I lost my sense of smell after Covid. Here’s what I’ve learned about life without it | Infectious diseases
To celebrate our anniversary, my partner and I dine in a trendy London restaurant in Hackney with a Michelin star – my first time in such a place. A crispy little bonbon is introduced to us simply as “Pine, kvass lees and vin brûlé.” I watch my partner light up, the flickering candle in her eyes, as the waiter sets the thing down. The impact of the aroma has already registered on her face. With her first bite she is transported to her childhood in Massachusetts. “Gosh,” she gasps, closing her eyes as a New England virgin pine forest explodes in her mind. When she blinks open, returning to the here and now, she looks at me guiltily. I take a bite and wince. No coniferous wonderland for me. Just unpleasant bitterness, confined very much to the tongue.
I am pleased for her, truly. I’m a magnanimous guy. But from that moment on, the whole evening is a bit of a spectator sport and, by the end of it, I have a feeling that she is even playing her enjoyment down, muting her reactions, as if to say, “You’re not missing out.” She finds some dishes prove more successful than others – the sweetness of cherry, an umami-rich mushroom – but I am missing out: on the nuances, the emotions, the memories. The smell.
It’s been three years since I lost it. November 2020. I was living with three friends in a flat in Glasgow when we all caught Covid in the pre-vaccine days. Two of us lost our smell and never fully recovered it. We’re in good company. Around 700,000 people in the UK are believed to have total smell loss caused by the virus, with around six million still experiencing some olfactory dysfunction. I estimate mine has returned by about 30%, but it’s inconsistent and often distorted. To summarise my symptoms of anosmia, as total or partial loss of smell is known: some things have a faint odour, some don’t smell as they should and others don’t smell at all. For example: basil smells mild but good, ground coffee and a certain brand of toothpaste smell like fish and, mercifully, shit doesn’t stink at all. Apart from the latter, all bad news.
Sometimes, I get one glorious accurate sniff of something before it disappears. It’s as if my olfactory receptors wake up to the novelty of a scent, but immediately become bored and go back to sleep. If I cut open an orange, I’ll get a floral, citrus hit on the first inhale – oh my God, my nose has returned! But when I take another whiff, I get nothing back.
On a call with Carl Philpott, professor of rhinology and olfactology at the University of East Anglia, I start with the obvious. What is smell? “Smell,” says Philpott, “is a chemo-sensory perception, which allows us to detect odours in the world around us, as a source of enjoyment and pleasure, but also as a hazard warning.”
Where once my nose was the first responder, it now fails to detect dangers. I once left a moka coffee pot on the hob for so long that the plastic handle completely melted off along with the rubber gasket between the chambers. I was in the living room at the time when a neighbour knocked on the door to check what on earth was going on. He could smell the asphyxiating fumes from next door. In better times I’d have smelled brewing coffee as soon as it started to bubble. God knows what toxic fumes I’m not smelling. Stale milk detection: useless.
Professor Philpott confirms how common accidents like the molten coffee pot are, and how, “without smell, we are forced to rely on visual clues for danger”. As he explains, “We use smell in one of two ways – orthonasal olfaction, smelling stuff from the outside when air comes through the front of the nose, and retronasal olfaction, when the air travels backwards through the nose and we essentially breath out the smell of the food we are eating.” Either way, odour particles reach the olfactory epithelium, at the top of the nose, where the specialised receptor cells live.”
The nerves travel from the receptors upwards through a bone called the cribriform plate and into the olfactory bulb at the bottom of the brain. Philpott describes this as a “relay station” that sends information on to the amygdala, the orbitofrontal cortex and the hippocampus. A 2023 study found that brain activity in anosmia sufferers is reduced and communication between these parts is impaired. With a healthy functioning olfactory system we can, according to a 2014 study into the resolution of the olfactory system, detect more than a trillion scents, “far outperforming the other senses in the number of physically different stimuli it can discriminate”.
Taste, on the other hand, is a fairly rudimentary sense. Because the experience of eating is drained of pleasure when people lose their sense of smell, they often believe they have lost their sense of taste, too. In fact the ability to taste is usually entirely intact. “From a medical perspective,” says Philpott, “taste is what we perceive on the tongue: salt, sweet, sour, bitter and umami. In the vast majority of anosmia cases this function is preserved. Most of the causes of loss of smell do not affect the taste receptors.” It’s true, a spoonful of salt still packs the same punch. But the complexity and pleasure of eating predominantly comes from our sophisticated smell apparatus.
