key: cord-273311-dl9u85nh
authors: Boscolo‐Rizzo, Paolo; Borsetto, Daniele; Hopkins, Claire; Polesel, Jerry
title: Challenges in interpreting the diagnostic performance of symptoms to predict COVID‐19 status: the case of anosmia
date: 2020-06-25
journal: Int Forum Allergy Rhinol
DOI: 10.1002/alr.22650
sha: 
doc_id: 273311
cord_uid: dl9u85nh

nan

There is mounting evidence that a sudden-onset of altered sense of smell and/or taste is strongly related to coronavirus disease 2019 (COVID-19) with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) impairing the sense of smell and/or taste in about two-thirds of mild-to-moderate COVID-19 1,2 . Consequently, several studies have tried to estimate the sensitivity and specificity as well as the positive predictive value of self-reported new onset of smell and/or taste impairment for COVID-19 in populations of patients with flu-like symptoms. When facing with this task in the context of COVID-19, two main problems are predictably encountered. The first is that the standard diagnostic tool for diagnosis of SARS-CoV-2 infection, i.e. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved. 3 predictive values were calculated as a function of prevalence of COVID-19 ranging from 0% to 100% using pooled sensitivity and specificity.

Forest plots of the sensitivity and specificity of new onset of chemosensory impairment for diagnosing COVID-19 are shown in Figure 1a . While the pooled sensitivity was 61% (95% CI, 55-68%), the pooled specificity reached 87% (95% CI, 80-92%); publication bias is possible (Figure 1b In conclusion, despite we believe that the new onset of smell and/or taste loss during COVID-19 pandemic should be considered a manifestation of SARS-CoV-2 infection until proven otherwise, sufficient to justify testing, self-isolation and the use of personal protective equipment by medical personnel interacting with these subjects, taken into account the above considerations, diagnostic performance of single symptoms should be fully understood and considered with caution when predicting SARS-CoV-2 infection in patients with flu-like symptoms.

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