Onset, duration, and persistence of taste and smell changes and other COVID-19 symptoms: longitudinal study in Israeli patients

Objectives: The multifaceted disease manifestation of COVID-19 requires longitudinal characterization of symptoms, to aid with screening and disease management. Methods: Phone interviews and follow-ups were completed with 112 mild COVID-19 RT-PCR-positive adult patients, over a 6 week period. Results: More than one symptom at disease onset was experienced by ~70 of the patients. Over one third of patients experienced fever, dry cough, headache, or muscle ache as the first symptom. If fatigue was reported, it was usually the first symptom to appear. Smell and taste changes had occurred 3.9 ± 5.4 and 4.6 ± 5.7 days (mean ± SD) since disease onset and emerged as first symptoms in 15% and 18% of patients, respectively. Fever was the shortest lasting symptom (5.8 ± 8.6 days (mean ± SD), and smell and taste changes were the most long-lasting symptoms (24.3 ± 22.9 days and 19.4 ± 19.1 (mean ± SD), respectively), with longer smell recovery correlated with smell change severity. In one third of patients who reported cough, smell and taste changes, these symptoms persisted after negative RT-PCR tests. Conclusions: Each symptom can occur as first or later, though some are more likely to appear as firsts, and typically more than one symptom occurs at disease onset. The severity of olfactory change is associated with its recovery time. Lack of chemosensory recuperation in recovered patients is common. These findings can aid patients through their illness and provide expected recovery patterns.