Conclusion: you don’t know what taste really is until you lose your sense of smell and your tongue is left to fend for itself. The ruination of food – and newfound ways to cope – may be the most widely discussed aspect of anosmia. My fellow-afflicted friend, Megan, said she became “absolutely obsessed with crunchy food” because texture became so important. “Porridge: a no-go.” Agreed. When I had absolutely no smell at all, I found myself drawn to spicy crisps as a kind of sensory compensation. Tejal Rao, a food critic for the New York Times, lamented that, “Cheese became rubber and paste. Popcorn turned into thorny foam.” In her anosmic state, Rao found solace in a Sichuan seasoning called mala which, thanks to a special molecular compound, “you experience as a buzzing current through your mouth and lips”.
And some consumables are all nose! Wine, for instance. We used to have a lot of fun with it, my partner and I. It was a highlight of the first lockdown bubble. “Hose-pipe rubber; armpit sweat; my gran’s closet…” the usual stuff. She would go further. “There’s an elasticity about this chianti.” I always thought she was being a bit fanciful, but she was defiant. “Yes. Elastic as opposed to tight.” The bouquet and the high jinks disappeared with my smell. Imagine hugging the ghost of an old friend. You recognise it, you are primed for its embrace, but it has no substance. You fall through it, grasping for something to hold on to before it vanishes.
As things have improved, the ghost has regained a little opacity. One hack I have discovered is that if you take a whiff of fresh (fishy) coffee grounds between sips of wine, you can trick your olfactory receptors into smelling the wine anew each time. Not a very elegant solution.
Philpott tells me that loss can be caused variously by a physical blockage to the receptors (as in the case of rhinosinusitis); from viruses like Covid, which cause the receptor cells to become dysfunctional; from a head injury, which can damage any part of the olfactory equipment from the receptors through to the brain; or by certain neurodegenerative diseases, such as Parkinson’s, which can cause the equipment to fail, too.
I fall into the second category. Duncan Boak, the founder of Fifth Sense, a charity dedicated to smell and taste disorders, is in the third. In 2005, he suffered a head injury which left him with complete anosmia. Initially he counted his blessings for having survived the accident and tried to move on from it, writing off his lost sense of smell, but over the next five years he found that the emotional bandwidth of his life was steadily narrowing. “I became disconnected from the world around me,” he recalls. “The places and memories that one relates to through smell became inaccessible. I even lost intimacy with my girlfriend. I lost something I didn’t even know I had.”
There is a strong relationship between smell and memory. A 2023 study found that people may experience an impaired sense of smell before symptoms of Alzheimer’s disease appear. In the early days of my smell loss, my partner produced a small library of essential oils for me to practise “smell training” – a common anosmia treatment that involves deliberately and repeatedly smelling familiar odours to rebuild frayed connections between nose and brain. As I sniffed away, the scents were mostly faint and distorted, but there were a few I recognised.
One bottle smelled just awful though, like chemical faecal matter. When I was told what it was – lavender – I wept. It’s my mother’s favourite smell. She grew it in the garden and used to make lavender oil and lavender bags for the clothes drawers and under the pillows. On a holiday to Provence years ago I walked through an endless field of the purple flower. I learned that the word is derived from the Latin lava, meaning “to wash”. The flower was used by the Provencales to wash linen, which gave the washerwomen their name, lavandières. In the past, the fragrance alone would have evoked this emotional and memory-laden trivia. It stands to reason, then, that without access to the transportive power of smell, memory itself may dwindle.
In 2011, Boak came across Molly Birnbaum’s book Season to Taste, about her smell loss. “It was completely revelatory. More than a lightbulb moment. Imagine turning the lights on in an aircraft hangar. Everything bursting into light.” Having avoided dwelling on his disorder for five years, he finally realised his inability to smell was the root of his desolation. He also realised he was not alone. Through Birnbaum’s book, Boak started connecting with fellow sufferers and experts like Professor Philpott and he saw that there was a desperate need for an organisation to provide support and raise awareness of the disorder. Motivated, too, by a determination to transform “the most negative experience of his life into a positive one”, he set up Fifth Sense.
