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We may be out of the COVID pandemic, but COVID is still with us, not least because of the lasting impact it has had on so many.

Much of that impact occurred back in 2020 and 2021, before so many of us were vaccinated multiple times, before the immunity laid down by previous infection combined with a weaker variant (Omicron), to decrease the risk of SARS COV 2 dangerous sequelae, before an effective anti-viral drug Paxlovid was developed to help prevent sustained damage.

By sequelae I mean of course the amorphous multi-organ inflammation known as long COVID. Long COVID effects many organs including the heart and lungs, and many symptoms including fatigue, tinnitus, and joint aches.

But a new study, just published in the Journal Laryngoscope, focuses on the prominent symptoms of loss of smell and taste. A National Health Interview survey of over 30,000 people who developed COVID in 2021 (mainly the Delta variant), found that over 60 percent lost their smell or taste at least transiently, and while the majority recovered, a significant minority (over 20 percent), continued to report at least a partial loss of smell or taste for many months afterward.



The answer is to be found in the olfactory lobe of the brain, which abuts the nasal cavities and the sinuses. Research from Duke, Penn State, and NYU Langone Health have described what happens when the SARS COV 2 virus invades the nasal passages, damages cell leading to debris and inflammatory chemicals known as cytokines. As Dr. Ben TenOever, director of the Virology Institute at NYU and lead author of the definitive research on this published in the journal CELL in 2022, told me in an interview, the virus infects support cells inside the nose which die and release genetic debris, causing an inflammatory response in nearby cells that effect the nerves in the olfactory lobe.


Sense of smell is lost for a few days but over time these nerves retract their tentacles (known as neurites), as a reflex against all the inflammation. “When this happens, smell is disrupted for months while you wait for those extensions to grow back. In very rare circumstances, prolonged antiviral signaling can actually kill those neurons which leads to permanent smell loss.” Unfortunately, when it comes to smell, this sense does more than allow us to enjoy our food, it also warns us against noxious smells such as gas, smoke, and fires.

Treatments for severe and prolonged loss of smell are still primitive, including nerve blocks and injections.

Unfortunately, it isn’t only the sense of smell that’s affected. According to TenOever, the rest of the brain is impacted as well, leading to brain fog, as well as worsening of underlying neurological conditions including Alzheimers and Parkinsons Disease. Effective treatments for most patients aren’t there yet, but Tenoever agrees with me that treating the inflammation as well as the body’s own healing is key to recovery.


What is it about COVID that has led to such a strong reaction on the part of the immune system? Three and a half years after the first cases, no one knows all the answers yet, but there is much evidence tying the response to the fact that it was a new pathogen that we hadn’t ever seen before. This is one of the unfortunate effects of a pandemic pathogen. So even as we exit the pandemic, many scars remain which will affect millions for many years to come.


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