Infectious Diseases | Mount Sinai Today

How the Loss of Smell and Taste Relates to COVID-19

Updated on Jun 30, 2022 | COVID-19, Ear Nose Throat, Your Health

Cough and fever—followed by potentially life threatening pneumonia—have been the most talked about symptoms of COVID-19. However, as we learn more about the illness, it appears that the initial symptoms can often be associated with the upper respiratory tract or the nose, mouth, throat. In particular, otolaryngologists in South Korea, China, and Italy have noted that a decrease in the sense of smell and taste—medically known as anosmia and dysgeusia respectively—often precedes the other symptoms of COVID-19. Patrick Colley, MD, rhinologist and skull base surgeon within the Division of Rhinology and Skull Base Surgery at New York Eye and Ear Infirmary of Mount Sinai, answers frequently asked questions about this discovery.

Are these symptoms common among COVID-19 patients?

Observations from physicians in Germany noted that two out of three patients in that country who were COVID-19 positive experienced a loss of smell and taste. In other countries where a larger number of patients were tested for COVID-19, they noted that 30 percent of patients that tested positive for the virus had loss of smell and taste as the major presenting symptom. This means that somewhere between 30 to 60 percent of patients infected with the illness will experience these symptoms. For this reason, The American Academy of Otolaryngology has recommended—in the absence of other respiratory diseases such as allergic rhinitis, acute sinusitis or chronic rhinosinusitis—that a loss of smell and taste should alert physicians to the possibility of COVID-19 infection and warrant serious consideration for self-isolation and testing.

Is this an early or late symptom of COVID-19 infection?

Based on the data that is currently available from other countries with COVID-19 outbreaks, it appears that the loss of smell and taste associated with this virus is an early sign of infection. This means that many individuals will experience these symptoms prior to showing the signs of fever, cough, or shortness of breath more commonly associated with COVID-19.

How can I tell the difference between a loss of smell due to seasonal allergies and a loss of smell due to COVID-19? What should I do if I have these symptoms?

Patients suffering from allergies can experience decreased senses of smell and taste, but will usually have nasal congestion, a runny nose with predominantly clear liquid, and sneezing. They also frequently note itchy eyes, nose or throat. This is very different from the cough, fever, and shortness of breath that is typically seen in COVID-19 patients.

If you experience sudden loss of smell and taste in the absence of recent head trauma, allergic rhinitis, or sinusitis; observe strict self-isolation protocols and contact your primary care doctor, otolaryngologist, or a COVID-19 hotline to discuss the appropriate next steps of care.

How long will the loss of smell and taste last? Will patients fully regain their senses after recovering from COVID-19?

When associated with a viral upper respiratory tract infection, the senses of smell and taste can be expected to return to normal in three weeks to three months. The time course is dependent on whether the virus damaged any nerves in the nasal cavity.

It is unknown at this time how many patients will recover their sense of smell and taste completely after COVID-19. In other upper respiratory tract infections, the recovery rate is 90 to 95 percent by three months after the infection has resolved. Older patients and patients with underlying medical problems tend to have a lower recovery rate. We are assuming a similar recovery rate for COVID-19, but it is too early to provide any accurate data at this time.

How is the loss of smell and taste associated with COVID-19 treated? How can I be evaluated for a decreased sense of smell or taste?

The primary treatment of loss of smell and taste associated with COVID-19 is to treat the viral infection itself. Proper rest, self-care, and monitoring of symptoms are important for ensuring the best outcomes in patients infected with this virus. The loss of senses is only a symptom of this infection and will often resolve after the infection has resolved.

Individuals experiencing a decreased sense of smell or taste in addition to a cough, fever, or shortness of breath should contact their primary care doctor or a COVID-19 hotline (NY/NJ/CT). If this is the only symptom you are experiencing, schedule an appointment with an ear, nose, and throat specialist. Physicians at Mount Sinai’s Department of Otolaryngology are available for telemedicine consults.

Patrick M. Colley, MD

Assistant Professor, Department of Otolaryngology and Division of Rhinology and Skull Base Surgery, New York Eye and Infirmary of Mount Sinai

Call 212-979-4200 to make an appointment with Dr. Colley

What Causes the Loss of Smell and Taste?

