key: cord-1022926-t9mt0u5z authors: Boudjema, Sophia; Finance, Julie; Coulibaly, Fatoumata; Meddeb, Line; Tissot-Dupont, Hervé; Michel, Moïse; Lagier, Jean Christophe; Million, Matthieu; Radulesco, Thomas; Michel, Justin; Brouqui, Philippe; Raoult, Didier; Fenollar, Florence; Parola, Philippe title: Olfactory and gustative disorders for the diagnosis of COVID-19 date: 2020-09-06 journal: Travel Med Infect Dis DOI: 10.1016/j.tmaid.2020.101875 sha: 98e0ef4888ce5bd151f5a6489f4834eb81214bf0 doc_id: 1022926 cord_uid: t9mt0u5z nan Early in the course of the still on going COVID-19 pandemic, clinicians noticed the significance of olfactory and gustative disorders 1 . A recent systematic review and metaanalysis of ten and nine available studies, reported a prevalence of 52.7% olfactory and 43.9% gustatory dysfunction respectively 2 . As soon as the outbreak reached France, we established in Marseille massive early PCR screening from a nasopharyngeal sample for patients suspected of having COVID-19, and anybody seeking treatment or SARS-CoV-2 screening 3 . Here, we questionned for recent loss of smell (LOS) and/or taste (LOT) in a cohort of patients and health care workers (HCW) before they were tested for SARS-CoV-2 by asking "have you lost your sense of smell or taste in the last 2 months?" A total of 3,497 patients were questioned between 24 March and 25 April 2020 (Table) LOT only, and 58.08% (60% in women and 53% in men under the age of 65) for LOS and/or J o u r n a l P r e -p r o o f LOT. Overall, the negative predictive value (NPV) of smell and/or taste disorders was 89.01% (92% in men and 88% in women under the age of 65) ( Table 1) . A total of 432 HCWs, including 271 women, were tested for COVID-19 using RT-PCR on nasopharyngeal swabs, in addition to an IgM / IgG antibody test (Sure Bio-Tech, Hong Kong) which was performed according to the manufacturer's instructions, and using an in-house indirect immunofluorescence assay (IFA), as described 4 , in the context of occupational medicine consultation between 17 and 22 April 2020. Among of them, 23 reported having a fever or cough in the last two months. Of the HCWs who did not report having a fever or cough (n=409), seven reported LOS and LOT, and two with LOT only. Of the HCWs without a fever or cough, 10 (2.4%) reported LOS and/or LOT and all were positive for COVID-19. In addition, three HCWs without a fever or cough did not report any smell or taste loss, despite testing positive for SARS-Cov-2. In this population of HCWs, the PPV of LOS and/or LOT was 73% and the NPV was 99%. In this study, we did not use one of the numerous tests of olfactory/gustatory function, nor did we use a score according to the number of smells recognised. We made the choice to use a single question, in order to be able to use this question in the context of real-life triage, family medicine, occupational medicine and self-evaluation, at an early stage of COVID. To date, the exact pathogenesis responsible for olfactory or gustatory effects in COVID-19 patients is not known 2 . In acute phases of upper respiratory infection (URI), it is common to experience transient olfactory symptoms, sometimes accompanied by taste disorders, as a result of nasal inflammation, mucosal oedema, and obstruction of airflow. SARS-CoV-2 may also cause an inflammatory response in the nasal cavity that temporarily leads to the obstruction of airflow and then to anosmia/ageusia. Indeed, cells in the olfactory epithelium present the highest expression of the SARS-CoV-2 receptor, angiotensinconverting enzyme 2, making them a potential specific target. 2 Interestingly, the olfactory J o u r n a l P r e -p r o o f bulb is known as an important pathway for neurotropic viruses such as influenza viruses and previously known coronaviruses. 5 However, these disorders have not been described in previous URI epidemics, although this may be a bias of observation. We found a higher prevalence of smell and taste complaints in women than in men. In addition, we revealed that smell and taste complaints were more prevalent under the age of 65, whereas there were no difference in uninfected patients. This result is consistent with a previous cross-sectional survey 6 . Moreover, our questionnaire appeared to be very suitable for HCWs because this population in our institution is mainly composed of young women. Questioning patients and HCWs will be useful for selecting patients or HCWs to be tested in countries where access to testing is politically or technically limited, or when identifying patients to be isolated or self-isolated while awaiting testing and treatment, and with regard to taking public health measures. Ethics Data presented herein were collected in the context on regular care for patients, and occupational medicine for HCWs; and analysed retrospectively using the electronic health recording system of the hospital. This study is part of a non-interventional retrospective study that was approved by our institutional review board committee (Mediterranean Infection N°: 2020-021). According to European General Data Protection Regulation No 2016/679, patients were informed of the potential use of their medical data (N° MR 5010010520 in the AP-HM register) and that they could refuse the use of their data. The authors declare no competing interests. Anosmia in a healthcare worker with COVID-19 in The Prevalence of Olfactory and Gustatory Dysfunction in COVID-19 Patients: A Systematic Review and Metaanalysis. Otolaryngol--Head Neck Surg Off J Am Acad Otolaryngol-Head Neck Surg COVID-19 Task force. Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: a retrospective analysis Evaluating the serological status of COVID-19 patients using an indirect immunofluorescent assay, France Sinonasal pathophysiology of SARS-CoV-2 and COVID-19: A systematic review of the current evidence Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study This study was supported by the Institut Hospitalo-Universitaire (IHU) Méditerranée Infection, and the French National Research Agency under the "Investissements d'avenir"