Lindsay Davis had already put in her two weeks’ notice when she contracted COVID-19 at the Galveston, Texas, hospital where she worked in food service in February. Her symptoms were typical: headache, sore throat, fatigue.
But by the end of March, the 21-year-old was spiraling: Memories of the acrid scents of the hospital burn unit haunted her — she showered three times a day and cleaned her home top to bottom over and over, but she couldn’t escape the stench of rotting flesh. It radiated off her clothes, filled the RV where she lived with her family, and flavored her food. At night, the sensation of sleeping in a “heap of bodies” kept her awake. She considered shaving her head to stop smelling her hair.
After three weeks, she broke down crying to her mom: “Something is wrong. I think I’m dying.” They searched “COVID smell loss” on Google and discovered Davis wasn’t dying; she had parosmia, a neurological disorder that affects a small percentage of COVID-19 survivors, by some estimates 11 percent according to a new Canadian preliminary study released in August that surveyed 704 health-care workers. Unlike anosmia, which is the complete loss of taste and smell, or phantosmia, an olfactory disorder that causes people to smell phantom odors that are not actually present, parosmia distorts smells. Parosmia does not, technically, alter taste — i.e., the ability to distinguish saltiness, sourness, sweetness, bitterness, and umami — but it does alter the ability to accurately experience flavor because most of what we perceive as tasting is really what we are smelling.
In June, Davis turned down an opportunity to work at a nursing home, fearful the odors would be too triggering, and eventually landed a gig that allows her to work from home. She’d once dreamed of opening up her own bakery; now she’s disgusted by the smell of baking bread and can’t tell when ingredients are spoiled or food is burning.
Most people with COVID-19-induced parosmia can pinpoint the moment smells — and subsequently taste — changed. For Kate Carpenter, it was when she tried her friend’s lime-flavored seltzer and it tasted like burnt hair. Carpenter shrugged it off as a weird brand. Next, she tried a lime-ginger chocolate candy and immediately vomited from the off-putting taste. She had a gut feeling it was connected to her recent bout of COVID-19.
Carpenter, 31, tested positive in December and lost her ability to taste and smell for eight days, a terrifying week for a sommelier and craft cocktail bartender who relied on her taste to work. To her relief, it returned. Then two months later, parosmia showed up. For the past six months, she’s been on a relentless roller coaster of smells: At first, everything she encountered smelled like burnt hair or rancid patchouli. Her food tasted like someone had dripped garbage juice on top before serving it. Then her trigger smell, singed hair, morphed into a bouquet of stale cigarettes, spoiled maple syrup, and cheap cologne. While the nauseating smells have mellowed with time, they rush back when she eats or drinks. Lime is still a big trigger, and chicken tastes like “if you had cat food and left it out for three days.” Every day, she smells ginger and every day, it still smells like patchouli.
The timeline will sound familiar to most people with parosmia: anosmia, a brief period of normalcy, then a world that suddenly reeks. Carpenter’s anxiety, she says, has “skyrocketed.”
“I feel a little trapped,” she tells me over the phone. Before parosmia, Carpenter was a level-one sommelier, a certified specialist of spirits (CSS), and the chapter president of the United States Bartenders’ Guild with scholarship money toward pursuing her level-two sommelier certification. Now, she can’t distinguish between cranberry and strawberry, much less concoct cocktails, judge competitions, or educate others. Carpenter is preparing herself for the possibility that her dream career is over and trying to answer a devastating question: “When you literally base your life off of your career, what do you do when that’s taken away from you because of this disease?”
Oh, and on top of all that, at the restaurant where she works in Jacksonville, Florida, she’s subjected to daily mask harassment and customers who don’t treat the pandemic seriously. “I know you might not die and that’s great that you don’t die,” Carpenter says. “But also it could completely strip you of your career and your identity, because that’s what it did for me.”
Anosmia is a well-known symptom of COVID-19, but the lesser-known (and lesser-understood) parosmia is plaguing workers around the country, forcing people to switch careers and sending them on a desperate quest for answers — and food that won’t make them gag.
While smell disorders have been publicized by the pandemic, they long predate it. Cancer, chemotherapy, pollutants, head trauma, and other viruses can all disrupt the olfactory system, and it’s estimated that at least 12.4 percent of Americans live with some form of olfactory dysfunction. Dr. Federica Genovese, a postdoctoral fellow with the Monell Chemical Senses Center in Philadelphia, has devoted much of the past year and a half to studying the chemosensory effects of COVID-19. Smelling, she says, is straightforward: You breathe in molecules that are intercepted by olfactory sensory neurons lining your nose. Each odor activates a specific set of neurons, which replenish weekly, that then transmit this information to the brain to code the specific smell.
From birth, our brains are refining this process to identify the wide variety of smells we encounter. If your neurons — or worse, your reserve of soon-to-be neurons — are damaged, then it gets complicated. And COVID-19 grinds the process of neuron regeneration to a halt.
If you think of your neurons as a keyboard, Genovese says, then the olfactory bulb in your brain is the computer. COVID-19 essentially crushes your keyboard, cutting off all transmission to the computer. As you reassemble the keyboard, you might put a few keys in the wrong place, or even misplace some altogether, and the computer is left to decode misfired cues.