The sense of smell stems from small olfactory nerve fibers that are found in the superior portion of the nose. These nerve fibers connect through small holes in the skull directly to the first cranial nerve inside the brain. Air that flows through the nose deposits smell particles in the superior portion of the nose where these nerves can detect smell.

This is the same mechanism that is used to taste the majority of the foods that you eat. The taste receptors, or taste buds, that are found in the mouth only detect salty, sweet, bitter, sour, and umami flavors. The remaining flavors are detected by air flow from your mouth back into your nose where they come in contact with the same olfactory nerve fibers. These nerve fibers in the nose are actually where you taste garlic, onions, herbs, and many other flavors commonly used while cooking.

The decreased sense of smell and taste that is often seen in upper respiratory tract infections such as COVID-19 can either be due to nasal congestion causing decreased air flow through the nose and obstruction of the nerve fibers. It may also be caused by a viral infection of the nerve fibers themselves, causing them to stop functioning or die.

Mount Sinai Turns Hundreds of Machines for Sleep Apnea into Hospital Ventilators, Shares Instructions Worldwide

Updated on Jun 30, 2022 | COVID-19, Featured, Research

Members of the Mount Sinai team that created the ventilator prototype seen here, included, from left, Drew Copeland, RPSGT; Thomas Tolbert, MD; Brian Mayrsohn, MD; and Hooman Poor, MD.

A team of pulmonologists, anesthesiologists, sleep and critical care specialists, and medical students at the Mount Sinai Health System are reconfiguring hundreds of donated machines that are typically used at home for sleep apnea and deploying them as ventilators to be used for severely ill patients who are hospitalized with COVID-19. Mount Sinai has shared the protocols and instructions with the Greater New York Hospital Association and the American Thoracic Society, as well as with other hospitals that are dealing with a national shortage of invasive ventilators during this pandemic. COVID-19 affects the respiratory system and has greatly increased the number of patients who are entering intensive care units and require assisted breathing.

When Mount Sinai received a shipment of 200 ResMed VPAP ST machines as a donation from Elon Musk, Chief Executive Officer of Tesla, Inc., in late March, a Health System task force was immediately organized to repurpose them. Within several days, the team put together a prototype that was tested in the Simulation HELPS Center at Mount Sinai, a unique laboratory run by the Department of Anesthesia that enables clinicians to simulate human responses to innovative technologies and procedures.

Three important modifications were made by the Mount Sinai team. First, a connection to an endotracheal tube replaced the typical mask that can present a risk of COVID-19 aerosolization; second, alarms that can alert clinicians if there is a problem with air flow were included; and third, the team enabled doctors and respiratory therapists to view and control the machine’s settings from outside the patient’s room, so they do not need to enter the room to make minor adjustments.

These VPAP machines will be used as an option under the current circumstances at Mount Sinai to prevent a shortage of invasive ventilators needed to serve the ongoing surge of patients. They are preferable to splitting invasive ventilators that serve two patients at the same time, a move that many hospitals are concerned they may have to pursue as a last resort.

Among the clinicians leading the effort at Mount Sinai is Charles A. Powell, MD, Janice and Coleman Rabin Professor of Medicine, Chief of the Division of Pulmonary, Critical Care, and Sleep Medicine, and Chief Executive Officer of the Mount Sinai – National Jewish Health Respiratory Institute. Dr. Powell says the machines can be used “in patients who do not require all the power of a regular ventilator, freeing up those conventional devices for the acutely ill.” He adds, “Our objective is to share our protocols widely with our colleagues around the globe facing this crisis. This project is a demonstration of the success of the team science collaborative research infrastructure at Mount Sinai that allowed us to make these innovations quickly.”

Any type of high-performing sleep device that delivers a comparable level of pressure to the ResMed VPAP ST model can work as a repurposed ventilator, according to Drew Copeland, Director of Operations for the Sleep Program at the Mount Sinai Health System. He says, “For many patients, this can save their life. We are not yet at a critical mass for ventilators but we may be getting there. This is a moving target. Hopefully, we can keep pace.”

