“Things start to smell like garbage.” Latest research on possible permanence of COVID smell loss

FOXBOROUGH, Mass. — It started with a cheap candle and an assumption.

“I remember lighting a candle the night before I came home for Easter,” Christina Germino said. “And it was from the Dollar Tree. I just remember I couldn’t smell it. And I didn’t know why. But I just kind of shrugged it off. I was just like, ‘Oh, bad candle’”.

Germino had no cough, fever or sniffles — but unbeknownst to the 22-year-old college student — she was infected with COVID-19, with loss of sense of smell the only apparent symptom.

Over the next few months, Germino would regain some smell — then, in an odd twist, begin smelling things that weren’t there.

“Things started to smell like trash or just garbage,” she said. That phase was followed by one in which everything smelled to her like Mexican food.

“Like a tangy salsa,” Germino described it.

Now, almost a year later, Germino said the virus’s attack on her olfactory system has left her with an occasional whiff of what she has come to call ‘the COVID smell.’

“I don’t even know how to describe it,” she said. “It’s like a tangy... or it’s not like sweet. It’s just like… it’s weird.”

All those weird smells are known as ‘parosmias,’ said Jay Piccirillo, MD, a professor in the Department of Otolaryngology, Head and Neck Surgery at Washington University School of Medicine in St. Louis, Missouri.

“Meat smells rancid, food doesn’t taste like it’s supposed to,” Piccirillo said. “It has a metallic taste or a smoky taste. It’s just unpleasant.”

In fact, Piccirillo has only had one patient with a pleasant parosmia.

“She commented to her husband when they were taking a walk, about how pleasant the lilacs smelled. And he looked at her and said, Honey, that’s a skunk.”

How does COVID affect sense of smell and, in turn, taste?

Piccirillo said it appears the virus attacks ‘supporting’ cells in the nostrils that provide nutrients and clear away wastes to help smell-sensing nerve cells function.

“Now there’s also some suggestion that maybe the virus actually gets into the olfactory nerve and can actually track up into the brain,” Piccirillo said. “But overwhelmingly it looks as though the virus attacks the supporting cell and not the olfactory nerve cell itself.”

There is good news in that: it implies sense of smell should return to those affected once those supporting cells recover or regenerate — but it’s a process that can sometimes take months.

However, a Swedish study of health care workers who lost sense of smell because of COVID infections is not as optimistic.

“If you have had your problems for a year or longer and they have ceased to improve, it’s likely they will last for a very long time or be permanent,” said Evelina Thunell, PhD, of the Karolinska Institute, one of the authors.

Thunell’s study found an astounding 65 percent of the workers still had issues with smell 18 months later

As sense of smell diminishes, so, too, does sense of taste — as there’s an intimate connection between the two.

Take bananas.

“Banana is not a taste, it’s a smell,” Thunell said.

Holding your nose while eating a banana approximates what happens to taste with loss of smell.

“You will be able to experience the taste, like sweet — and the texture,” Thunell said. “But the banana identity, the flavor, it will not be there because that’s a smell.”

Here’s what worries Piccirillo:

“What is the burden of lifetime anosmia (loss of smell) or smell problems? That’s what I think we need to start thinking about as we hopefully get to the end of this pandemic,” he said.

Because while most COVID patients who lose sense of smell regain it within weeks, five to ten percent don’t.

“We’re going to be left with a huge number of Americans who are suffering chronic, permanent olfactory dysfunction and that could be a loss of smell, reduced smell, reduced taste and flavor,” Piccirillo said.

Like everything else with COVID, the situation is unprecedented.

“We don’t know what the long term consequences are of such a dramatic reduction in the olfactory system to our lives,” Piccirillo said. “You know, we just don’t know.”

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