The more complex a smell, the more potential there is for your brain to mess up. Take coffee, for example. Imagine brewing a fresh cup and inhaling deeply. As the warmth washes over your nose, you might notice a rich, earthy smell with hints of honey. Or maybe a sweet, caramel aroma. Unless you’re experiencing parosmia, in which case all of that just smells like rotting sewage.
For workers that rely on their sense of smell, like perfumers, sommeliers, nurses, and chefs, parosmia can be debilitating. Melissa Wilson, a cook at a hunting lodge in Illinois, has been trying to leave her job since May. She can’t tell when food is burning, the smell of meat cooking drives her out of the kitchen with nausea, and once a customer had to inform her of a gas leak she couldn’t detect. Everything smells like a “rotting dead carcass laying out in the sun for several days,” the 54-year-old tells me. “When you make mashed potatoes, you have to try them, but I can’t. I’ll throw up.”
Her boss has been looking for a replacement so Wilson can take a hostess job at the lodge outside of the kitchen, but no one has applied. Wilson has anxiously been watching the calendar: September marks hunting season and an increased volume of meat in the kitchen. She doesn’t know what to do.
Deanna Fowler, 58, wonders if parosmia will be the end of a job she’s loved for six years: developing fragrance for cosplayers and actors. She started her business, Duft Werks, after using essential oils to mask the strong odor of fiberglass in a Mandalorian helmet. Now, Fowler pulls from 350 scents to offer premixed fragrances and custom orders to level up the cosplay experience. If you want to smell like Captain Jack Sparrow, a blend of leather and rum fragrances will do the trick, and metal and musk will bring the Winter Soldier to life. But the pandemic has crushed business: No one is attending conventions or wanting to wear custom-made fragrance when everyone is masked. And parosmia has made it so Fowler can’t stomach fulfilling orders or rely on her nose to know if a mix works. Every scent has the same specific, sickening smell: Dremeled dog toenails mixed with sewage.
“It’s just really crippling,” Fowler says. Going on eight months of parosmia, her hope for healing is dwindling. On a particularly rough day, she fantasized about walking into the Barrow Neurological Institute in Phoenix and demanding, “Fix this!”
Parosmia also haunts less obvious jobs that don’t necessarily rely on scent but are inundated with strong triggering odors: pilots and flight attendants, painters, vets and ranchers, hairstylists and nail technicians, janitors.
Zenaida Estrada caught COVID-19 in December, just four months after she started working as a technician in a dialysis-treatment center in Michigan. Once her parosmia started, her life became a “mind game.” At work, the cleaning chemicals overwhelmed her nose, but her body’s own odor made her even more paranoid. The 36-year-old constantly asked her co-workers if they could smell what she was smelling, even going out to buy new shirts in the middle of the day in a desperate attempt to rid herself of her own putrid scent. Her co-workers, of course, assured her she smelled normal. She regularly had to leave the building and even vomited several times from the strong smell. Her anxiety, paranoia, and nausea were incessant, and by February, she quit.
Others are powering through cases of parosmia that are enough to make work unpleasant but not intense enough to quit. Like Ohio-based hair-salon owner Carrie Murtaugh, 39, who developed parosmia after catching COVID-19 when her son brought it home from school. Hairspray, dyes, shampoos, and conditioners are overwhelming, and she says it can get lonely living in a community that has polarizing opinions on the virus itself; one client suggested the parosmia was all in Murtaugh’s head. It’s been more than six months, and she is no longer hopeful for a full recovery.
There is some hope(-ish), though — the preliminary findings of the Canadian study found that the majority of the 704 health-care workers who experienced olfactory damage reported an improvement over time, and recovery is possible even after a year of dysfunction. And parosmia itself signals the beginning of cellular-regeneration attempts. Time is the only true healer, Genovese says, and the extent of neurological damage predicts the healing timeline. In the meantime, Genovese recommends smell training, the process of consistently sniffing essential oils while focusing on the memories of that particular scent. Long-haulers with parosmia tend to respond better to training than those with other olfactory dysfunction, according to a 2020 Laryngoscope study on olfactory training. But avoid any risky remedies marketed on social media. “Don’t do anything weird,” Genovese says, e.g., smelling bleach or putting anything up your nose. Vaccination also cannot help or hurt parosmia, nor can getting swabbed for COVID-19, both commonly cited concerns on Facebook support groups.
Facebook support groups offer thousands of parosmia sufferers community while they wait. People swap recipe ideas, bemoan spouses who treat their condition callously, and suggest remedies. Every few weeks, someone posts that they feel cured enough to leave, sparking a flurry of congratulations. Occasionally, someone admits parosmia has plunged them into a deep darkness of depression or renewed an eating disorder.
The good news for long-haulers is that the significant bump in people with smell disorders will provide much-needed data for scientists to better understand the olfactory system and develop potential remedies. The Monell Center is also working to educate and equip primary-care doctors with better tools to test people’s smell and take their concerns seriously.
But until then, long-haulers are left to navigate a sensory minefield that’s constantly changing: Will my mint toothpaste make me throw up? Yesterday, bananas tasted normal, but will they make me gag today? Does my sweat smell this toxic to everyone else around me, too, or is it just me?