hydration and isolation. If you need more information about symptoms and when to seek care we have a small handout you can find here.

Was there some difficulty in creating a test for coronavirus? It feels like celebrities were getting tests really early but nothing for us common peeps who don't have 5k to shell out.

The issue is that we don't have enough. There are some doctors being investigated for just what you are discussing. It is a question we are ALL asking. If we have such strict criteria, why are the celebrities getting tests? Testing is supposed to be free for all that qualify. The key issue here is that we don't have enough and neither do hospitals. I know one facility that has no RAPID tests and only has 250 nasal swabs left. They are a big system that services millions of people. One of our patients for sure had COVID and severe cough and illness. No test was performed because it did not change the management. We need more community testing centers to help out but nobody can get tests and the barrier to entry is very high.

I’ve been having shortness of breath, which I believe to be purely psychosomatic, as I already have bad anxiety and the symptoms go away when I’m distracted, but for the past day or so my lungs have felt a little raw. I know this isn’t necessarily a covid-specific question, but it would definitely give me some peace of mind to know if a person can experience sore windpipe/lungs from like... breathing too hard and too much?

Sorry to hear you are not feeling well, and if it helps this is a really anxiety provoking time for all of us. It is possible to feel like breathing is labored and a type of soreness by breathing more deeply and rapidly for longer periods of time. It's important to monitor for other symptoms like fever and cough (which usually come first) but if you think it's progressing it's a good idea to connect with a doctor through a telemedicine visit.

Hope you start to feel better, and remember we are all in this together.

Thank you! I’ve read a lot of other’s stories about feeling similar anxiety-induced belabored breathing, and since I don’t have a cough or fever, I’m inclined to think that’s what it is. I’ve been so paranoid and therefore absurdly safe in my quarantining measures, but this really gets in my head.

I have a post nasal/thick mucus thing in the back of my throat (I'm staying at my bfs place and everything is covered in cat hair). It hasn't progressed or changed in about 11 days but I feel you on the anxiety. Drinking cool water, hot tea, and taking deep breaths has been helping because even though it's uncomfortable and panic including I can still get deep breaths. Try that xo

It is incredible how many symptoms people can have from being quarantined. The anxiety and panic sets in and the mind is very powerful. It's ok. Just breathe. Maybe try meditation!

Have you been in quarantine? I have noticed a lot of my patients in quarantine are experiencing complaints such as this.

I know there’s no cure or vaccine for COVID-19, and despite there being various articles and videos on YouTube, there’s no sure way to prevent the coronavirus. With that said, is there anything you recommend doing as an ENT to help bolster up your immune system against this virus? Or anything you would recommend for us not to do ie smoking, etc.?

Sleep is probably your best tool. Getting good restorative deep sleep is the most important developer of NK Cells which fight of viral illness. Deep sleep happens in the first hours of the night. The best way to ensure deep sleep is to have a normal sleep schedule (recommend 930pm bedtime), no alcohol (sorry...), regular exercise (no idea how to do this during quarantine) and almost the most important would be regular wake up time. Get yourself a schedule. Sleep well. Eat well. Stay safe.

If you want more info I suggest looking at Matthew Walker as a source for sleep. Oura ring to measue if you can afford it.

Also, meditation is very helpful during this time. I use an app called "headspace."

I have no financial interest in either of those above. Just like them cuz I'm a nerd...

Sidenote: I am currently ordering taco bell from postmates which is breaking every rule... Not that you needed to know that but we are all HUMAN!

Ok, so I tried getting a test through a clinic and I was told the cost would be $300- I thought the government was making the tests available for free? Turns out the cost was to have the results read to me. The worst part is I have insurance but was told I'd have to pay cash because my plan is not in network.. I know these tests are in high demand but what's your opinion on doctors/clinics capitalizing on having their own supply of tests? Why are some places offering them free and some aren't?

This is a tough subject to tackle. The testing is free to all that need it. There can be a cost if you have no insurance for consultation but if you do qualify the test is free. We wish we could just do consults for free and test for free but then you wouldn't have any doctors...

