The Scent of COVID: Can a Nurse's Nose Know?
Nursing is an art as well as a science. Nurses have an instinctual way of knowing their patients’ status. Currently, healthcare providers are discovering a distinct smell associated with the sputum and stool of patients with the novel coronavirus disease. Some people even claimed to know that they were infected solely based upon the smell of their stool. This is not something that should be immediately ruled out.
Anyone with experience working in a medical facility, myself included, can tell you that certain bacteria and viruses have very distinctive smells. I remember walking onto a unit and instantly knowing that we had a case, if not more, of Clostridium Difficile (CDI) based on the sickly odor that hit me in the face when I opened the door. These scents are so strong that they simply cannot be ignored and tend to leave a lasting impression!
Some medical professionals, and patients alike, have been finding similarities in their experiences with patients suffering from COVID-19.
“The mask has a smell, so it tends to block stuff out. I did notice that patients complain of a bitter metallic taste in their mouths. And that was my experience when I had it,” a resident doctor in Montreal described their experience with COVID-19.
“I think people should look for that too,” they added.
Several nurses on messaging boards expressed the awful taste that they experienced when infected with the exact same description.
“So I don't remember smelling anything on the ward but I got COVID and I remember the loss of sense of smell hit about 7 days in. What tipped me off was I found myself wanting to add salt to Campbell's soup. Things tasted metallic and strange, really hard to describe. I have a pumpkin spice candle that I could feel the spices in my nose but couldn't smell it at all,” recounts Dr. Laura Sang, local family health resident.
“What's challenging, at least in my case, is that I got the symptoms in a random order. The loss of smell was in the middle and would gradually improve over the day, and then by morning was gone again - this went on for 2 weeks,” she recalls. Reports of strong, nausea-inducing chalky, moldy, musty, grainy smells are circulating on nursing message boards as well. Medical providers who have been diagnosed with coronavirus disease themselves report experiencing loss of taste and smell - yet can still sense a moldy scent in some cases. What if nurses’ noses are the tools that we’ve been looking for the entire time? Maybe not exactly their noses, but considering taste and scent as another means of diagnostic criteria could open the door to a new realm of discoveries.
In 2012, 18 Nurses participated in a study published by Oxford University Press on behalf of the Infectious Diseases Society of America. “It is a common ‘urban legend’ among nursing staff that they can identify patients with CDI by the odor of their stool alone. Based on studies that used gas chromatography, this is biologically plausible—in 2004, Probert et al demonstrated the presence of unique volatile organic compounds (VOCs) in stool from patients with CDI . Similarly, Garner et al demonstrated in 2007 that derived discriminant scores from VOC data had 100% predictive accuracy in distinguishing stool from patients who were asymptomatic, had ulcerative colitis, had Campylobacter jejuni infection, or had CDI .”
We all know that nurses are real-life superheroes, but do they have a sixth sense? Nursing is a career that changes you as a person. The more experience that one has, the more they start to notice patterns that will eventually be recognized sub-consciously by the supercomputers in our skulls. We may not even sense that the change is happening. It’s gradual, but we adapt to our surroundings and what we’re subject to most often. These days, the majority of working nurses are exposed to people infected with SARS-CoV-2 daily on the frontlines.
Many nurses, myself included when I rounded in hospice facilities, have had the experience of an innate knowing when a patient is near death. Some say it’s a smell, others a feeling. For me, it was both. This is something that’s developed over time.
It’ll be interesting to see what else medical professionals will begin to naturally pick up on as more time passes where we’re faced with coronavirus. It’s only natural that healthcare professionals evolve to better meet the needs of their patients and become more efficient in treating them.
What if these frontline workers have picked up on another way to discover if someone who is otherwise asymptomatic could be a carrier for this volatile virus? While taste and smell alone are not diagnostic factors, it may lead to a reduction in the spread of this pandemic. Imagine if someone were to recognize said taste or smell and decided to stay home and get a COVID-19 test rather than taking that extra shift at the long-term care facility.
Seasoned medical professionals are some of the most innovative people around. They’re used to working with limited supplies, support staff, and time as well as overflowing beds and unsafe staffing ratios. It would come as no surprise to me if these selfless souls were onto something noteworthy here. Could this be the breakthrough we’ve been waiting for? Stay tuned for the next article discussing how we can put this theory to work!
This article is purely speculative based on discussions between nurses and healthcare providers. It should not be used as a factor for diagnosing COVID-19. This article is not intended as advice or to replace the information and instructions provided by a licensed healthcare provider. This piece aims to get people thinking and to start a dialogue.
Sources: Oxford University Press.
Rao, Krishna et al. “The Nose Knows Not: Poor Predictive Value of Stool Sample Odor for Detection of Clostridium difficile.” Clinical infectious diseases : an official publication of the Infectious Diseases Society of America vol. 56,4 (2013): 615-6. doi:10.1093/cid/cis974