After the first prototype was developed, Mr. Copeland enlisted a team of medical students from the Icahn School of Medicine at Mount Sinai to write the instructional user manual. They completed it in one day.

The students are now assembling the machines to be used throughout the Health System’s eight hospitals in the event of a shortage of invasive ventilators. Two floors of the medical school’s library have been set up as a staging area for the makeshift assembly line. The goal is to have all of the machines ready to be deployed by the end of this week.

To view the new Mount Sinai protocol, click below

Repurposing bi-level ventilators for use with intubated patients while minimizing risk to health care works during insufficient supply of conventional ventilation for patients with COVID-19

COVID-19: Coping and Resiliency Skills

Mar 31, 2020 | COVID-19, Mental Health, Psychiatry, Your Health

As the outbreak of COVID-19 spreads throughout the greater New York area, people are adjusting to radical changes in their daily life. Businesses are closed, people are working from home—if they are able to work at all—and kids are trying to learn at home. It’s a stressful time for everybody. Rachel Yehuda, PhD, Professor of Psychiatry and Neuroscience at the Icahn School of Medicine at Mount Sinai, offers this advice about resiliency skills and coping with the COVID-19 crisis.

It’s hard not to get overwhelmed by the news. Should you limit the amount of news you watch?

There’s a part of me that wants to keep up with every update. I try to limit my exposure because much of the news is repetitive and some of it is sensationalized. I was out west in mid-March for a brief trip, and saw pictures on the news of empty shopping shelves here in New York. I was pretty worried until I got home that there might be shortages. Of course when I did return, I realized that the situation wasn’t quite as bad as portrayed. People did panic-shop, but the shelves were also getting restocked. So my worry in that case was exaggerated.

On the other hand, it is a good idea to check in a couple times a day to get the latest reports. Let’s face it, a pandemic is a scary thing to be a part of, and there are important updates that we need in real time. The important news is information about what we can do or should be doing. We need to make sure we get our news from reputable sources, like the World Health Organization. Some news outlets have an agenda that they are trying to promote, and I don’t think that’s helpful or healthy to engage in because it may increase distress. But, even if you’re getting news from reputable sources, you don’t need it 24/7.

It’s hard to avoid if you’re home.

True, but it’s also a time when you can do other things at home other than having the TV on. It’s a time that you can read, write, do something creative, meditate, or try a recipe you’ve wanted to try. You can spend time playing with your children, writing letters, or get organized, even clean out your closet.

Think of something you can do at home that will make you feel productive, and that you’ve accomplished something at the end of the day. Put the focus on enhancing your home experience as opposed to what you can’t do in the outside world.

It’s also a really good time to check in on friends, neighbors and particularly, older folks. Now is the time to catch up with other people, perhaps there’s someone you haven’t had a chance to talk to. Or maybe there’s an older person who’s shut in and isolated and needs help. It’s a healthy and healing thing to think about other people, rather than focus exclusively on yourself.

Some people are reporting that they are learning a new “coronavirus skill or art.” Think about the things you have always wanted to do, but never had the time. Arts and crafts. Watercolors. Play a musical instrument.

Does sticking to a daily routine help keep you on track?

For some people it’s very good. For children, in particular, the structure of a routine is very grounding. But there is also something liberating about a guilty pleasure of going off routine. If you always wake up really early to commute to work, there is nothing wrong with giving yourself a treat of an extra hour of sleep to make up for some of the negative aspects of not being able to go out and do whatever you want. So I wouldn’t rigidly advocate it for everyone. If you feel lost without a structure, like you are wasting the day or failing to be industrious or productive, a schedule can be important. But for people who find themselves over-scheduled, there is something about putting the world on mute and listening to one’s needs that can promote a sense of well-being.

The key is to be mindful about it. We are being given an opportunity to connect with something inside of ourselves that hasn’t been nurtured. We have been given more time. Sleep an extra hour, or skip a meal if you want. Do something you don’t ordinarily get to do. It’s a chance to embrace possibilities outside the box. We’re in a serious situation, but we can try to make the most of it and squeeze something positive out of it.

