Обоняние страдает меньше

chuka_lis — 19.02.2022 Итальянцы сравнили, на сколько часто нарушается обоняние (изменение чувствительности или потеря) и вкус при омикроновом ковиде, по сравнению с предыдущими волнами. Основываясь на самоощущениях (опросники) тех, кто болел ковидом, преимущественно, "умеренно".
Выборка у них не особо большая: 338 (средний возраст 46 лет) для омикрона, и 441 для предыдущих волн, с похожим распределением по полу и возрасту (и курению),  при университетском госпитале. Однако разница вышла  очевидная.
Любопытно, что среди тех, кто подхватил омикрон- 82.5% были полностью привиты, и 5.3% переболели ковидом  в какую либо из предыдущих волн.  То есть в их выборке, почти 90% заболевших омикроном, вроде бы, должны были бы иметь хоть какой-то иммунитет к коронавирусу (полностью привитые или переболевшие).
У исследователей вышло, что во время омикроновой волны, нарушения вкуса или запаха, а так же потеря нюха случались в 2-3 раза реже, чем  для предыдущих ковидных волн. Примерно у каждого 3-5 опрошенного.
Авторы отмечают, что симптоматика болезни  при омикроновой и предыдущих волнах слегка отличалась, и, хотя есть вероятность, что  положительную роль сыграла иммунизация, чтоб заболевание протекало полегче, в том, что касается вкусовой и обонятельной функции, то, скорее всего,  прививка ни при чем- тк  схожий паттерн  урежения наблюдался и среди привитых и среди непривитых, так что вероятнее, что сильно мутировавший вирус по другому влияет на клетки и локальный иммунитет в воротах инфекции.
Ниже выдержки,  для сравнения симптоматики.
Omicron seems to cause a less severe disease with determinants of severity being multifactorial and including a lower replication competence in the lung parenchyma compared to bronchus 4. Consistently, the spectrum of symptoms is expected to differ from that observed in the coronavirus disease 2019 (COVID-19) driven by other SARS-CoV-2 strains. However, to the best of our knowledge, only one report has been published so far regarding the prevalence of different symptoms in infections driven by this VOC 5. Smell and taste dysfunction were consistently reported among the most common symptoms of COVID-19 with about 65-70% of patients with mild-to-moderate disease experiencing a chemosensory impairment during the acute phase of the COVID-19 6–8. Recently, in a series of 81 subjects tested positive for the SARS-CoV-2 Omicron variant, the impairment of the sense of smell and taste was self-reported by 12% and 23% of patients, respectively 5. Since January 17, 2022, Omicron variant was by far the most predominant variant in Italy with an overall prevalence of 95.8% 9. Particularly, in Friuli Venezia-Giulia and Sardinia, the prevalence of SARS-CoV-2 infection driven by Omicron variant was 97.0% and 96.2%, respectively 9. The aim of this study was to determinate the prevalence of self-reported chemosensory dysfunction in a series of Italian subjects who developed a mild-to-moderate COVID-19 after January 17, 2022 and to compare it with that of a cohort of patients who tested positive for SARS-CoV-2 infection and were evaluated during the first wave of the pandemic in Italy. The study was approved by the Ethics Committees of the Friuli Venezia Giulia Region (CEUR-OS156) and University Hospital of Cagliari (PG 2021/7118). Informed consent was obtained for telephone interviews. This is a prospective study on mild-to-moderate symptomatic adult patients resident in Friuli Venezia Giulia and Sardinia, who tested positive for SARS-CoV-2 RNA by polymerase chain reaction (PCR) on nasopharyngeal swabs performed according to World Health Organization recommendation between January 17 and February 4, 2022. Telephone interview were conducted between January, 28 and February 14, 2022. Demographic and clinical data were collected through standardized questions administered during the interview including gender, age, self-reported height and weight, smoking habit, and the following co-morbidities: immunosuppression, diabetes, cardiovascular diseases, active cancer, chronic respiratory disease, kidney disease, liver disease. Obesity was defined as having a body mass index (BMI) of 30 or more. Symptoms were assessed through standardized questions and structured questionnaires, including the Acute Respiratory Tract Infection Questionnaire (ARTIQ; with symptoms scored as none, 0; a little, 1; a lot, 2) and the Sino-Nasal Outcome test 22 (SNOT-22), item “sense of smell or taste” as previously reported 6. The SNOT-22 ranks symptom severity as none (0), very mild (1), mild or slight (2), moderate (3), severe (4), or as bad as it can be (5).The study included 779 patients, 338 from the study cohort (proxy Omicron period) and 441 from the control cohort (comparator period). total of 338 (70.1%; median [IQR] age, 46 [34-59] years; 183 [54%] women) who participated in the study. Patients’ characteristics are reported in Table 1. Associated co-morbidities were reported by 116 subjects (34.3%) with the most common being cardiovascular diseases reported by 56 patients (16.6%). A total of 279 patients (82.5%) reported that they had been fully vaccinated for SARS-CoV-2. 