April 6, 2020

Covid-19 Update: Sense of Smell and Taste, Fever, and Airborne Spread

A conversation with our Editor-in-Chief Tina Kaczor, ND, FABNO

This interview was recorded on April 4, 2020.

This podcast addresses new information regarding the loss of smell and taste as symptoms, as well as airborne spread of the virus. In addition to being editor-in-chief of the Natural Medicine Journal, Tina Kaczor, ND, FABNO, has been seeing patients since earning her doctorate from the National University of Natural Medicine in 2000.

Approximate listening time: 22 minutes

About the Expert

Tina Kaczor, ND, FABNO, is editor-in-chief of Natural Medicine Journal and a naturopathic physician, board certified in naturopathic oncology. She received her naturopathic doctorate from National University of Natural Medicine, and completed her residency in naturopathic oncology at Cancer Treatment Centers of America, Tulsa, Oklahoma. Kaczor received undergraduate degrees from the State University of New York at Buffalo. She is the past president and treasurer of the Oncology Association of Naturopathic Physicians and secretary of the American Board of Naturopathic Oncology. She has been published in several peer-reviewed journals. Kaczor is based in Portland, Oregon.


Karolyn Gazella: This COIVD-19 update will feature information on airborne spread, fever, and new information on the loss of sense of smell and taste as a key symptom. Hello, I'm Karolyn Gazella, your host and the publisher of the Natural Medicine Journal, an online peer-reviewed journal for integrative medical professionals. At the Natural Medicine Journal we strive to provide practical clinical information to the practitioners who read our journal and listen to this podcast. That's why today I've invited our editor-in-chief, Dr Tina Kaczor, to join me for this Covid-19 update. In addition to being editor-in-chief of the Natural Medicine Journal, Dr Kaczor has been seeing patients since earning her doctorate from National University of Natural Medicine in 2000. Dr Kaczor, thank you for joining me.

Tina Kaczor, ND, FABNO: Thank you for inviting me.

Gazella: Well, this is going to be an interesting conversation because I have to tell you, and I don't even think you're aware of this yet, but you know this crisis is hitting home for a lot of people and it just hit home for me and my family. My niece, who is a nurse, she was sick, developed a fever, got tested, and she now has Covid-19. So, fortunately, I have been in close contact with her, she's doing well, and she has given me permission to talk to you today about her particular case. So if you don't mind, I'd like to just kind of go over a couple of things with you and then talk to you about some issues that have arisen as a result of this conversation.

So my niece was sick, had kind of like allergy symptoms, and yet never had allergies, and cold and flu-ish kind of symptoms, but because of the lack of testing available, despite what the president and the administration is telling people, there's not enough tests. So in her healthcare system they were only testing healthcare workers who developed a fever. So she eventually did develop a fever and she tested positive. Just last night her fever spiked again, and she lost her sense of smell and taste.

So if you don't mind, I'd kind of like to start with that symptom and then I'd like to circle back and talk about this issue of fever and the timing of the fever. So with this loss of sense of smell and taste, on our last update, we covered a lot of different symptoms of Covid-19, but there's some new information about this new symptom. It's unpublished data from King's University in London that was reported by Reuters on March 31st, and I know you have other sources of data regarding this particular symptom. Can you give us an update about this particular symptom, loss of smell and taste?

Kaczor: Sure, yeah. There have been anecdotal reports really starting to hit mid-March, there was anecdotal reports, but since then there's been a concerted effort to see what the prevalence is for the loss of smell in those who test positive for Covid-19. And I should say Covid-19 is the name of the disease process, the SARS coronavirus-2 is the name of the virus. So if I use those interchangeably, it's because that's what's happening as we read all these reports and they're coming out faster than they can be proofread. So just for the sake of conversation, if I say Covid-19 it may mean the virus, it may mean the disease process, this just makes our discussion a little easier.

Gazella: I agree.

Kaczor: So early on South Korea reported approximately 30% of patients with Covid had loss of sense of smell. To date I have seen up to 70%, and that was out of some doctors out of Bonn, Germany who interviewed 100 patients randomly who had Covid asking them about their sense of taste and smell. Seventy percent of them reported a complete loss of sense of smell, and I think the Reuters report you're referring to was a 60% or 59% I believe. So we're looking at 30% to 70% of the time.