The people who are going to do the best are those who find special moments, special meaning, and special opportunities during this time. During the past couple days, I’ve gotten texts from people just asking “How are you doing? I’ve been thinking about you.” It’s wonderful to get those messages and connect when, otherwise, we might not have had time. And we’ll come out the other end of this changed in some way—maybe for the better.

Can you talk a bit about resiliency skills?

Optimism is certainly a big resiliency skill. Being able to look at the positive side of things is very important. I believe spiritual mindfulness is key; understanding what is in your control and what is not. And taking whatever control you can take, acting on it, and not feeling victimized. And knowing that this will all pass, and maybe good things will come from it in the future. This is hard to do while people are getting sick and dying, and when people are losing their jobs and faced with economic hardship. Grieving losses in real time is an important key to resilience in the future. Realistically assessing and starting to think about what will need to happen in the weeks to come if one has lost one’s job is also important.

Not feeling helpless, but trying to act is also an important way to build resilience. I am reminded of 9/11. At this time we want to behave in a way that when we look back, we will be proud of what we did during this pandemic—individually and as a society. If you bear that in mind, you won’t have disappointed yourself, and that is an important key to resilience.

Doing things for others—altruism—is also key. If you help others, even if there’s a certain amount of risk to yourself, you’ll feel good about yourself when all is said and done. Certainly health care workers on the front lines are expressing altruism each day. People are scared right now. Even people I know who are always positive are worried about getting sick, or even worse, being a carrier and getting someone even more vulnerable at risk. You should be careful if being helpful means posing a risk to yourself or to others. Yet there are many ways to contribute without leaving the house. We can show up each day in our lives—for ourselves and other people—and ask what can we do today to help. That’s resilience.

SARS-CoV2: How a Low-Powered Virus Turns Deadly

Mar 31, 2020 | COVID-19, Featured, Infectious Diseases, Research

File photo of the team from the tenOever Laboratory, from left to right: Kohei Oishi, PhD, Tristan Jordan, PhD, Daniel Blanco-Melo, PhD, Skyler Uhl, PhD candidate, Ben tenOever, PhD, Rasmus Moeller, PhD candidate, Maryline Panis, Lab Manager, Ben Nilsson-Payan, PhD, and Daisy Hoagland, PhD candidate

Early laboratory tests show the SARS-CoV2 virus, which leads to COVID-19, behaves very differently from the flu or common respiratory syncytial virus (RSV) in that it travels under the radar and enters human and animal cells quietly, eliciting a low-powered immune response that tends to fester, according to preliminary research led by Benjamin tenOever, PhD, the Fishberg Professor of Medicine, and Director of the Virus Engineering Center for Therapeutics and Research, at the Icahn School of Medicine at Mount Sinai. The observations, which provide a snapshot of how cells and organisms respond to the SARS-CoV2 virus, were based on studying RNA from live animal models and human cell lines. RSV often occurs in young children with symptoms that mimic the common cold.

“The take-home message of what we found so far is that the immune response to the virus is actually very muted,” says Dr. tenOever. In a typical reaction to the flu or RSV, the body secretes a whole family of proteins or interferons that assemble to take on a variety of functions to prepare for an imminent attack. Some of the interferons directly inhibit the virus. But with the SARS-CoV2 virus, Dr. tenOever says, “We see little to no evidence that the virus-infected cells are secreting these proteins. So a program that should be induced is not launching.” At most, the defense appears to be only 40 percent to 50 percent as strong as it would be for the flu or RSV.

The new virus behaves differently in another way, as well. Whereas the flu is particularly wily in dismantling the innate immune response in several places, SARS-CoV2 does not appear to do so, according to postdoctoral fellow Daniel Blanco Melo, PhD, who was a lead author of the study in Dr. tenOever’s lab. “We may find that the immune response is being blocked by this new virus too, but it won’t be in the same way as the flu,” he says.

