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. 2020 Apr 24;277(8):2389–2390. doi: 10.1007/s00405-020-05999-5

The role of self-reported olfactory and gustatory dysfunction as a screening criterion for suspected COVID-19

Liang En Wee 1,2,, Yvonne Fu Zi Chan 2, Neville Wei Yang Teo 3, Benjamin Pei Zhi Cherng 2, Siew Yee Thien 2, Hei Man Wong 2, Limin Wijaya 2, Song Tar Toh 3, Thuan Tong Tan 2
PMCID: PMC7180656  PMID: 32328771

Dear Editor,

We read with interest the paper written by Lechien et al. [1] describing a multi-centre cohort of COVID-19 patients, in which 85.6% had olfactory or taste disorders (OTD). If the association between COVID-19 and OTD is not recognized, the diagnosis may be missed. However, while a large proportion of COVID-19 patients had OTD, [13] the actual specificity as a criterion for screening suspected COVID-19 cases is unknown, as other viral infections may also cause OTD. Other studies have reported patients presenting with acute anosmia with or without upper respiratory tract symptoms, [4, 5] but not all patients were tested for COVID-19 [4]. Additionally, information on OTD in Asian cohorts is lacking [1]. In Singapore, the first case of COVID-19 was reported in end-January 2020. At our institution, the largest acute hospital in Singapore, from end-March 2020 all new admissions were screened for self-reported OTD at emergency department (ED) triage. All patients reporting new-onset OTD were admitted to exclude COVID-19. We report our experience using self-reported OTD as a screening criterion for suspected COVID-19.

Over a 2-week period from 26 March–10 April 2020, given ongoing community transmission and the difficulty in distinguishing COVID-19 from ordinary viral infection, a questionnaire including respiratory symptoms, self-reported OTD, and travel and epidemiological risk factors was administered at ED triage to risk-stratify admissions. Suspect case criteria for COVID-19 were defined as the presence of respiratory symptoms and suspicious epidemiological links or travel history; or new-onset OTD. Testing was not limited to hospitalised inpatients; as part of the national strategy of containment, all patients who fulfilled suspect case criteria for COVID-19 were tested via real-time reverse transcription PCR (rRT-PCR) of oropharyngeal swabs, even if hospitalization was not otherwise required. Inpatient, if patients had respiratory symptoms and a viral prodrome, or OTD, oropharyngeal specimens were also tested for a routine panel of respiratory viruses. As this study was based on aggregated surveillance data, ethics approval was not required under our hospital’s Institutional Review Board guidelines.

Over the study period, a total of 870 patients fulfilled suspect case criteria for COVID-19 at ED triage. A minority (5.05%, 44/870) presented with OTD. The majority of suspects (65.3%, 568/870) were well and discharged to self-isolate while awaiting results. Amongst suspected COVID-19 cases, 154 patients (17.9%, 154/870) tested positive. Of those, roughly one-fifth (22.7%, 35/154) had OTD. The presence of OTD had high specificity as a screening criterion for COVID-19 (98.7%, 95% CI 97.6–99.4%), but lower sensitivity (22.7%, 95% CI 16.4–30.2%). This was roughly equivalent to the specificity and sensitivity of a history of close contact with a confirmed COVID-19 case (specificity: 94.8%, 95% CI 93.0–96.3%; sensitivity: 27.3%, 95% CI 20.4–35.0%), Supplementary Table 1. Amongst the 35 COVID-19 positives with concomitant OTDs, three presented with isolated anosmia without other symptoms. Fever was the most common concomitant symptom (21/35, 60.0%), followed by cough (10/35, 28.5%) and rhinorrhea (10/35, 28.5%). Over the same period, a total of 71 admitted inpatients tested positive for other respiratory viruses, of which the most common was rhinovirus (53.5%, 38/71); followed by influenza (21.1%, 15/71), adenoviruses (8.5%, 6/71), other coronaviruses (7.0%, 5/71). Only 2.8% (2/71) self-reported OTD (one rhinovirus, one human coronavirus 229E). Amongst patients with PCR-proven acute respiratory viral infections, those positive for COVID-19 had higher odds of OTD compared to those positive for other respiratory viruses (odds ratio, OR = 10.14, 95% CI 2.37–43.49, p < 0.001).

In conclusion, self-reported OTD had high specificity as a screening criterion for COVID-19 in an Asian cohort. Patients with COVID-19 appeared to have higher odds of OTD compared to those positive for other respiratory viruses. Routine screening in patients with new-onset OTD can improve case detection during a COVID-19 outbreak.

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Funding

This work was not grant-funded.

Compliance with ethical standards

Conflict of interest

The authors report no conflicts of interest.

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References

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Articles from European Archives of Oto-Rhino-Laryngology are provided here courtesy of Nature Publishing Group

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