An Explanation for Reports of Increased Prevalence of Olfactory Dysfunction With Omicron: Asymptomatic Infections

Abstract The prevalence of olfactory dysfunction (OD) in people infected with the Omicron variant is substantially reduced compared with previous variants. However, 4 recent studies reported a greatly increased prevalence of OD with Omicron. We provide a likely explanation for these outlier studies...

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Bibliographic Details
Published inThe Journal of infectious diseases Vol. 229; no. 1; pp. 155 - 160
Main Authors von Bartheld, Christopher S, Wang, Lingchen
Format Journal Article
LanguageEnglish
Published United States Oxford University Press 12.01.2024
Subjects
Brief Report
COVID-19
meta-analysis
SARS-CoV-2
systematic review
asymptomatic cases
Asymptomatic cases
Olfactory dysfunction
Prevalence
Systematic Review
Omicron
Meta-analysis
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Summary:Abstract The prevalence of olfactory dysfunction (OD) in people infected with the Omicron variant is substantially reduced compared with previous variants. However, 4 recent studies reported a greatly increased prevalence of OD with Omicron. We provide a likely explanation for these outlier studies and reveal a major methodological flaw. When the proportion of asymptomatic infections is large, studies on the prevalence of OD will examine and report predominantly on nonrepresentative cohorts, those with symptomatic subjects, thereby artificially inflating the prevalence of OD by up to 10-fold. Estimation of the true OD prevalence requires representative cohorts that include relevant fractions of asymptomatic cases. Olfactory dysfunction is thought to be much less frequent with Omicron than it was with previous variants, yet a few outlier studies concluded the opposite. The discrepant reports appear to be due to a methodological flaw: examination of nonrepresentative cohorts.
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Potential conflicts of interest. All authors: No reported conflicts.
All authors have submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Conflicts that the editors consider relevant to the content of the manuscript have been disclosed.
ISSN:0022-1899
1537-6613
1537-6613
DOI:10.1093/infdis/jiad394