We are trying our best to take all insurance whether we have a contract or not. We are billing and hoping that the insurance companies will do the right thing. If they don't we know that at least we did. I know that doesn't help you but you can get a consult with us if you live in LA. I promise if you have insurance it won't cost you anything. Sorry for the plug.

How are the wealthy getting tests whereas everyday people and even first responders are struggling to get tested?

That is a great question. My attending in residency used to say this to me. "Geoff, it's not about money. It's ALL about money." As sad as that statement is it holds too much truth.

I suspect that just like anything else, there is always a price. That is why we started our testing center that takes all insurance regardless of contracts. We will do our best to get testing to as many people as we can free of charge. As more tests become available it will become more widely accessible.

Hi Doctors

I am a Speech Pathologist with a background in brain injury rehabilitation. Part of my role includes anosmia testing and therapy.

My question is from a rehabilitation perspective: Do you have any guesses on what the mechanism of the anosmia might be? If so, what approach to rehabilitation would you use to promote sense of smell and taste?

​

Thanks for your time!

Hi! Right now we obviously don't have a lot of data on the pathophysiology but I would assume it is the same as any viral attack on the olfactory nerve. As for rehab, I'm sure you know more than I do about how to rehab it! I would start with time to see if it resolves and afterwards doing sensory retraining to see if there is any ability to regain the sense. I would also look for other causes of nasal obstruction

There were earlier mentions in the media of people with only very mild symptoms. What could those symptoms be?

Fever and cough are the biggest that people have without others. For more info check here

Do you think that everyone should just get tested? Since you can have it for up to 2 weeks without any symptoms?

If we had that ability it would be great. Unfortunately resources are very scarce and we need to save testing for those that really need it. Hopefully innovation will drive a mass production test that everyone can take easily. This is unlikely in the coming months...

It seems like testing is hard to find in SoCal. The city is saying they have places but it feels likes it’s nearly impossible to get a COVID-19 test. Do you know anything about why that is? Is the Government controlling all testing?

Yes this has been a big issue in the US in general and in cities like LA and NYC especially. Testing centers are super hard to come by because we don't have adequate protective equipment in the hospitals and in the clinics. We NEED government support and to make sure we can get tests from outside the country. Nobody understands why we don't have it but some suspect it is to keep the numbers down. I hope that isn't the case, but we were able to find tests as a private practice and even our hospitals don't have them. It is really sad and we are all being exposed right now. We are all doing the right thing by staying inside but it will take much more than that to fight this unprecedented pandemic.

I don't think the government is "controlling" the testing but it sure seems like they aren't helping us get more...

Which populations have you seen anosmia with COVID? Has this been noted globally? Or something your noticing with cases locally.

I wish we had more epidemiologic data. We need more testing to start getting real correlation.

I have ongoing intermittent hyposmia. About 90% of the time, I smell very little or nothing. Occasionally, I'll have a day where it's like someone turned up the volume on every smell by a magnitude of 10.

1) Is loss of smell for most people a reliable indicator that there is something going on, or is this an occasional coincidence?

2) What's the most likely cause of my situation? I don't have midline defects, but I do have major allergies and pituitary issues.

Here are my thoughts:

1. Is loss of smell for most people a reliable indicator that there is something going on, or is this an occasional coincidence?- - I think it is usually more common that there is some pathology than coincidence. Having intermittent hyposmia would make me believe you may have more obstruction than you think which could be seasonal or allergic related. I'd have this checked out for sure. Here are some other causes of anosmia
2. What's the most likely cause of my situation? I don't have midline defects, but I do have major allergies and pituitary issues. - I may have answered this above. Allergies are a very common cause of hyposmia. Have you considered immunotherapy? There are a lot of other things that can help with obstruction. We also do a lot of minimally invasive procedures that can help with nasal obstruction.

We’re under stay-at-home orders, hospitals are getting overrun. Why is it so important to get tested if we’re all going to get COVID-19 anyways?