And I think what's really interesting about this is it's not unique to coronavirus, let's just be clear, this can happen with the flu, so it's not a very sensitive test. Forty percent of all cases of loss of smell that present to the doctor are due to a viral infection of some sort. So that could be some other viral infection that affects the nasal passages, so it's not unique to Covid. So I just want to be really clear about that. People who are catching the flu out there might also lose sense of smell, but it is also, given this pandemic that we're going through, it's an early symptom in people who have no other symptoms often.

So the American Academy of Otolaryngology-

Gazella: I know, that's a tough one.

Kaczor: Anyway, the ear, eyes, nose, and throat folks of the United States added in a statement just yesterday I believe to its membership that any patient that presents with a loss or reduction in smell and taste should be tested for Covid-19 and should be isolated. So that also was said by some British doctors, they’re actually saying even in lieu of going to the doctor, if you lose your sense of smell, just stay home and self-isolate. And I think we would test them in an ideal world, but as you mentioned, testing is not universal at this time.

Gazella: Right. Now you bring up a couple of good points, especially from a clinical perspective, which is what I want to rely on you today for. Now you mentioned that it can be an early sign with no other symptoms, and when I was reading the data I thought, okay, that's pretty great information. Now in hearing my niece's case, with the fact that it came after, and she has had a fever now for three days, so it didn't even present itself after the first fever spike, this is her third fever spike. So what I want to talk to you a little bit is about the timing of these symptoms, which to me is very confusing, and I'm just wondering how clinicians wrap their head around that. Because you mentioned that early, no other symptoms, and then I mentioned the fact that her fever didn't come right away. How do you manage that aspect where the symptoms themselves are such a moving target?

Kaczor: Yeah. The unfortunate truth, and I think this has been known for quite some time, is that it's quite contagious when you're a carrier and asymptomatic. So this is in the news all over the place, asymptomatic carriers of the virus, you can have very few symptoms, and no one knows exactly why this is happening. Some people will have dramatic symptoms and others will have very little symptomology but still be carriers, and be out there in the world obviously as a vector of sorts for spreading the virus. We know that diabetes, cardiovascular disease, some hypertensive patients, there are some comorbidities or conditions that we know those populations will be more susceptible to the disease.

But there's also some confusion, because in the United States, at least in the state of New York, almost 50% of the people who were diagnosed with Covid were young, they're under the age of 50, so we are not following the demographic of other countries. And so I think we should be really mindful of that, that our young people are not spared here. So all those spring breakers, they all scattered home, they may or may not have gotten sick themselves, but we don't have the same demographic shifts in the disease processes as others.

But back to the symptomatology, so this is one of the reasons the masks are being talked about now, right? There are other countries that have been using masks the entire time, whether it's an official mandatory recommendation as they did, and the only country I know of in the world that had enough masks for their population was Taiwan. And they basically were ready for this because according to every coronavirus expert in the world, after the first SARS epidemic, and there's been several, I think there's 9 different coronaviruses that have been epidemic levels in the past, since 1994 or so, but SARS was in the early 2000s, and they learned a lot from that, including the fact that every expert said we're going to have this happen again, coronaviruses will happen. So certain countries got ready for it, especially Asian countries: China, Japan, Taiwan, South Korea, they were all much more prepared for an epidemic at the very least, and of course this became a pandemic, and other countries in Europe and here in America, we were just less prepared for this.

Gazella: Yeah. And I want to talk about masks, but you bring up such a good point. My niece just turned 40, she's young. So I think you're right, I think things are going to be a different perhaps here in the United States. It's good to use the data from China and now London and Italy, et cetera. And this issue of masks is one that has been debated and even this morning, Dr Kaczor, people are split. So the CDC is saying, yes, wear a cloth mask. WHO is saying no, not necessary. Dr Sanjay Gupta from CNN: yes, definitely. Dr Fauci, Anthony Fauci, who everybody respects, says yes. So take us through what you're telling your patients about wearing masks, why is wearing masks such a big deal?

