Recent smell loss is the best predictor of COVID-19 among individuals with recent respiratory symptoms
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Richard C. Gerkin
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Kathrin Ohla
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Maria G. Veldhuizen
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Cédric Bouysset
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Veronica Pereda-Loth
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Ilja Croijmans
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Cailu Lin
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Mari A. Sandell
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Luis R. Saraiva
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Gaurav Ahuja
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Mohammed K. Alwashahi
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Marco A. Fornazieri
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Eugeni Roura
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Sara Spinelli
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Jonas K. Olofsson
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Carl M. Philpott
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Denis Pierron
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Moustafa Bensafi
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Johan N. Lundström
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Alberto Macchi
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Debarka Sengupta
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Paloma Rohlfs Dominguez
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Thomas Hummel
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Masha Y. Niv
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Steven D. Munger
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Valentina Parma
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Jessica Freiherr
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Thierry Thomas-Danguin
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Rafieh Alizadeh
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Emmanuelle Bignon
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Claire Hopkins
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G. Coureaud
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Hong Wang
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María Adelaida Bock
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Abstract
In a preregistered, cross-sectional study, we investigated whether olfactory loss is a reliable predictor of COVID-19 using a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness. We quantified changes in chemosensory abilities during the course of the respiratory illness using 0–100 visual analog scales (VAS) for participants reporting a positive (C19+; n = 4148) or negative (C19−; n = 546) COVID-19 laboratory test outcome. Logistic regression models identified univariate and multivariate predictors of COVID-19 status and post-COVID-19 olfactory recovery. Both C19+ and C19− groups exhibited smell loss, but it was significantly larger in C19+ participants (mean ± SD, C19+: −82.5 ± 27.2 points; C19−: −59.8 ± 37.7). Smell loss during illness was the best predictor of COVID-19 in both univariate and multivariate models (ROC AUC = 0.72). Additional variables provide negligible model improvement. VAS ratings of smell loss were more predictive than binary chemosensory yes/no-questions or other cardinal symptoms (e.g., fever). Olfactory recovery within 40 days of respiratory symptom onset was reported for ~50% of participants and was best predicted by time since respiratory symptom onset. We find that quantified smell loss is the best predictor of COVID-19 amongst those with symptoms of respiratory illness. To aid clinicians and contact tracers in identifying individuals with a high likelihood of having COVID-19, we propose a novel 0–10 scale to screen for recent olfactory loss, the ODoR-19. We find that numeric ratings ≤2 indicate high odds of symptomatic COVID-19 (4 < OR < 10). Once independently validated, this tool could be deployed when viral lab tests are impractical or unavailable.
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