AFRL surgeon, principal author on COVID-19 olfactory research

WRIGHT-PATTERSON AIR FORCE BASE, Ohio – Col. (Dr.) Michael Xydakis, an otolaryngologist in the Air Force Research Laboratory, along with a multidisciplinary team of world-renown medical experts, authored an article titled “Post-viral effects of COVID-19 in the olfactory system and their implications” published July 30 in The Lancet Neurology.

The article discusses a link between those infected with COVID-19, whose sense of smell did not return, and the potential for future neurological conditions.

“Because loss of smell was so common with COVID-19, we knew we needed to analyze and distill the data so that providers could begin to track patients whose smell never came back and then monitor their neurological symptoms,” Xydakis said.

Xydakis offered an analogy as a way to better understand the manner in which olfactory function may be affected, which is essentially controlled by memory and attention centers in the brain.

“The brain is fundamentally an electrical organ,” Xydakis explained. “So in that regard, think about the cable box hooked to your television. If lightning strikes it during a storm, in most cases, the box will short circuit, turn off and then reboot itself. In some cases, however, due to the age of the box or wiring, it comes back on but has a glitch. As a result, the picture on your television set appears distorted. People who lost their sense of smell and it never came back—their systems didn’t reboot properly. In this case, the lightening is the SARS-CoV-2 virus which is aggressively attacking the olfactory smell receptor high up in the nose – a structure that is just one neuronal synapse away from the brain.”

This research is just the beginning, and suggests a potential for future neurological problems in the near or distant future.

“Little is known about whether neurons and neuronal networks in the brain that survive a period of excessive stimulation due to neuroinflammation from this virus remain persistently dysfunctional or can completely repair themselves over time,” he said.

Xydakis added that what those future problems might be cannot be speculated, but that what’s important is that a person whose loss of smell never recovered should be tracked by a physician. He also emphasized a need for the development of additional olfactory testing.

“With this research, there is now great potential and need to develop additional tests. As it stands, what is needed is population-level scalable testing strategies that can monitor the symptoms of this specific subset of people who were infected with COVID-19 and whose smell never returned. That’s the data needed next. We don’t have that yet and can’t study it yet because the virus is too new.”
“AFRL has robust national and international partnerships,” Xydakis said. “For this research, a blue-ribbon panel, invited by The Lancet, quickly came together in hopes of not just furthering the research, but to save lives. This was an all-hands-on-deck effort.”

The Lancet Neurology is recognized as being a global and authoritative forum for neurological diseases research and opinion.

“The ability to make a significant contribution to the clinical standard-of-care in medicine for COVID-19 patients is all the reward that we need,” Xydakis concluded. “It is a very nice feeling to be able to apply your subject-area expertise towards such an important issue for humanity and to make a difference.”