Kaczor: Well I think that the confusion lies in the reason to wear a mask in the first place. So we've been talking about asymptomatic carriers of the virus then spreading that, both in the community as well as within their own family. There's 2 reasons to wear a mask. When one wears a mask, like our healthcare workers in the frontlines, they need this personal protective equipment. The PPEs are one type of mask and it's a fairly technical, well-fitted and tested within the hospital to make sure that viral particles cannot get around the mask and still be inhaled. And it's really interesting, when they are properly fitted they put this hood on, this clear hood, and they spray a mist of aspartame, basically NutraSweet, and if the person can taste that then they failed the test.

So this is like a little more high tech than what we need to be doing out in public, right? So PPE, personal protective equipment, is to protect them from inhaling the virus and obviously being exposed to it and becoming sick. So that's the most important. I think the confusion is this: I think people hear mask and they automatically think they need to do it to protect themselves. But as is customary in other countries, especially in Asia, everyone knows the reason you wear a mask is to protect other people.

So wearing a mask that is cloth, for example, is not meant to protect you, the wearer, from the virus, it's meant to protect other people in case you are a carrier. So that's different. All you need is a piece of cloth, a handkerchief, something to cover your face. Arguably it also keeps you from touching your face, so you're not going to touch your mucus membranes as much if you have any coronavirus on your hands. So there's 2 reasons to wear a mask: one is to protect yourself, which is those PPE equipment, and yes, the frontline should always have that, we shouldn't be out there buying N95 masks because they need to be there in the hospital setting and clinical settings.

The other reason is to protect other people. And to be honest, I think it's just a social and cultural norm that is the difference. And here in America we see masks, we think people are infected. And so there's almost like a social shunning of people who wear a mask. And that is not true of many Asian countries. And so I think that has been our biggest hurdle, more than the science, because I think it's been fairly clear this entire time that this coronavirus is at the very least transmitted by droplet, and some of it does get aerosolized. Granted it's a small amount, so the viral load is not high, but we know that it's spread through droplets because this coronavirus is called coronavirus-2 for a reason. There was a first coronavirus, and it looks identical except for some spike proteins and minor changes, but otherwise it behaves very similarly. So it's not like we don't know the transmission routes.

Gazella: Well, I want to get to the airborne because I want to push back a little bit on that, but first of all, I just want to let you know there's a lot of information out there about how people can sew a mask. And Dr Kaczor, you know me pretty well, you probably can guess I don't own a sewing machine and I don't even know if there's needle and thread in my home. So I went online and I found a way to make a no-sew mask with a handkerchief and rubber bands. So even for your patients who do not sew or do not have the ability to sew a mask, that information is available online, and the mask that I made works pretty slick. So just wanted to put that out there.

Now let's talk about this debate about whether or not it is airborne, versus droplets. Because if it is airborne it can be more challenging to contain. There was a great article published on April 2nd in Nature online, provided a good back and forth: is it, is it not, came to the conclusion that it probably is. I think that it is airborne, and that's why the spread has become so high and it's become such a crisis. So what do you feel, have you been able to draw any conclusions? Is it airborne or not, or are you still on the fence?

Kaczor: I'm not on the fence. I just looked back at the original SARS epidemic and used that as my guide, just from a logical perspective, that's the coronavirus that this one is closest to. And I've been watching this since the first reports in early, or I should say late January. Because I'm in the Northwest, some of the first cases in America, the first case was up there in Seattle so I wasn't far from it. So I got looking at this stuff really early on.

But that said, I think they're quibbling over the difference in terminology. Droplets are larger than an aerosol, and so the question has been, does it get aerosolized? Well it may or may not get aerosolized from a technical perspective, so aerosols stay in the air a little bit longer, and I think it does get aerosolized myself, my personal belief. The other thing is droplets are bigger, so they fall after about a couple feet out of your mouth and they drop to the ground. So if you're up close, and this would explain New York City in the subways if you've ever ridden it, you certainly know you're within 2 feet of people, you're sharing space.

