New study shows loss of smell may indicate mild to moderate Covid-19

People who experience loss of smell as one of the symptoms of coronavirus are likely to have a clinical course of the disease ranging from mild to moderate, according to a study which might help healthcare providers determine which patients need hospitalisation, PTI reported.

The findings of the study, published in the journal International Forum of Allergy and Rhinology, follow an earlier study which stated that loss of smell and taste were indicators of a coronavirus infection.

Scientists from the University of California (UC) San Diego Health in the United States, said patients who reported loss of smell and taste were 10 times less likely to be hospitalised for the disease when compared to those without the symptom.

Carol Yan, a rhinologist from the UC Sand Diego Health and first author of the study, said, “One of the immediate challenges for health care providers is to determine how to best treat persons infected by the novel coronavirus.”

Yan said that it appears that loss of smell may predict that a SARS-CoV-2 infection will not be as severe, and less likely to require hospitalisation.

Other studies have stated age and underlying medical conditions such as chronic lung disease, serious heart conditions, diabetes and obesity as the risk factors for COVID-19.

The current study includes a retrospective analysis done on data of 128 out of 169 COVID-19 patients between March 3 and April 8, 26 of whom required hospitalisation.

Researchers said that patients who were hospitalised for treatment were less likely to report loss of smell (anosmia) — 26.9 per cent compared to 66.7 per cent for COVID-19-infected persons treated as outpatients. Similar percentages were observed for loss of taste (dysgeusia)

“The site and dosage of the initial viral burden, along with the effectiveness of the host immune response, are all potentially important variables in determining the spread of the virus within a person and, ultimately the clinical course of the infection,” said Adam S DeConde, study co-author.

Scientists suggested that if the virus initially concentrates in the nose and upper airway, it might result in an infection which is less severe and sudden in onset, decreasing the risk of overwhelming the host immune response, respiratory failure and hospitalisation.

The study said that loss of smell may also indicate a robust immune response which has been localised to the nasal passages, limiting effects elsewhere in the body.

Scientists cited the limitations of the study and said that they relied upon self-reporting of anosmia from participants, posing a higher chance of recall bias among patients once they had been diagnosed with the disease, adding that patients with more severe respiratory disease may not be as likely to recall or recognise the loss of smell. Hence more expansive studies were needed to validate the results.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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There is a ‘tipping point’ before coronavirus kills

The new coronavirus causes little more than a cough if it stays in the nose and throat, which it does for the majority of people unlucky enough to be infected. Danger starts when it reaches the lungs.

One in seven patients develops difficulty breathing and other severe complications, while 6% become critical. These patients typically suffer failure of the respiratory and other vital systems, and sometimes develop septic shock, according to a report by last month’s joint World Health Organization-China mission.

The progression from mild or moderate to severe can occur “very, very quickly,” said Bruce Aylward, a WHO assistant director-general who co-led a mission in China that reviewed data from 56,000 cases. Understanding the course of the disease and identifying individuals at greatest risk are critical for optimizing care for a global contagion that’s killed more than 3,700 people since emerging in central China in December. 

About 10-15% of mild-to-moderate patients progress to severe and of those, 15-20% progress to critical. Patients at highest risk include people age 60 and older and those with pre-existing conditions such as hypertension, diabetes and cardiovascular disease.

“The clinical picture suggests a pattern of disease that’s not dissimilar to what we might see in influenza,” said Jeffery K. Taubenberger, who studied the infection in Spanish flu victims, including one exhumed more than 20 years ago from permafrost in northwestern Alaska.

Covid-19 most likely spreads via contact with virus-laden droplets expelled from an infected person’s cough, sneeze or breath.

Infection generally starts in the nose. Once inside the body, the coronavirus invades the epithelial cells that line and protect the respiratory tract, said Taubenberger, who heads the viral pathogenesis and evolution section of the National Institute of Allergy and Infectious Diseases in Bethesda, Maryland. If it’s contained in the upper airway, it usually results in a less severe disease.

But if the virus treks down the windpipe to the peripheral branches of the respiratory tree and lung tissue, it can trigger a more severe phase of the disease. That’s due to the pneumonia-causing damage inflicted directly by the virus plus secondary damage caused by the body’s immune response to the infection.