On the website, you can find your nearest regional Fifth Sense support hub, see the latest research and treatment and read stories from sufferers. “Creating a sense of community is absolutely paramount,” says Boak. “When you are cut off from so many of life’s pleasures, sharing this stuff really helps. It reduces the sense of isolation.” I’ve always had a Groucho Marx attitude toward club- membership, but I must admit that comparing notes with Boak has been comforting; there’s even something of the gallows humour to be found in sharing.
As well as the comparable emotional stuff, he too had an oven-related near-miss; he left the gas on in the oven all night, had a cigarette in his mouth and was poised to light it before deciding to smoke outside. Moments later, his flatmate informed him of the leak. (Gas safety is high on the agenda for the charity.)
Philpott meanwhile assured me that weird-smelling coffee and toothpaste are common distortions, known as parosmia. Though I’m not the severest of cases, I do appreciate this sense of kinship, knowing others go through similar experiences, especially since, as Boak is keen to emphasise, smell is the most overlooked and understudied of all the senses. “You can walk down the high street and get a sight and hearing test from Specsavers.” Why not a quick smell test? Instituting nationwide smell screening is one of Fifth Sense’s primary goals. For many medical reasons, from hazard perception and mental health issues to neurodegenerative diseases, smell loss is linked to early mortality, so the sooner it is detected the better.
Odd, how losing something can actually bring it into focus. Not that I’m an expert, but I wouldn’t know what an olfactory bulb was if mine actually worked. And then there’s the newfound gratitude. It’s a theme running through my research like a Joni Mitchell song, that you don’t know what you’ve got until it’s gone. I ask Boak, if he could turn back time, avoid the accident and get his smell back, would he? “No,” he replies, before composing himself. “No. Whilst there are still very difficult things about the condition, on the flip side, I’d have never become this passionate about something or started a charity.”
So what about treatments? I ask Philpott. “Sinus disease, which is the most common cause of smell loss, has numerous established treatments,” he says. “Smell loss caused by viruses like Covid is an area with a much greater need for treatment development, though there are various medications that have not been taken through the gold standard of a random controlled trial.” There is some, albeit weak, evidence for drugs such as theophylline (an asthma drug) and sodium citrate (a kind of buffer solution sprayed into the nose).
In the last few years, people have also received “plasma-rich protein injections” into the nose. Philpott is particularly sceptical about this. The efficacy is inconclusive: it’s a “resource-hungry” process involving “substrates” and needles. No thanks. “There is some interesting research going on in the US in terms of stem cell treatment, which may cause a reactivation of smell receptors,” says Philpott, who is on his way to Geneva for a conference on olfactory implants. “In the same way that a cochlear implant can restore hearing, in theory a device could be implanted, perhaps under the skin of the forehead, with a wire running to the olfactory bulb with an electrical stimulus.” Sign me up. “Still a long way to go…” he says.
And then there’s smell training. “There is some evidence to support it, but it doesn’t work for everyone,” says the professor. After my lachrymose lavender sessions in early 2021, I gave up on the exercise – it was too depressing. Like Boak, I didn’t want to dwell on my disorder. But while writing this piece over the last couple of weeks, I’ve had the essential oils lined up on my desk to dip into a couple of times a day. I can’t smell jasmine, sandalwood or pine, but lemon verbena makes my eyes well with joy.
On a freezing December morning, I’m in London to have my photo taken. After the shoot, the photographer, who had read an early draft of the piece, tells me she has a present for me. “I’m told lavender tastes like it smells,” she says, handing me a bar of paper-wrapped chocolate. It’s a gesture worthy of a Dickens novel and, of course, as per my magnanimity, I do not mention the discoveries of my recent research: that what one might think of as the taste of lavender probably is its smell. Bah humbug. When I get home I eat a piece. The bitterness of the chocolate overwhelms all else. But I have a second piece. And another. And then, an aroma like a spectre. It’s there, lavender, like it ought to be. Faint but powerful in its evocations, stimulating the hippocampus, bringing Provence and scented pillows into focus, counterpointing the sharpness of the cacao on my tongue like some benign floral ghost. “I live in the past, the present and the future!”
