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9 maltatoday | WEDNESDAY • 1 APRIL 2020 NEWS INTERNATIONAL Countries with highest number of coronavirus cases and deaths THROUGHOUT the course of the coronavirus pandemic, discussions have taken place surrounding the pos- sibility that the virus can be spread by people who are asymptomatic. Though the two primary symptoms of Covid-19 have been widely cited as a high temperature and a new, contin- uous cough, health officials have re- cently stated that loss of smell and taste could also be lesser-known symptoms of the virus. In a statement published online, the British Association of Otorhinolaryn- gology (ENT UK) outlined that the symptoms had been found among "a number of patients" in the "absence of other symptoms". Professor Claire Hopkins, president of the British Rhinological Society, and Professor Nirmal Kumar, president of ENT UK, said in the joint statement that there had been a sudden rise "in cases of isolated anosmia" - total or par- tial smell loss - in the UK, US, France and northern Italy. "I think these patients may be some of the hitherto hidden carriers that have facilitated the rapid spread of Covid-19," the statement said. "Un- fortunately, these patients do not meet current criteria for testing or self isola- tion." Several high-profile figures who have been diagnosed with the coronavirus have revealed they have experienced loss of taste and smell as a result, in- cluding health minister Nadine Dorries and Dancing on Ice star Matt Evers. "A side effect of #coronavirus for me is the fact that I have lost [100 per cent] of taste and smell," Dorries tweeted on Thursday 19 March. "Absolutely zero of both, so weird. Eating and drinking warm or cold that's all I can tell. No point in putting a tea bag in the water." - So why are loss of smell and taste supposedly symptoms of the coronavi- rus? In the joint statement released by Professor Hopkins and Professor Ku- mar online, it explained that there are a "significant" number of coronavirus patients in South Korea, China and It- aly who have developed anosmia and hyposmia (reduced ability to smell and detect odours). The release outlined that post-viral anosmia is "one of the leading causes of loss of sense of smell in adults", ac- counting for approximately 40 per cent of cases. "Viruses that give rise to the common cold are well known to cause post-in- fectious loss, and over 200 different viruses are known to cause upper res- piratory tract infections," the profes- sors said. "Previously described coronaviruses are thought to account for 10 to 15 per cent of cases. It is therefore perhaps no surprise that the novel Covid-19 virus would also cause anosmia in infected patients." Professor Carl Philpott, director of medical affairs and research at charity Fifth Sense, explains to The Independ- ent that as common colds and viruses often cause initial congestion of the nose, this can lead to "post-viral smell loss". "If you look at the tissue in detail un- der the microscope you see that the fine hair-like endings of the recep- tor cells have fallen off and therefore the cells are no longer able to pick up odour molecules from the nose," Pro- fessor Philpott says. He adds, that Covid-19 "appears to have a high concentration in the nose", and states that as the majority of anec- dotal reports are showing people expe- riencing transient smell loss that lasts for around seven to 14 days, "it's prob- ably more likely that the virus is caus- ing some sort of inflammation in the olfactory nerves, rather than it causing any damage to the structure of the re- ceptors". The Washington DC-based Taste and Smell Clinic stressed that it is common to experience smell and taste loss after a "viral-type infection". "During the acute phase of a viral cold a patient may experience nasal conges- tion and blockage caused by nasal ob- struction, membrane edema and excess nasal secretions," the clinic explains on its website. "This congestion may cause tempo- rary loss of smell and taste but with re- covery from the cold, over time, these nasal symptoms disappear, ease of na- sal breathing is resumed and smell and taste function commonly reappear as they did prior to the onset of the viral cold." The clinic adds that in approximately one per cent of cases, patients suffer a "persistent loss of smell and taste". The organisation states that the ques- tion as to why viral infections cause smell and taste loss is one that has "caused much confusion for several years". "What we began to hypothesise was that after recovery, which eliminated the acute systemic viral attack, there was a residual and persistent viral pro- cess affecting the protein secreting glands in the nose and mouth which caused smell and taste loss," it said. "Although the dynamics of this viral process are still unknown its mecha- nism of action is critical to our under- standing of how smell and taste loss occur after a viral illness." Professor Philpott explains that the reason why people may think they are experiencing taste loss is actually be- cause their sense of smell - which has a huge impact on their ability to detect flavour - has been impacted. "The loss of taste issue is really just down to language and concept. Because everyone does smelling and tasting to- gether when you eat, most people don't separate the two mechanisms," the pro- fessor explains. "Salt, sweet, sour and bitter sensations are all detected on the tongue, which we don't think is really affected in this situation. People will think they can't taste because a large proportion of fla- vour is down to smell." Country USA Italy Spain China Germany Iran France UK Switzerland Belgium Netherlands Turkey Austria S. Korea Canada Portugal Israel Brazil Australia Norway Sweden Czechia Ireland Denmark Malaysia Chile Russia Romania Poland Philippines Luxembourg Ecuador Japan Pakistan Thailand Indonesia Saudi Arabia Finland South Africa India Greece Mexico Iceland Panama Argentina Peru Dominican Rep Singapore Slovenia Colombia Total Cases 164,359 101,739 94,417 81,518 67,051 44,605 44,550 22,141 15,922 12,775 11,750 10,827 9,851 9,786 7,474 6,408 4,831 4,661 4,557 4,494 4,028 3,002 2,910 2,815 2,766 2,449 2,337 2,245 2,132 2,084 1,988 1,966 1,953 1,865 1,651 1,528 1,453 1,418 1,326 1,251 1,212 1,094 1,086 1,075 966 950 901 879 802 798 Deaths 3,173 11,591 8,189 3,305 650 2,898 3,024 1,408 359 705 864 168 128 162 92 140 17 165 19 34 146 25 54 77 43 8 17 69 31 88 22 62 56 25 10 136 8 13 3 32 46 28 2 27 24 24 42 3 15 14 Why are loss of smell and taste reportedly symptoms of coronavirus?