The doctor slid a miniature camera into the right nostril of the patient, making her entire nose, with its bright miniature light, glow red.
Tickles a little bit, eh? As he rummaged through her nasal passages, he asked about the pain causing her eyes to tear well and roll her cheeks down.
Gabriella Forgione, the patient, wasn’t complaining. The 25-year-old pharmacy worker was delighted to be prodded and poked at a hospital in southern France’s Nice to advance her increasingly urgent quest to regain her sense of smell. It abruptly disappeared, along with her sense of taste, when she fell ill in November with COVID-19, and none of them returned.
In her body and mind, being deprived of the pleasures of food and the scents of things she loves proves difficult. Shorn of good and bad smells, Forgione is losing weight and self-confidence.
I ask myself occasionally,’ Do I stink?’ ” she admitted. Normally, I wear perfume and I like to smell good stuff. Not being able to smell annoys me greatly.
Doctors and researchers continue to try to better understand and manage the ensuing outbreak of COVID-19-related anosmia, loss of smell, a year after the coronavirus pandemic, draining much of the joy of life from a growing number of sensorially frustrated longer-term sufferers such as Forgione.
Also specialist physicians admit that they really don’t know much about the disease and are learning as they go along with their diagnosis and treatments. With COVID-19, deficiency and smell modification have become so widespread that some researchers propose that simple odour tests in countries with few laboratories may be used to detect coronavirus infections.
Olfactory problems are temporary for most individuals, sometimes resolving in weeks on their own. But a small group, even after other COVID-19 signs have vanished, complain of chronic dysfunction. Six months after infection, some have reported continued complete or partial odour loss. The longest one, some doctors say, is reaching a full year now.
Researchers working on the vexing disability state that they are hopeful that everyone will recover eventually, but others will not be afraid. Some physicians are worried that a rising number of odor-deprived patients, many of them young, may be more vulnerable to depression and other issues and may be weighing on stressed health systems.
“In their lives, they are losing colour,” said Dr. Thomas Hummel, who heads the outpatient smell and taste clinic at the University Hospital in Dresden, Germany.
“Hummel added, “These people will survive and be good in their lives, in their careers. “But their lives are going to be far poorer.”
Dr. Clair Vandersteen wafted tube after tube of odours under Forgione’s nose at the Face and Neck University Institute in Nice after he had rooted around with his camera in her nostrils.
Do you detect some kind of smell? Huh? Nothing? Huh? Zero? All right,’ he asked, as she replied repeatedly and apologetically with negative reactions.
Only the last tube caused an unambiguous reaction.
“Urgh! Urgh! Yeah, that stinks,’ yelped Forgione. Fish! Fish. ”
Test total, delivered his diagnosis by Vandersteen.
“To be able to smell something, you need an enormous amount of odour,” he told her. “You have not lost your sense of smell completely, but it’s not good either.”
He sent her away with homework: an olfactory rehab for six months. Twice a day, he ordered, selecting two or three fragrant items, like a sprig of lavender or jars of fragrances, and smelling them for two or three minutes.
“If there’s anything you smell, fine. No issue if not. Again, try to focus hard on the picture of lavender, a lovely purple bloom,’ he said. “You’ve gotta persevere.”
It can be more than a simple annoyance to lose the sense of smell. Smoke can all pass dangerously unnoticed from a spreading fire, a gas leak, or the stink of rotten food. It is embarrassingly possible to ignore fumes from a used diaper, dog’s dirt on a shoe or sweaty armpits.
And as poets have known for a long time, scents and thoughts are always like entwined lovers.
Evan Cesa was used to enjoying meals. They’re a chore now. A September fish dinner that unexpectedly seemed to be flavourless first flagged the 18-year-old sports student that had assaulted his senses with COVID-19. Foodstuffs have become mere textures, with only sweet and salty residual hints.
Five months later, breakfasting before school on chocolate cookies, Cesa only chewed without pleasure, as if swallowing cardboard.
“Eating has no purpose for me any more,” he said. “This is only a waste of time.”
Cesa is one of the patients with anosmia studied in Nice by researchers who used scents in the diagnosis of Alzheimer’s disease before the pandemic. After a truck terror attack in Nice in 2016, when a driver ploughed through holiday crowds, killing 86 individuals, they have used soothing fragrances to treat post-traumatic stress among children.
The researchers are now turning their expertise to COVID-19, working together with perfumers from the nearby town of Grasse, which produces fragrances. Perfumer Aude Galouye worked on the fragrant waxes that were wafted under Cesa’s nose to measure his olfactory impairment, with scents at varying concentrations.
Galouye said, “The sense of smell is a sense which is forgotten fundamentally.” “Except, obviously, when we no longer have it, we do not realise the impact it has on our lives.”
Language and attention checks are also used in the examinations on Cesa and other patients. The Nice researchers are investigating whether olfactory symptoms are connected to cognitive issues related to COVID, including focusing problems. On one test, Cesa stumbled by using the word “ship” when “kayak” was the obvious choice.
“That’s totally unexpected,” said Magali Payne, the team’s speech therapist. “You should not be experiencing linguistic problems with this young man.”
“We’ve got to continue digging,” she said. “As we see patients, we figure out things.”
To celebrate the taste of pasta in carbonara sauce, his favourite food, and a run through the fragrant wonders of the great outdoors, Cesa yearns to have his senses restored.
“One might think that being able to smell nature, trees, forests is not important,” he said. “But if you lose the sense of smell, you realise how lucky we really are to be able to smell that stuff.”