If you don’t smell anything, you’re going to sniff everything. Your skin, your child, even a breeze under the covers. Esther Erwteman (42) has been doing this since she didn’t smell or taste anything from one moment to the next on April 6 and immediately became ill the same day. Corona most likely, she temporarily worked in a care center where almost thirty elderly people have died of Covid-19. For a few weeks she had a hard time, at the beginning of May she recovered. But the first thing she noticed that she was getting sick is also the last thing that still torments her: she still smells and tastes almost nothing.
Many Covid-19 patients, but also people who do not (yet) feel ill or hardly feel ill, report a loss of smell and taste. In the United Kingdom, it has therefore been included in the list of symptoms for which you should be quarantined, in order to detect more cases of infection. In the Netherlands, loss of smell and taste are not included in the stay-at-home list, although the symptom is known to RIVM.
Scientists were already on their qui-vive in March. For example, Wageningen University & Research is participating in an international study in which complaints from patients in more than fifty countries are inventoried using a questionnaire. More than 30,000 respondents have been surveyed to date. But the experts do not yet know what exactly happens to smell and taste in Covid-19.
It is clear that the changes are ‘serious’, says scent researcher Sanne Boesveldt on the phone. “The decline in smell and taste is enormous.” Because corona patients cannot be examined in the lab, they are asked what they experience. “When I talk to people, I sometimes hear: I don’t taste anything anymore.”
Pepper and mint
With a normal flu or cold, a stuffy nose is often the culprit – probably that you no longer smell anything. With the new coronavirus, something else seems to be going on. “One hypothesis is that loss of smell and taste occurs because the virus binds to a receptor that is also in the nose. The nose is a kind of gateway, from there the virus penetrates further into the body. As a result, loss of smell could already occur before you develop other complaints.”
Smell is more vulnerable than taste, with many disorders people lose their sense of smell but not their taste. But although not everyone can distinguish smell and taste equally well – what you ‘taste’ is an interplay of senses – both seem to be disrupted in Covid-19.
The only sensations that remain are tingling, heat and cooling – for example, from carbon dioxide, red pepper or mint. It is the trigeminal system, the relatively unknown third test sense, that takes care of this.
For example, Pea Man remembers the juice with ginger, lemon, lime and red pepper that her husband made for her when she was just sick. “That burned pleasantly in my throat, it was all I tasted.” The question is how well she perceived those intense stimuli. Because even that trigeminal system seems to work less well for many patients,” says Boesveldt.
What Peaman smells extremely good in any case, she says, is the smell of disinfectant. “It’s not there, but I can smell it.” Fantasy odors and distorted smells are more common in people who smell bad, but this phenomenon too is still in the early stages of research into its relationship with Covid-19.
Coffee and milk
Esther Erwteman has made espresso with a dash of milk in her cooking studio in Amsterdam. She notices that she is slowly starting to taste coffee again. “Especially strong flavours. I taste the coffee, not the milk.” Almost no one likes not being able to smell and taste. But for Pea Man, who cooks for a living, it’s terrible. Her vegetarian-Jewish cookbook Nosh was thankfully ready before corona. The cooking studio that she runs with her husband will open again on June 1. With a nose and mouth she doesn’t trust yet, that’s exciting. “It’s like having a blind person paint a portrait,” she describes it. “I’m chewing something and it’s not there. I smell something and it’s not there. Everything I cook, I have to let others taste.”
She misses the airy freshness that rises when you chop a bunch of fresh herbs, the deep taste of good olive oil. “The first sip of a glass of wine, the only moment when you taste all the nuances.”
Though she knows what she’s missing, she can’t recall the smells. She doesn’t even dream about food anymore, she says sadly. She has left the fear of dying from the virus behind her. But slight panic is still there. “Will I ever enjoy eating again? I only eat functionally now. Suddenly you see how much you actually dissolve and regulate with food.” Celebrate, comfort, care, be busy, celebrate. “Everything is food. I am an eating person.”
On Mother’s Day she ate a little with taste for the first time. She had red curry for breakfast – tomato, spicy masala, the softness of paneer and coconut, yes, delicious. The matzo balls that her mother traditionally makes for Passover, Peaman has this year frozen until they are worth eating – if she tastes good again.
For now, she gets ‘taste’ from texture: silky smooth hummus, creamy charred aubergine, crunchy pistachios, crunchy Maldon salt.
Ginger and liquorice
Combine hot and cold, crispy and soft, small and large, spicy and cooling. Cook yourself, eat with care and follow the recipe (if you also cook for others). If anyone knows how to eat well with defective senses, it is Joke Boon (59). She is the blind portraitist among cookbook writers – having her tonsils pulled at the age of four, she caught a bad cold and lost her sense of smell. It never came back, she says, drinking liquorice tea with fresh ginger. She tastes sweet, sour, salty, bitter and umami (savoury), the ‘tongue flavours’. Her trigeminal system, for spice and stimulation, also works. But she smells nothing.
Her mother let little Joke eat from her plate, “so I tasted what I expected, that it was tasty.” She had to learn to enjoy food, because “all communication in our home was through food”, not talking about food was not participating.
Once grown up and figured it out, she learned to approach food differently. You can see food, hear it (“a carrot sounds different from an apple”) and feel it. “Even the sound of the words gives food taste.” She experimented with all her senses, noticed that others wanted her recipes, and since 2010 she has been a cookbook writer. The way Boon talks about food—the layering of flavors in Indonesian and Mexican cuisine, or the concentrated flavors from her new food dehydrator—you’d be hard pressed to believe she smells nothing.
Boon has learned to “experience” flavors other than with her nose. The questions she now receives from people who have lost their sense of smell and taste due to corona are sometimes almost desperate. Also because it is not yet certain that it will always turn out well. Don’t despair, she would say. “If you let go of what you are used to, you will find new ways to taste.”
Boon will never regain her sense of smell. There is hope for corona patients – but no certainty. “We hear from patients that it can take a long time, sometimes weeks or months,” says Boesveldt. Whether smell and taste always come back and fully recover in the long term, nobody knows.
Rose and cloves
What Boesveldt can only recommend is an smell training developed in Dresden, in which you sniff rose, lemon, eucalyptus and cloves five times a day for at least twelve weeks, twice a day. “I was skeptical about that, but it seems that the training provides either more receptors or better connections with the brain. People benefit from it.”
Boesveldt is also aware that despair and even depression lurk with a loss of smell. “Not only do you miss your appetite and your pleasure in eating, you also do not smell the smell of your loved one and your children. Scent is part of all facets of life.”
Supplement (4/6): after the publication of this article, the RIVM added ‘sudden loss of smell and/or taste (without nasal congestion)’ to the list of symptoms where you should stay at home on May 31.