Self-reported loss of smell without nasal obstruction to identify COVID-19. The multicenter Coranosmia cohort study - 22/09/20

Doi : 10.1016/j.jinf.2020.07.005

Dominique Salmon Ceron ^a,^b,^⁎,^{^{#
co-author, equally contributed to the manuscript},}^{^{$
First co-authors, and last co-author equally contributed to this manuscript}} , Sophie Bartier ^c,^d,^e,^f,^g,^{^{$
First co-authors, and last co-author equally contributed to this manuscript}}, Charlotte Hautefort ^h,^i,^{^{#
co-author, equally contributed to the manuscript}}, Yann Nguyen ^j,^k, Jérôme Nevoux ^l,^m, Anne-Laure Hamel ^h,ⁱ, Yohan Camhi ^j, Florence Canouï-Poitrine ^d,^e,ⁿ, Benjamin Verillaud ^h,ⁱ, Dorsaf Slama ^a, Stephanie Haim-Boukobza ^o, Elise Sourdeau ^p, Delphine Cantin ^p, Alain Corré ^q, Agnes Bryn ^b,^r, Nicolas Etienne ^a, Flore Rozenberg ^b,^s, Richard Layese ^d,^e,ⁿ, Jean-François Papon ^e,^g,^l,^m,^{^{#
co-author, equally contributed to the manuscript}}, Emilie Bequignon ^c,^d,^e,^f,^g,^{^{$
First co-authors, and last co-author equally contributed to this manuscript}}
on behalf of the APHP COVID-19 research collaboration
^a Department of Infectious Diseases and Immunology, Hotel Dieu Hospital, Paris Public Hospitals (APHP), 1 Place du Parvis de Notre-Dame, Paris 75004, France
^b University of Paris, School of Medicine, Paris 75005, France
^c Department of Oto-rhino-laryngology, Head and Neck Surgery, Intercommunal Hospital of Créteil, Créteil 94000, France
^d University Paris-Est Créteil (UPEC), School of Medicine, Créteil 94000, France
^e INSERM U955, IMRB- CEpiA team, 94000 Créteil, France Paris Public Hospitals Henri Mondor Hospital (APHP), Créteil 94000, France
^f Department of Oto-rhino-laryngology, Henri Mondor Hospital of Créteil, Paris Public Hospitals, Créteil 94000, France
^g Centre National de la Recherche Scientifique CNRS, ERL 7000, Créteil 94000, France
^h Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, Lariboisière Hospital (APHP), Paris 75010, France
ⁱ University Paris Diderot, School of Medicine, Paris 75010, France
^j Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals, AP-HP Sorbonne University Hospital Pitié Salpêtrière Hospital (AP-HP), Paris 75006, France
^k Sorbonne University, Paris 75013, France
^l Groupe Hospitalier Paris-Saclay, Hôpital Bicêtre, Department of Oto-rhino-laryngology Head and Neck Surgery, Paris Public Hospitals. Le Kremlin-Bicêtre 94270, France
^m Université Paris-Saclay, Faculté de Médecine, Le Kremlin-Bicêtre F-94275, France
ⁿ Clinical Research Unit: (URC-Mondor), Department of Public Health, Henri Mondor Hospital Paris Public Hospitals (AP-HP), Créteil 94000, France
^o Cerba Laboratory, Saint-Ouen L'Aumône, France
^p Emergency Department, Hotel Dieu Hospital, Paris Public Hospitals (APHP), Paris 75004, France
^q Department of Oto-rhino-laryngology Head and Neck Surgery, Hopital Rothschild Foundation, Paris, France
^r General Medical Practioner, Paris, France
^s Virology Department, Cochin Hospital, Paris Public Hospitals (APHP), Paris 75004, France

^⁎Corresponding author.

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Highlights

•	Isolated loss of smell without nasal obstruction is an early red-flag of COVID-19.
•	These patients should adopt all the preventive measures and a lockdown.
•	Olfactory/gustative dysfunction had high predictive value to identify COVID-19.
•	Olfactory/gustative dysfunction had high specificity to identify COVID-19.
•	Self-reported loss of smell, among other symptoms, could help to screen COVID-19.

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Abstract

Objectives

To determine the frequency of SARS-CoV-2 positive samples in a subset of patients consulting for primarily isolated acute (<7 days) loss of smell and to assess the diagnostic accuracy of olfactory/gustatory dysfunction for COVID-19 diagnosis in the overall population tested for COVID-19 in the same period.

Methods

Prospective multicentric cohort study in four olfactory ENT units and a screening center for COVID-19.

Results

i) Among a subset of 55 patients consulting for primarily recent loss of smell, we found that 51 (92.7%) had a COVID-19 positive test (median viral load of 28.8 cycle threshold). Loss of smell was mostly total (anosmia), rarely associated with nasal obstruction but associated with a taste disorder in 80%. Olfactory dysfunction occurred suddenly, either as first complaint or preceded by mild symptoms occurring a median of 3 days. The majority of patients (72.9%) partially recovered the sense of smell within 15 days. ii) In a population of 1824 patients tested for COVID-19, the positive predictive value and the specificity of loss of smell and/or taste were 78.5% and 90.3% respectively (sensitivity (40.8%), negative predictive value (63.6%)).

Conclusions

Self-reported loss of smell had a high predictive positive value to identify COVID-19. Making this sign well known publicly could help to adopt isolation measures and inform potential contacts.

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Keywords : COVID-19, SARS-CoV-2, Anosmia, Dysguageusia, Loss of smell, Positive predictive value, Viral load

Plan

Introduction

Material and methods

First part of the study: COVID-19 status of a subset of patients self-reporting smell loss as a main symptom

Data collection

Second part of the study: diagnostic accuracy of self-reported loss of smell or taste for COVID-19 diagnosis on the whole cohort

Results

First part of the study: COVID-19 status of a subset of patients self-reporting smell loss as a main symptom

Second part of the study: diagnostic accuracy of self-reported loss of smell and/or taste for COVID-19 diagnosis on the whole cohort

Discussion

Ethics approval and consent to participate

Consent for publication

Availability of data and materials

Funding

Authors' contributions

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Vol 81 - N° 4

P. 614-620 - octobre 2020 Retour au numéro

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Self-reported loss of smell without nasal obstruction to identify COVID-19. The multicenter Coranosmia cohort study - 22/09/20

Highlights

Abstract

Objectives

Methods

Results

Conclusions

Plan

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