18 patients (5.3%) reported having already contracted a SARS-CoV-2 infection during the previous two years. Most frequent symptoms were blocked nose (68.3%), fever (58.9%), and dry cough (56.8%) (Table 2). Alterations of sense of smell or taste were reported by 110 patients (32.5%, 95% CI 27.6-37.8), with 61 patients reporting a SNOT-22>2 (18.0; 95% CI: 14.1.-22.6). Eighteen patients (5.3%) reported a score of 5 (Table 3). When asked about basic taste and flavour perception, 72 (21.3%) and 87 (25.7%) patients, respectively, self-reported an impairment with 68 (20.1%) subjects reporting both. The study cohort was compared with an historical cohort of 441 patients who developed SARS-CoV-2 infection during between March and April, 2020 (comparator period). The two cohorts showed similar distribution by gender, age and smoking status. Approximately one third of patients reported comorbidities in both periods (34.3% in the proxy Omicron period and 32.7% in the comparator period). However, multimorbidity was more frequent in the proxy Omicron period than in the comparator period (14.2% vs 7.7%, p=.008). Cardiovascular disease was significantly most frequent in the Omicron period (16.6% vs 9.3%, p=.003). Significant differences in the prevalence of symptoms between the two period were observed. Particularly, blocked nose (68.3%% vs. 26.3%; P<.001), dry cough (56.8% vs. 45.1%; p=.002), headache (55.0% vs. 45.4%; p=.005), sore throat (50.9% vs. 25.6%; p<.001), coughing up mucus (26.0% vs. 12.7%; p<.001), and sinonasal pain (20.1% vs.12.2%; p=.004) were more common in the proxy Omicron period, while loss of appetite, diarrhoea, and red eyes were significantly reported more frequently in the comparator period (Table 2). The prevalence of self-reported chemosensory dysfunction during the proxy Omicron period (32.5%) was significantly lower from that during the comparator period (66.9%) (p<.001). 24.6% of patients reported an altered sense of smell during the proxy Omicron period compared to 62.6% during the comparator period (p<.001). Similarly, the prevalence of an altered sense of taste dropped from 57.4% during the comparator period to 26.9% during the proxy Omicron period (p<.001). Moreover, the severity of chemosensory dysfunction, as measured by SNOT-22 score, was significantly lower in proxy Omicron period compared to comparator period (p<.001). Variables associated with chemosensory dysfunction None of the tested variables emerged as significantly associated with chemosensory alteration in patients who contracted the infection during the proxy Omicron period (Supplementary Table). Vaccination status was not predictive of the chemosensory outcome with 33.3% and 32.3% of fully-vaccinated and partiallyvaccinated/ unvaccinated subjects, respectively, self-reporting a SNOT-22≥1 (p=.888). Although nasal obstruction was present in more than two thirds of patients, the prevalence of smell dysfunction in patients with and without nasal obstruction was 25.1% (58/173) and 24.3% (26/81), respectively (p=1.000). We observed a statistically significant reduction in the prevalence of smell and taste alterations in patients who developed the disease during the proxy Omicron period compared to that observed in patients who contracted SARSCoV- 2 infection during the comparator period with the prevalence of smell and taste dysfunction dropping from 63% to 25% and from 57% to 27%, respectively. One of the possible reasons for this difference is the modulation that the vaccine may have had on clinical expression of SARS-CoV-2 infection. Indeed, vaccination has amply demonstrated its effectiveness in making the clinical manifestations of COVID-19 less severe 16,17. However, in the present series the prevalence of chemosensory dysfunction was not influenced by the vaccination status. Furthermore, a vaccination effect on the prevalence of chemosensory disorders does not appear to be supported by several other observations. Current vaccines against SARS-CoV-2 are based on systemic injection which predominantly induces production of circulatory IgG and, potentially, cytotoxic T cells, while are poorly effective at generating mucosal immune responses, i.e. secretory IgA 18. Therefore, the olfactory neuroepithelium appears theoretically still vulnerable to SARS-CoV-2 even in vaccinated patients. Early studies found no significant correlation between serum immunoglobulin levels and duration of olfactory disfunction 19,20. The correlation is instead significant with nasal immunoglobulin 20. Also, vaccination was demonstrated to be less effective against the highly mutated Omicron variant21 and the data of the present analysis support this: even patients who received the booster dose developed a symptomatic disease. Finally, we previously observed that chemosensory dysfunctions were among the most frequent symptoms of COVID-19 in vaccinated subjects when the pandemic was mainly driven by the Delta variant 22.

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