If we have more data, then we can plan better for how many people have it etc. It would also help with making potential cures and knowing who may have antibodies. Also, if we know the genetic makeup of many people who had it an have no symptoms, we can use AI to find patterns and maybe find a cure.

As long as I can remember, I have had little to no sense of smell. I had a septoplasty done in January and while I can finally breathe through my nose, I still have little to no sense of smell. The smell has to be really strong, and I have to be right on top of it to smell it. Cooking gets interesting. Why can't I smell things like a normal person?

There are a number of causes of anosmia but yours sound like they may be genetic. Airflow is a very important part of that. Septoplasty can address the inside of the nose but the majority of flow starts with your nostrils or nasal valve. If you do notice when you breathe in well that you get smell back you may be able to improve it. This is a novel new procedure that addresses the nasal valve and septal swell bodies which can obstruct airflow higher into the nasal cavity. Be happy to help if you need more info on it.

Do patients that had anosmia and recover, get 100% of their sense of smell and taste back or is it generally muted compared to before the loss?

Also how do patients with Covid-19 that presumably have it in their nose and throat prevent it from spreading to their lungs?

Question 1: That is hard to know and is widely variable. It is possible to get 100% back, 0% back, or somewhere in between.

Question 2: They don't. Your immune system will start to fight it immediately, but many patients get acute bronchitis which is why they are coughing.

When is the best idea to get tested? Thank you for your hard work! Stay safe!

I agree with Dr. Rami. I would add that another reason to be tested is if you work in the healthcare industry and are exposed to other people and patients or if you are the sole caregiver for somone over 65 or that is immunocompromised. I would not recommend getting tested in an ER though. Find a local testing center or someone that does telehealth to get screened first.

If you do test positive for COVID-19, how long after you stop showing symptoms are you still contagious?

Up to 14 days! If you are positive stay in quarantine for at least 2 weeks after last symptoms to be safe. More info here

Is it possible to test positive for both Covid-19 and a flu strain?

I tested positive for Flu B around a month and a half ago after having to take a friend to the ER. I had all the normal flu symptoms: a high fever, aches, sore throat that felt like glass, and a mostly dry cough so bad I couldn’t catch my breath and would leave me gasping for air. Now I’m wondering if I was possibly infected with both?

*Edited to add I also experienced a mild loss of my ability to taste anything except for sweet. Even salt had no real taste at the time.

Yes you can definitely be positive for both but as Dr. Rami said it would be really unlucky. If you have symptoms now I would seek help. Find someone doing telehealth that can screen you and find out if there is a testing center anywhere near you if you are around any elderly people. If you can self quarantine you don't need to be tested.

How many more months, years, or decades should the global lockdown continue?

This is a question for an epidemiologist and the range I have heard is very wide. We live in LA so will likely be locked down for some time. I would say at least 1-2 months to protect our elderly and hospital bandwidth. I just spoke to our hospital CEO today and they don't even have access to tests or ventilators to ramp up right now. We need more testing centers right now so that we can get real numbers and data to answer questions like this.

My friends and I were discussing this the other day and couldn’t find an answer, but would smoking marijuana maybe once or twice a day increase a person’s susceptibility to the more pernicious symptoms of COVID-19? Or in other words, would you recommend people stop smoking marijuana or would you consider the additional risk (if any) negligible?

As doctors we almost always recommend people don't smoke. I would say that if you are healthy otherwise and staying in quarantine then the increased risks are negligible. THAT SAID! This virus attacks surfactant in the lungs which is very important in clearance. It does not always cause a focal pneumonia but it attacks the alveoli diffusely which causes ARDS (a deadly lung disease). Even those that come out of that will take months to recover on a ventilator. There are multiple cases of this happening to young people. Smoke at your own risk...

Fortunately all of my friends that do smoke are paranoid enough to have given it up for now, but I greatly appreciate your response. Fighting misinformation right now is vital and you guys are doing great work by doing things like this. Thank you!

