Almost a year later, his taste buds still aren’t functioning, though his sense of smell is slowly coming back. “Everyone takes for granted things like taste and smell,” says Kennedy, 42, who runs the New York City–based Todd Kennedy Cakes. But in the aftermath of COVID-19, he adds, “the simple pleasures are gone.”
What Causes Loss of Smell and Taste in COVID-19 Patients?
Upwards of 90 percent of COVID-19 patients experience some temporary anosmia, or loss of smell, says Richard Doty, PhD, director of the University of Pennsylvania’s Smell and Taste Center in Philadelphia. “At least presently, we think the major loss is due to the damage to the cells in the periphery of the epithelium,” the tissue on the roof of the nasal cavity that plays a key role in smell detection. While scientists are still studying the connection between the novel coronavirus and anosmia, research by Harvard Medical School neuroscientists, published in July in Science Advances, suggests that the virus does not cause permanent damage to the olfactory neurons, as can sinus infections and autoimmune diseases like multiple sclerosis. Doty explains, “As we chew food and swallow, puffs of molecules go up through the olfactory receptors and get perceived as taste. If you hold your nose and have some coffee or chocolate, there will be no coffee or chocolate sensation — you get just the bitter or the sweet.” Some patients with anosmia from COVID-19 may find that foods have an unpleasant smell or taste. Anthony Del Signore, MD, director of rhinology at Mount Sinai Union Square in New York City, says he has heard from COVID-19 patients who complain that “things used to smell one way but now they’re rancid.” The good news is that smell and taste usually bounce back, even though it may take a while. “The majority of cases will improve within a matter of months,” says Doty. But for some patients it takes longer. There are indications that long-haul anosmia can result from the virus entering the brain, he adds. “It’s not yet clear why certain people have longer insults to their sense of smells,” says Dr. Del Signore, adding that viral load fluctuations may be another factor. Del Signore himself had COVID-19 in March of last year, and while his sense of smell came back for the most part within a few weeks, “it was a slow and gradual increase to about 90 to 95 percent, give or take.”
Smell or Taste Loss Can Pose Certain Health Risks
Not being able to smell can be frustrating, but the symptom can also bring with it more serious risks. “If you have loss of smell, you’re unable to smell rancid food or a gas leak,” says Del Signore. “It’s an everyday safety issue.” The loss can also take a psychological and emotional toll. “Some people become depressed, and people can get despondent if they’re with friends or family and they can’t taste the food,” says Doty. “People don’t relate to their problem, so they learn to shut up about it. It becomes debilitating, and they change their social behaviors, so they become very insular.” Patients who are struggling with anosmia should seek medical attention, even if they’ve since recovered from COVID-19 or are not even sure the virus was the cause. Dr. Linsenmeyer offers these strategies for people living with anosmia:
Make smoothies. If you’re feeling turned off by food, “It can be easier to drink a certain amount of calories rather than having to eat the solid food version of that,” says Linsenmeyer. “There is no risk and no problem with having three liquid meals a day.” To make an easy, nutrient-packed smoothie: “Use full-fat yogurt, peanut butter, or another nut butter so you’re getting healthy fats and proteins. I also recommend frozen fruits — nutrient-dense ones like mixed berries — and some fresh leafy greens like spinach or kale. Add liquid, like a 100-percent fruit juice or a full-fat milk; alternatives like soy milk or oat milk are fine too, and are fortified with vitamins and minerals.” For an extra nutritional punch, she suggests adding flax seeds or chia seeds: “They’re energy-dense and have really good protein, healthy fats, and fibers.”Mix up textures. “Even if you can’t perceive a variety of flavors, you can still perceive a variety of textures,” Linsenmeyer adds. “For example, have yogurt with granola. People get greater satisfaction from a meal when there is more texture.”Eat meals at room temperature or cold. When everything smells or tastes off, a lower temperature makes it harder to notice the change, “compared with when foods are hot and the aroma particles are moving around more quickly so we smell them more strongly,” Linsenmeyer says. That applies to liquids, even water. “If water has an off flavor, try cold water.”Stay hydrated. “We can get our fluids from all sorts of beverages: tea, brothy soups — all of that counts toward our overall liquid intake,” notes Linsenmeyer. Coffee in moderation is fine too. “Coffee can increase urination but it’s still 99-percent water, so it counts toward total fluid intake.” Noncaffeinated herbal tea is another good option, as is up to one 8-ounce cup of juice per day.Take a multivitamin. “It’s ideal to get vitamins through food, but if you’re eating completely differently, then it’s an appropriate time to use a multivitamin to make sure you get the nutrients you need,” says Linsenmeyer.
Researchers Are Exploring Therapies to Recover Smell and Taste
People who have lost their sense of taste and smell because of COVID-19 and who want to try taking an active role in recovering can experiment with a few strategies, at home or with their physician. “I tend to use a saline rinse with a small amount of steroid in it that helps to reduce some of the inflammation around the olfactory bulb and nasal nerves,” Del Signore says, describing a method he is exploring but that has not yet been extensively studied. “Nasal rinses typically need to be prescribed, although neti pots can be [available] over the counter,” he adds. “There’s also interest in looking at fish oil and omega-3 vitamins and the anti-inflammatory properties of those as being helpful with sense of smell issues. We’re running a trial at Mt. Sinai to see if fish oil and omega-3 combinations help with the sense of smell.” Del Signore has also seen promising results for patients with an approach known as smell therapy. “We’ve been using essential oils, basically as smelling rehab. We typically use lemon, cloves, around three or four different oils.” Rose and eucalyptus are common scents to try. “We tell patients to breathe it in and out and try to remember what it smelled like. It can help to get neural pathways reestablished. You’re just smelling the oil; you’re not putting it inside the nose.” He adds, “It does take a little bit of time, around three to six months, but we’ve seen a good response with that.” The U.K.-based charity Fifth Sense has tips on how to try smell therapy at home. Even though smell therapy has not yet been rigorously studied for COVID-19 patients, Del Signore says, “We do recommend patients at least try it. It’s not really going to hurt anything, and you’re not burning any bridges, so to speak.”
Patients Are Devising Their Own Home Cures to Revive Their Sense of Smell and Taste
Ever since COVID-19 led to his own long-haul battle with smell and taste loss, Todd Kennedy has seen surprising results with a trick he made up himself: “I went to a Starbucks and got an iced chai latte with hazelnut, which is my favorite drink there, and I took a sip of that and put my mask back on. I realized that when I’m breathing into my mask after taking a sip, I felt like I could taste it.” Meanwhile, all kinds of fad treatments have popped up on the internet. One is the burnt orange hack, which suggests roasting an orange over a flame until it’s charred on the outside, then cutting it open, mixing the fruit with brown sugar, and eating it. Raves about the trick abound on TikTok, but does it actually work? “We don’t have research to say this is an effective strategy,” says Linsenmeyer, but she adds that if someone feels a certain food is helping bring back taste or smell — certain Sichuan dishes, for example, made a difference for one New York Times restaurant critic — it’s worth a shot. “If it works for people to eat a curry, say, and they can taste those flavors, it can’t hurt to try.”