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“Your body is immediately trying to repair the damage in the lung as soon as it’s happening,” Taubenberger said. Various white blood cells that consume pathogens and help heal damaged tissue act as first-responders. “Normally, if this goes well, you can clear up your infection in just a few days.”


Coronavirus-update as March 11
In some more-severe coronavirus infections, the body’s effort to heal itself may be too robust, leading to the destruction of not just virus-infected cells, but healthy tissue, Taubenberger said. Damage to the epithelium lining the trachea and bronchi can result in the loss of protective mucus-producing cells as well as the tiny hairs, or cilia, that sweep dirt and respiratory secretions out of the lungs.

“You have no ability to keep stuff out of the lower respiratory tract,” Taubenberger said. As a result, the lungs are vulnerable to an invasive secondary bacterial infection. Potential culprits include the germs normally harbored in the nose and throat, and the antibiotic-resistant bacteria that thrive in hospitals, especially the moist environments of mechanical ventilators.

Secondary bacterial infections represent an especially pernicious threat because they can kill critical respiratory tract stem cells that enable tissue to rejuvenate. Without them, “you just can’t physically repair your lungs,” Taubenberger said. Damaged lungs can starve vital organs of oxygen, impairing the kidneys, liver, brain and heart.

“When you get a bad, overwhelming infection, everything starts to fall apart in a cascade,” said David Morens, senior scientific adviser to the director of the National Institute of Allergy and Infectious Diseases. “You pass the tipping point where everything is going downhill and, at some point, you can’t get it back.”

That tipping point probably also occurs earlier in older people, as it does in experiments with older mice, said Stanley Perlman, a professor of microbiology and immunology at the University of Iowa in Iowa City, who has studied coronaviruses for 38 years.

Still, even healthy younger adults have succumbed to the illness. Li Wenliang, the 34-year-old ophthalmologist who was one of the first to warn about the coronavirus in Wuhan, died last month after receiving antibodies, antivirals, antibiotics, oxygen and having his blood pumped through an artificial lung.

Some people may be more genetically susceptible, possibly because they have a greater abundance of the distinctly shaped protein receptors in their respiratory epithelial cells that the virus targets, Taubenberger said. It’s also possible certain individuals have some minor immunodeficiency or other host factors that relate to underlying illnesses.

This is only for your information, kindly take the advice of your doctor for medicines, exercises and so on.     

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People with sleep apnea at greater risk of pneumonia

People suffering from sleep apnea appear to be at a higher risk of pneumonia, new research says.

“Our findings show that sleep apnea is an independent risk factor for incident pneumonia,” said Vincent Yi-Fong Su and Kun-Ta Chou from Taipei Veterans General Hospital, Taiwan.

“Our results also demonstrated an exposure-response relation in patients with more severe sleep apnea may have a higher risk of pneumonia than patients with sleep apnea of milder severity,” they noted.

Sleep apnea is characterised by disrupted sleep, caused when the upper airway becomes obstructed by soft tissue, cutting off oxygen.

It has been linked to several types of heart disease and cognitive impairment.

To determine whether sleep apnea is linked to the development of pneumonia, Taiwanese researchers followed 34,100 patients for 11 years.

They found that pneumonia was more likely to develop in the people with sleep apnea than in the control group.

The people with pneumonia were older and had more comorbidities such as heart disease, diabetes, dementia and other diseases.

The authors suggest that the higher incidence of pneumonia in people with sleep apnea could be because of increased risk of aspirating contents or liquid from the throat.

The study was published in the Canadian Medical Association Journal (CMAJ).

ps- this is only for information, always consult you physician before having any particular food/ medication/exercise/other remedies.

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Didgeridoo for Sleep Apnea

Okay, so this probably isn’t something you’ve got lying around the house. You may not have heard of it either, but if you’ve got sleep apnea, this strange-sounding Australian wind instrument may be just what you need.

According to a study from Switzerland, four months of learning to play the didgeridoo worked well for patients with moderate sleep apnea, made for a better night’s sleep, and reduced daytime sleepiness. Even more, their bed partners slept better, too. Playing the instrument addressed sleep apnea by strengthening the upper airway, which prevents it from narrowing as you inhale.