Ha! I love that the paranoia potentially caused by the marijuana could be the saving grace! Sometimes the symptom is the cure I guess.

how does using a nasal rinse impact someone who has Covid-19?

does it help clear the infection? or would it aspirate some of the virus and have it enter where it should not? (your lungs)

The evidence is uncertain, but many have said to stop using nasal corticosteroids if you suspect COVID-19 infection.

Hey docs. Have you seen anything convincing on why sars-cov-2 causes anosmia? Is it viral infection of nerve nasal nerves? And would this imply that meningitis or brain involvement is possible?

Also, can other viruses like the herpesviruses cause the same effect?

Most viral attacks can cause anosmia but we aren't sure why this one seems to have a higher preponderance to cause it. I don't think there is any reason to believe that there is a higher yield of meningitis. Most are dying from ARDS or other Pulmonary issues due to the attack on surfactant in the lungs. I'm sure we will know much more in a year or so but that doesn't help anybody right now...

Do you think there's a neural component to SARS-CoV-2 infection? Could this explain some anosmia in the absense of congestion? Maybe some of the headaches as well?

Most viral attacks can cause anosmia but we aren't sure why this one seems to have a higher preponderance to cause it. I don't think there is any reason to believe that there is a higher yield of meningitis. Most are dying from ARDS or other Pulmonary issues due to the attack on surfactant in the lungs. I'm sure we will know much more in a year or so but that doesn't help anybody right now...

Sorry for the cut and paste but I just answered it!

What do you mean when you say you "need to save testing for those that really need it" ? Who is the ultimate triage decider here?... Are you really going to turn people away? I'm hearing of the young and the old dying and also hearing it can go from mild to severe very quickly. I know there are more and more testing popups happening and I didn't think they were limiting who could go?

Everyone is saying we aren't testing enough but aren't they going as fast as they can? It seems like we need to test as many as we can as long as their symptoms are legit and not try and reserve them "for those who really need it."

I have no clue who makes the tests or how long it takes to make them, but at least we are leading the world right now and trying to figure it out?

The problem right now is we have no tests available. This is a real issue. We wish we could test everyone and some say the way to save the economy in general is to test everyone. We just don't have the bandwidth to do so.

Right now the ultimate decider is the CDC. We are starting a testing center but our legal council has been very strict on who we can test. The criteria are very stringent. The idea is that we need to save hospitals and beds for those that are dying. We will run out very quickly if we don't slow the curve.

I know it is sad that people are not getting tested due to lack of tests. Please do anything you can to support further tests being made and shipped to the US so we can test more people.

Is loss of usually a stand alone symptom or is this accompanied by other indications?

As Dr. Rami says it usually comes with other symptoms but standalone anosmia is possible

I recently returned from "London", developed some symptoms, and have been self isolating for almost 2 weeks. The only real symptom I have left is a cough, and I'm wondering if that could mean I'm no longer contagious and might just have a lingering cough not due to any viral infection? From what I've read online it seems like anyone who contracted COVID is over it within 2 weeks, so why would it be that this one symptom isn't resolving for me?

This could definitely be a lingering symptom of something else entirely. Unfortunately, with the travel history you are still considered high risk. If you work around or live with anyone who is immunocompromised I would highly recommend staying in isolation until your symptoms are gone. You may want to try and find a doctor in your area that does telehealth to see how bad the cough really is. Lots of things can cause a lingering cough. If you have a testing site near you I would inquire (but only if you care for or are around healthcare providers or elderly).

Can It just pass without affecting the person a lethally?

Yes! In fact most people will not be affected at all as Dr. Abdou said. The reason for all the quarantine is that the virus spreads so easily and is very virulent. It is actually BECAUSE people have no symptoms that it is very dangerous. Imagine a virus that has a high death rate but low transmission. This is much easier to control (think Ebola). This virus is hard to control because so many people can have it without symptoms. They then pass it to elderly people who wind up in the hospital. Because the rate of infection is so high, even the low % of people with the disease requiring hospitalization will overrun our health care system which is ill equipped to handle it. Scary, scary stuff. Stay inside. Stay safe. Lets slow this curve together.

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I agree with Dr. Rami. I have not seen this as a presenting symptom. Are you in complete isolation right now?