But it hearkens back to something. I was at the Museum of Natural History in New York City years ago, and they had 2 young people in a glass booth who are just sitting in these 2 chairs, and they were showing in an enclosed space, and this could have been representative of say an elevator or a car ride or whatever, those 2 people were completely and utterly exchanging their biome in the air. The biome was going back and forth with every inhalation and exhalation, and they were just basically mishmoshing. And then they did a visual on a screen, and they'd kind of emphasize how once you're in a closed space, you are sharing your biota, and some of it does take to the air.

These are very small molecules, I mean this little coronavirus only has 28 proteins, it's an RNA virus. It's not very big. So to assume that that can go into the air and certainly maintain some buoyancy in the air and be exchanged is well within plausible.

Gazella: Yeah, I would agree. And I think that a clinician should be treating it as such. So is the advice there to tell your patients wear a mask? I mean is that another reason? Obviously practice social distancing, but if you have to go to a grocery store where it can be challenging to practice social distancing, wear a mask, is that the bottom line?

Kaczor: Yeah. And I'm going to vouch for the cultural, social norms in America is to not be doing that, right? You can probably get away with a handkerchief or a scarf and not look too conspicuous, but you're going to get a few looks. But this is often the case when you're doing something that is rational and makes sense, but it goes against the dominant culture. You have to be okay with that. I mean, I certainly got questions from folks when I went to our local market, but I think that it's smart, and I think that the idea is that I'm not even doing it for myself, I'm doing it for other people. So it makes it a little easier for me to do. I suppose if it was a pure act of selfishness it would be harder for me to pull off, but I know in my mind that this is for the best for the people out there in the world, and it just kind of makes it easier.

Gazella: Yeah, and it does depend where you live. I'm in New Mexico, which our governor has been a rock star and jumped on this really, really early, and I have to tell you, I went to the grocery store about a week ago and I was one of the only ones without a mask on at that time. Obviously now I'm going to be wearing that mask all the time. So it's far more common here and accepted here. So it does depend on where you live. And I want to correct myself, I keep forgetting to say physical distancing versus social distancing, because I think we are learning, and I'm assuming you're telling your patients, still stay social, still stay connected and do the video or use technology to stay connected. So let's look at this as being physical distancing. Is that kind of what you're telling your patients?

Kaczor: Absolutely. Yeah, I've tried to use the word physical distancing consistently, but it's hard because everywhere, like you said, when you're listening or reading media, they're saying social distancing. It should not be social distancing, particularly for our elderly folks who I'm concerned about, between staying home and not getting exercise out there in the world if they had an exercise routine that they can no longer do, and being isolated more, and not socializing with their friends. I think if this goes on for a long period people who are in danger of cognitive decline may have a faster cognitive decline because of socialization.

Gazella: Yeah, that's a good point. Well, I have one final question for you. So patients get confused, and let's face it, this is all really new and really shocking to all of us, so what advice do you have for clinicians to help them communicate these really complex and scary topics with their patients? Any advice?

Kaczor: I think that information and education gives people a sense of control. And I think our biggest issue right now is the unknown, and like you said in the beginning, the different guidances from different authorities on different days, and it seems so changeable and waffly. Anything we can do to give them a sense of control within the bounds of their understanding, so if they have a science background maybe we can talk about how much we do know about coronaviruses in general and give them a little sense of the fact that we're not just poking around in the dark out here. We actually do have a ton of information, and there are virologists around the world who have a career around studying stuff.

And basically just helping give them some ballast in whatever way we can to say, you do have some control over this, you can do some things. And helping them stay healthy at home mentally and emotionally, because as you know, as you mentioned, social isolation is not good for one's mood. So helping check in on people and helping them connect to other people as well. And I try to give them a sense of control, I guess, in whatever fashion they're feeling out of control or fearful, try to remedy that.

Gazella: Yeah, that's a good point. Control and consistency, I think you're right. A lack of consistency has been a big problem, so if we can get that from our healthcare provider that's going to help for sure. Well, Dr. Kaczor, thank you again for helping us break this down from a clinical perspective. I really appreciate you joining me today.

Kaczor: My pleasure. Anytime.

Gazella: Alright, so just a reminder that you can sign up to receive the Natural Medicine Journal for free via your email inbox each month by going to naturalmedicinejournal.com. Thanks for listening and stay safe everyone.

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