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Loss of Smell is an Often-Missed Warning Sign of Serious Illness

May 20, 2020

By Deborah Ballard, MD, MPH, Duke Integrative Medicine

When it became known that one of the early signs of infection with Covid-19 was the loss of smell or anosmia, I, (and I suspect many others), deepened my awareness of this somewhat unappreciated sense. I enjoyed as never before the smells of my soap and shampoo in the morning shower, of good strong coffee, of cinnamon, butter, and honey on freshly toasted bread, and honeysuckles exuding their sweetness along my walking trail.

Loss of Smell is an Often-Missed Warning Sign of Serious Illness

Smell greatly enhances our ability to enjoy food and drink. The scent of our partner intensifies an intimate connection. Memories of scents are entwined with powerful feelings. For me, these include a baby’s freshly washed hair and maternal bliss, grandfather’s cigars and a child’s shyness, and of damp earth mixed with wet spring grass and the exhilaration of being alive. Smells ground us in our moments and bring back our memories. Our sense of smell also protects us. The ability to detect noxious odors prevents us from eating spoiled food, breathing toxic fumes, and catching on fire. Loss of sense of smell is a symptom of many diseases, some reversible, some not.

European studies showed that about 50% of Coronavirus cases there reported a loss of sense of smell. (1). One paper from the United States reported that up to 80% of Covid-19 cases experienced decreased or absent sense of smell. (2)  We do not know for sure how many of the Covid-19 cases will regain their sense of smell, but typically between one third to two-thirds of people with anosmia due to an upper respiratory infection recover. (3).

My observation is that most patients recover their sense of smell after the respiratory infection resolves.
While anosmia associated with upper respiratory infections can have a sudden and dramatic onset, insidious anosmia can be a symptom of trauma or tumors in the nose and neurodegenerative disorders such as Alzheimer’s and Parkinson’s Disease. Persons with this type of anosmia may not realize they have lost their sense of smell unless their health care provider asks about it. People with disturbances in smell report difficulties with cooking decreased appetite and enjoyment of eating, difficulty maintaining personal hygiene and social relationships, and fear of hazardous events or feeling less safe. They also note more severe forms of depression and feelings of loneliness. (3)

A note of caution for those using zinc to boost their immune systems in response to Covid-19: Zicam, an intranasal zinc formulation has been linked to permanent loss of smell.  Substances with extraordinarily strong odors such as ammonia, certain hair dyes, and gasoline can also cause loss of smell, so make sure you have good ventilation when using strong cleaning products or that boxed hair color. The sense of smell can also be leveraged to heal. For example, aromatherapy with lavender is well known to promote good sleep and lessen anxiety. Lemon oil has been shown to lower blood pressure, stabilize heart rate, and normalize EKG changes in patients experiencing a myocardial infarction. (4)

If you experience persistent loss of smell that does not resolve along with an upper respiratory infection, you should see your physician. He or she can check you for nasal obstruction and if necessary, refer you to an Ear, Nose & Throat or Neurological specialist.


  1. Zayet, S., Klopfenstein, T., Mercier, J. et al. Contribution of anosmia and dysgeusia for diagnostic of COVID-19 in outpatients. Infection (2020).
  2. Sedaghat AR1, Gengler I1, Speth MM2. Olfactory Dysfunction: A Highly Prevalent Symptom of COVID-19 With Public Health Significance.
    Otolaryngol Head Neck Surg. 2020 May 5:194599820926464. doi: 10.1177/0194599820926464. [Epub ahead of print]
  3. Sanne Boesveldt,corresponding author1 Elbrich M Postma,1,2 Duncan Boak,3 Antje Welge-Luessen,4 Veronika Schöpf,5,6 Joel D Mainland,7,8 Jeffrey Martens,9 John Ngai,10 and Valerie B Duffy. Anosmia—A Clinical ReviewChem Senses. 2017 Sep; 42(7): 513–523.
    Published online 2017 May 22. doi: 10.1093/chemse/bjx025.
  4. Rambod M1, Rakhshan M2, Tohidinik S3, Nikoo MH. The effect of lemon inhalation aromatherapy on blood pressure, electrocardiogram changes, and anxiety in acute myocardial infarction patients: A clinical, multi-centered, assessor-blinded trial design.
    Complement Ther Clin Pract. 2020 May;39:101155. doi: 10.1016/j.ctcp.2020.155. Epub 2020 Mar 25.


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