Department of Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, Connecticut, United States of America.
Department of Neurology, Yale School of Medicine, New Haven, Connecticut, United States of America.
PLoS One. 2021 Mar 3;16(3):e0248025. doi: 10.1371/journal.pone.0248025. eCollection 2021.
Healthcare workers (HCW) treating COVID-19 patients are at high risk for infection and may also spread infection through their contact with vulnerable patients. Smell loss has been associated with SARS-CoV-2 infection, but it is unknown whether monitoring for smell loss can be used to identify asymptomatic infection among high risk individuals. In this study we sought to determine if tracking smell sensitivity and loss using an at-home assessment could identify SARS-CoV-2 infection in HCW.
We performed a prospective cohort study tracking 473 HCW across three months to determine if smell loss could predict SARS-CoV-2 infection in this high-risk group. HCW subjects completed a longitudinal, behavioral at-home assessment of olfaction with household items, as well as detailed symptom surveys that included a parosmia screening questionnaire, and real-time quantitative polymerase chain reaction testing to identify SARS-CoV-2 infection. Our main measures were the prevalence of smell loss in SARS-CoV-2-positive HCW versus SARS-CoV-2-negative HCW, and timing of smell loss relative to SARS-CoV-2 test positivity. SARS-CoV-2 was identified in 17 (3.6%) of 473 HCW. HCW with SARS-CoV-2 infection were more likely to report smell loss than SARS-CoV-2-negative HCW on both the at-home assessment and the screening questionnaire (9/17, 53% vs 105/456, 23%, P < .01). 6/9 (67%) of SARS-CoV-2-positive HCW reporting smell loss reported smell loss prior to having a positive SARS-CoV-2 test, and smell loss was reported a median of two days before testing positive. Neurological symptoms were reported more frequently among SARS-CoV-2-positive HCW who reported smell loss compared to those without smell loss (9/9, 100% vs 3/8, 38%, P < .01).
In this prospective study of HCW, self-reported changes in smell using two different measures were predictive of SARS-CoV-2 infection. Smell loss frequently preceded a positive test and was associated with neurological symptoms.
治疗 COVID-19 患者的医护人员（HCW）感染风险很高，并且他们与脆弱患者的接触也可能传播感染。嗅觉丧失与 SARS-CoV-2 感染有关，但尚不清楚监测嗅觉丧失是否可用于识别高风险人群中的无症状感染。在这项研究中，我们试图确定使用家庭评估来跟踪嗅觉敏感性和丧失是否可以识别 HCW 中的 SARS-CoV-2 感染。
我们进行了一项前瞻性队列研究，对 473 名 HCW 进行了三个月的跟踪，以确定嗅觉丧失是否可以预测该高风险人群中的 SARS-CoV-2 感染。HCW 参与者使用家用物品完成了嗅觉的纵向、行为家庭评估，以及详细的症状调查，其中包括嗅觉障碍筛查问卷以及实时定量聚合酶链反应测试，以识别 SARS-CoV-2 感染。我们的主要指标是 SARS-CoV-2 阳性 HCW 中嗅觉丧失的发生率与 SARS-CoV-2 阴性 HCW 相比，以及嗅觉丧失相对于 SARS-CoV-2 测试阳性的时间。在 473 名 HCW 中发现了 17 名（3.6％）SARS-CoV-2 阳性者。在家庭评估和筛查问卷上，与 SARS-CoV-2 阴性 HCW 相比，SARS-CoV-2 感染的 HCW 更有可能报告嗅觉丧失（9/17，53％vs 105/456，23％，P <.01）。在报告嗅觉丧失的 9 名 SARS-CoV-2 阳性 HCW 中，有 6 名（67％）在 SARS-CoV-2 检测呈阳性之前报告了嗅觉丧失，并且嗅觉丧失报告中位数比测试呈阳性提前两天。与没有嗅觉丧失的 SARS-CoV-2 阳性 HCW 相比，报告嗅觉丧失的 SARS-CoV-2 阳性 HCW 更常报告神经系统症状（9/9，100％vs 3/8，38％，P <.01）。
在这项针对 HCW 的前瞻性研究中，使用两种不同措施报告的嗅觉变化可预测 SARS-CoV-2 感染。嗅觉丧失常常先于阳性测试，并与神经系统症状有关。
