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Eleanor Hopwell is in the pharmacy to pick up her prescription.

“How are you doing?” enquires pharmacy technician Vicky. “I think it was six months ago that you were last in, and you were still feeling quite knocked about by Covid.”

“I’m much better, thanks,” replies Eleanor. “I still get quite tired, but the main thing is that my sense of smell is still not back to normal and random things still make me feel incredibly nauseous.”

“Things you don’t smell too often, I hope?” asks Vicky, with concern.

“Well, I go out of my way to avoid them, but it is still some of my favourite things – my usual perfume and herbal teas, for instance – and then certain ingredients that you realise are in everything, like onions and garlic,” explains Eleanor. “It is better, but I’m still not back to normal and sometimes I get a whiff of something and it either has me running to the bathroom for fear of throwing up or puts me right off eating and drinking. In fact, do you have any tips? I know I’m not the only one going through this...”

Answer

There are a few things Eleanor can try such as cleaning the inside of the nose using a salt water (saline) solution or using a steroid nasal spray or drops – though these need to be prescribed rather than purchased over the counter to avoid a license breach. Opting for bland foods such as steamed vegetables, natural yogurt, noodles and rice rather than strongly-flavoured or fried foods may also help, as can taking exercise to release feel-good endorphins, seeking out distractions in the form of brain-occupying hobbies such as crafts and puzzles, keeping a smell diary to track progress and smell training using essential oils or household items. If eating is very problematic, nutritional supplements may be necessary to bridge any gaps.

An important thing to bear in mind is that having an altered sense of smell means an important early warning sign for the body may be affected. Dangerous smells may be missed, such as a gas leak, a fire or food that has gone off, meaning carbon monoxide and smoke detectors, as well as keeping an eye on expiry dates, are all important. It also means that ensuring adequate ventilation in certain situations needs to become a habit rather than something that happens reactively, for instance when cleaning using bleach or disinfectants that emit fumes or doing DIY jobs such as painting. 

And of course, personal hygiene may be compromised due to a lack of self-awareness, so maintaining a regular routine in terms of showering or bathing, wearing antiperspirant and regularly laundering clothes, which may be better if they are made from natural fibres such as cotton as these tend to be more breathable, is a wise idea.

The bigger picture

Loss of sense of smell and taste is one of the recognised signs of Covid-19 infection and is believed to affect over half of patients. Most recover fully within a couple of weeks, but a significant number experience persistent anosmia which may last many months. Individuals may also experience parosmia, a condition in which smells are interpreted as distorted and unpleasant, and/or phantosmia, in which individuals smell things that aren’t there at all.

The reason these symptoms occur appears to be due to Covid-19 attaching to support cells, which cause the olfactory epithelium – the area of tissue in the nose that detects odours – to lose its structure. This, in turn, means olfactory neurones – the nerve cells that transmit information to the brain in order for it to be interpreted as various smells – malfunction. The support cells can regrow, and the olfactory epithelium can heal, but the process takes time, during which the information received and interpreted by the brain may be scrambled.

This can be distressing to deal with, affecting eating and potentially meaning that sufferers don’t get a healthy balanced diet in their attempts to avoid foods they find triggering. It can also sometimes have a negative impact on mental health. Meditation and other relaxation techniques may be helpful, as well as reaching out to, and perhaps supporting, others who are going through a similar experience.