NICE, France (AP) – The doctor slid a miniature camera into the patient’s right nostril, causing her entire nose to glow red with its bright miniature light.
“Tickles a bit, huh?” he asked as he rummaged in her nasal passages. The discomfort caused tears to well up and roll down her cheeks.
The patient, Gabriella Forgione, was not complaining. The 25-year-old pharmacy worker was delighted to be poked and prodded at the hospital in Nice, in the south of France, to continue her increasingly urgent quest to restore her sense of smell. Along with her sense of taste, it suddenly disappeared when she fell ill with COVID-19 in November, neither of which has returned.
Being deprived of the joys of food and the smells of things she loves are tough on her body and mind. Without both good and bad smells, Forgione will lose weight and confidence.
‘Sometimes I wonder,’ Do I smell? She confessed. “Normally I wear perfume and I like things smelling good. It really bothers me that I can’t smell. “
A year after the coronavirus pandemic, doctors and researchers are still striving to better understand and treat the accompanying epidemic of COVID-19-related anosmia – loss of smell – which is taking much of the joy of life from an increasing number of sensory frustrated longer-term sufferers such as Forgione .
Even specialist doctors say there is a lot about the condition that they are still unfamiliar with, and they are learning along the way through their diagnoses and treatments. Disturbance and change of smell have become so common with COVID-19 that some researchers suggest that simple odor tests can be used to detect coronavirus infections in countries with few laboratories.
For most people, the odor problems are temporary and often improve on their own within weeks. But a small minority complain of persistent dysfunction long after other COVID-19 symptoms have resolved. Some have reported having a persistent total or partial loss of odor six months after infection. The longest, some doctors say, is now approaching a full year.
Researchers working on the annoying disability say they are optimistic that most will eventually recover, but fear some will not. Some doctors are concerned that a growing number of odor-deprived patients, many of them young, could be more prone to depression and other difficulties and weigh on strained health systems.
“They lose color in their lives,” says Dr. Thomas Hummel, head of the fragrance and taste clinic at the University Hospital in Dresden, Germany.
“These people will survive and they will be successful in their lives, in their profession,” Hummel added. “But their lives will be much poorer.”
At the Face and Neck University Institute in Nice, Dr. Clair Vandersteen rubbed tube after tube of scents under Forgione’s nose after rooting his camera in her nostrils.
“Do you perceive a smell? Nothing? Zero? OK, ”he asked, as she responded repeatedly and apologetically with negatives.
Only the last tube elicited an unambiguous response.
‘Urgh! Oh, that stinks, “Forgione screamed. “Fish!”
Test completed, Vandersteen delivered his diagnosis.
“You need a lot of scent to be able to smell anything,” he told her. “You haven’t completely lost your sense of smell, but it’s not good either.”
He sent her away with homework: six months of olfactory recovery. Choose two or three fragrant things, like a sprig of lavender or pots of fragrances, twice a day and smell them for two to three minutes, he ordered.
‘If you smell something, great. If not, no problem. Try again and focus on the lavender, a beautiful purple bloom, ‘he said. “You have to hold on.”
The loss of the sense of smell can be more than just an inconvenience. Smoke from an expanding fire, a gas leak, or the stench of spoiled food can all pass dangerously unnoticed. Fumes from a used diaper, dog poop on a shoe, or sweaty armpits can be embarrassingly ignored.
And as poets have long known, smells and emotions are often like intertwined lovers.
Evan Cesa always enjoyed meals. Now they are quite a job. A fish dinner in September that suddenly seemed tasteless, the 18-year-old sports student first noticed that COVID-19 had attacked his senses. Foods became mere textures, with only residual hints of sweetness and salty.
Five months later, while eating chocolate chip cookies before class, Cesa was still chewing without joy, as if she were swallowing cardboard.
“Eating is no longer useful to me,” he said. “It’s just a waste of time.”
Cesa is one of the anosmia patients being studied by researchers in Nice who used scents in the diagnosis of Alzheimer’s disease before the pandemic. They also used comforting scents to treat post-traumatic stress in children after a terrorist attack on trucks in Nice in 2016, when a driver was plowing through holiday crowds. 86 people killed.
The researchers are now applying their expertise to COVID-19 and collaborating with perfumers from the nearby fragrance-producing city of Grasse. Perfumer Aude Galouye worked on the fragrant waxes that were rubbed under Cesa’s nose to measure his olfactory disorder, with scents in varying concentrations.
“The sense of smell is a sense that is fundamentally forgotten,” said Galouye. “We don’t realize what effect it has on our lives unless, of course, we don’t have it anymore.”
The studies in Cesa and other patients also included language and attention tests. The Nice researchers are investigating whether olfactory complaints are related to COVID-related cognitive problems, including difficulty concentrating. Cesa stumbled upon choosing the word “ship” while “kayak” was the obvious choice in one test.
“That’s completely unexpected,” said Magali Payne, a speech therapist on the team. “This young man shouldn’t have any language problems.”
“We have to keep digging,” she said. “We discover things when we see patients.”
Cesa longs to restore his senses, to celebrate the taste of pasta in carbonara sauce, his favorite dish, and to discover the fragrant wonders of the outdoors.
“You might think it’s not important to be able to smell nature, trees, forests,” he said. “But when you lose the sense of smell, you realize how lucky we are to be able to smell these things.”
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