COVID-19: Loss of Smell & Taste / Healthcare Workers' Mental Health / Allocating Resources

By Kelly Young

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

The American Academy of Otolaryngology — Head & Neck Surgery has proposed adding anosmia and dysgeusia to the list of screening items for potential novel coronavirus disease (COVID-19).

Anecdotally, these symptoms have been reported among some patients who've tested positive, and in some cases, anosmia has been reported as the only symptom. In the absence of other respiratory disease (e.g., rhinosinusitis, allergic rhinitis), anosmia, hyposmia, and dysgeusia "warrant serious consideration for self-isolation and testing of these individuals," the group says. At a news briefing on Monday, World Health Organization officials said they are investigating loss of smell and taste as potential early symptoms.

In other COVID-19 developments, a JAMA Network Open study of 1300 healthcare workers in China (mostly Hubei province) in late January and early February found that 50% had symptoms of depression, 45% anxiety, 34% insomnia, and 72% distress. Nurses, women, frontline workers, and those in Wuhan had more severe symptoms.

In MMWR, researchers report details of COVID-19 cases aboard cruise ships. On the Diamond Princess, 19% of the 3700 passengers and crew were ultimately infected. Nearly half were asymptomatic when they tested positive, although many eventually developed symptoms.

Meanwhile, a sounding board article in the New England Journal of Medicine offers six recommendations for allocating medical resources during the pandemic. The most important recommendation, the authors say, is maximizing benefits, e.g., saving the most lives. This may mean giving one patient's ICU bed or ventilator to another patient.

In a related NEJM perspective, authors say that using a triage committee to make decisions about withdrawing mechanical ventilation could help insulate clinicians from the distress of these decisions. They write: "Though some people may denounce triage committees as 'death panels,' in fact they would be just the opposite — their goal would be to save the most lives possible in a time of unprecedented crisis."