According to the scientists, the preliminary findings show that the very stealth nature of SARS-CoV2 may actually account for its lethalness, a hypothesis that complements the virus’s long clinical progression, with many severely ill patients being hospitalized for more than 10 days. The hypothesis also supports the clinical evidence that patients need a strong immune system to fight COVID-19, the disease produced by the SARS-CoV2 virus. Under the leadership of Miriam Merad, MD, PhD, the Mount Sinai Professor in Cancer Immunology and Director of the Precision Immunology Institute, Mount Sinai is working to improve outcomes in critically ill patients who experience an excessive inflammatory response.

“It would almost appear that if you are a healthy individual under the age of 50 and you get this virus your immune system would have no problem tackling it, inhibiting it, and getting rid of it,” says Dr. tenOever. “But in older individuals and those who have comorbidities—those whose immune system is waning—our early data would suggest that their reduced immune system means they’re not aggressively neutralizing this virus, which leaves it to fester in the lungs and keep replicating.” This low-grade inflammation in the body allows the virus to remain under the radar for days as the patient’s lungs become increasingly damaged.

“Maybe what we’re seeing is a slow burn in some people that eventually takes its toll over 10 to 20 days,” says Dr. tenOever. “In the end, the immune system is reacting both to the virus and to the accumulating damage being done to the lungs. So the body goes into this mode of overly trying to repair itself from lungs that are leaking fluid and becoming hypoxic. By the time these patients come to the hospital it is more about controlling the inflammation to the damage induced by the virus than inhibiting the virus itself.”

Is There a Connection Between COVID-19 and IBD?

Mar 27, 2020 | COVID-19, Digestive Diseases, Your Health

COVID-19 is a concern for everyone. But people with inflammatory bowel disease (IBD) may be at increased risk of contracting this virus–or developing a bad case of it. This mostly has to do with medications they may be taking. Ryan Ungaro, MD, Assistant Professor of Gastroenterology at the Susan and Leonard Feinstein Inflammatory Bowel Disease Center, shares information IBD patients need to know about COVID-19.

Is there a connection between COVID-19 and gastrointestinal conditions?

More and more information suggests that the gastrointestinal (GI) system is involved with COVID-19. We are seeing more reports of GI symptoms among COVID-19 patients. For instance, the very first case in the United States noted nausea, vomiting, and diarrhea. In addition, some reports out of China indicate that there are a significant number of COVID-19 patients experiencing GI symptoms. The virus has several ways to get into the human body. This includes the nasal passages, the airway into the lungs, and through the intestines. It may be that contact surfaces in the bathroom could cause transmission. Scientists have found the virus in the stool of some patients.

Are there any special precautious that IBD patients should take?

Any IBD patients who are taking immunosuppressants–drugs that reduce the body’s immune system–should follow the at-risk population guidelines issued by the Centers for Disease Control and Prevention. Take these standard precautions very seriously. Be vigilant with social distancing and limit the number of people you’re in contact with. Be particularly diligent about hand washing and trying not touch your face. Treat yourself as if you’re part of the high-risk population, like the elderly or people with lung disease.

If you are unsure if the medication you take qualifies as an immunosuppressant, check the Crohn’s and Colitis Foundation’s IBD Medication Guide.

If I’m taking any of these medications, should I stop?

In general, you should stay on your medications now. That includes biologic drugs and immunosuppressants. The one exception I would say is steroids. If you are on oral steroids, you should talk to your doctor to see if it’s possible to taper down to a minimum dose or get off them completely. Everyone’s case is individual and if you have any questions, you should raise them with your physician. You want to stay on your medications because the health system is overburdened or is potentially going to become overburdened. You do not want to have a flare-up that requires a trip to the hospital, where there will be increased risk of exposure. If you do need care, we’re trying to do this by telemedicine visits at the IBD Center, except for the most urgent cases.

Is there any research going on about COVID-19 and IBD?

There are several initiatives taking place. The International Organization for Inflammatory Bowel Disease is developing more nuanced guidance for patients and physicians. That should be out shortly. In addition, we, with collaborators at the University of North Carolina, have launched a registry for cases of COVID-19 in IBD patients called SECURE-IBD. The registry will gather information on confirmed cases; medications the patient was receiving; the activity of the disease; and the outcomes, in terms of hospitalizations and disease severity. The goal is to determine which medications may contribute to the risk of developing COVID-19 or having a more severe response to the virus. Gastroenterologists who have patients with COVID-19 are encouraged to report cases directly on the SECURE-IBD website.

Controlling Extreme Inflammation in Severe Cases of COVID-19 May Help Save Lives

Mar 27, 2020 | COVID-19, Featured, Research

Miriam Merad, MD, PhD, left, Director of the Precision Immunology Institute, with Adeeb Rahman, PhD, Director of the Human Immune Monitoring Center at the Icahn School of Medicine at Mount Sinai.

Immunologists at the Icahn School of Medicine at Mount Sinai are playing a major role in managing the care of severely ill patients with COVID-19, who often experience an excessive inflammatory response to the disease that can ultimately overwhelm them.

Under the leadership of Miriam Merad, MD, PhD, the Mount Sinai Professor in Cancer Immunology and Director of the Precision Immunology Institute, Mount Sinai has created a quick test that monitors a patient’s inflammatory response to COVID-19 and helped launch a clinical trial that uses the drug sarilumab to manage these responses. The drug, manufactured by Regeneron Pharmaceuticals Inc., is typically used to treat rheumatoid arthritis. Dr. Merad says she may also roll out clinical trials that would test drugs used after CAR T cell adaptive therapies.

“Immunologists understand inflammation and know how to control it,” says Dr. Merad. “We developed a test with a three-hour turnaround time that we will repeat many times a day to see what type of inflammation the patient is developing and potentially guide treatment.” By identifying the features of severe immunological reactions in patients quickly, “we can speed the implementation of a cytokine blockade and significantly improve patient outcome.”

Cytokines are small proteins that modulate immunity. In trying to fight the COVID-19 virus the immune system may mount a major response, which can lead to excess inflammation that is also called a ‘cytokine storm.’ This overdrive reaction is happening in a range of COVID-19 patients, from the elderly to some young people with no apparent underlying health conditions.

“You need a strong immune response to fight the virus and this is why some people do well,” says Dr. Merad. “But others develop this storm of cytokines and this is what leads to fatalities. People are not dying from a virus that is running rampant in their bodies and killing tissue. We believe people are dying because of excessive inflammation. If we learn how to prevent this damaging immune response without compromising the fight against the virus we will be able to save many lives while waiting for curative treatment such as an antiviral drug or a vaccine.”

Benjamin K. Chen, MD, PhD

Dr. Merad adds, “There is urgency in learning how to best block the fatal inflammatory response.” To that end, she and other researchers are using the leading technology platform that she helped build in Mount Sinai’s Human Immune Monitoring Center, which allows them to “map with unprecedented depth the immune response to the virus in our patients.”

Benjamin K. Chen, MD, PhD, the Irene and Dr. Arthur M. Fishberg Professor of Medicine, and Vice Chair for Research in the Department of Medicine (Infectious Diseases), has been supporting the evolution of many proposed clinical trials with the help of leaders throughout the Mount Sinai Health System. Dr. Chen says there is limited but encouraging data to support cytokine blockers. Dr. Merad’s lab and the Human Immune Monitoring Center are uniquely capable of mapping out the “cytokine release profile,” he says. “With these trials we have the opportunity to measure those changes very carefully and decide what other trials or studies might be best to use for coronavirus. We are doing everything we can to support promising developments against COVID-19.”

Dr. Chen is working with Linda Rogers, MD, Associate Professor of Medicine (Pulmonary, Critical Care and Sleep Medicine), and Michele Cohen, Clinical Research Program Director in the Department of Medicine, who have been coordinating several major COVID-19 clinical trials at the Mount Sinai Health System. Judith A. Aberg, MD, the Dr. George Baehr Professor of Clinical Medicine and Chief of the Division of Infectious Diseases, Department of Medicine, is leading key clinical trials, including one for the antiviral drug remdesivir, made by Gilead Sciences. Remdesivir has shown promise in treating patients with COVID-19 and was developed in response to the Ebola crisis.

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