The Reduced Frequency of Olfactory Dysfunction in Patients with Omicron SARS-CoV-2 Variant Infection - Abstract
Anosmia is a prevalent symptom of COVID-19 and has become almost synonymous with COVID-19 infection. It is known to emerge as either the sole symptom of the infection or at least prior to other symptoms. Surprisingly, it has been shown that the phenomenon is much less common in the COVID-19 Omicron variant infection compared with other previous variants of the disease. Our review explores several theories explaining the reduced frequency of olfactory dysfunction among the Omicron variant infected patients. Regarding viral host cell invasion, the process may occur by two distinct routes involving either the plasma cell membrane fusion or by viral uptake via endocytosis. The Omicron variant prefers using the endosomal pathway, which is less dependent on transmembrane serine protease 2 (TMPRSS2) activation. Therefore, the Omicron penetration of the olfactory epithelium, which expresses high levels of TMPRSS2, is less efficient and leads to the reduced frequency of anosmia. Moreover, the less-dependent TMPRSS2 pathway of the Omicron variant diminishes its ability to produce syncytia arrangement, a phenomenon associated with more severe symptoms. In addition, the new mutations make the Omicron variant more hydrophobic and alkaline, which may reduce its ability to appropriately penetrate the mucosal layer. Furthermore, there is evidence to show that the Omicron variant produces a milder inflammatory response and less of a cytokine storm. In conclusion, anosmia is much less common symptom within the Omicron variant, however, the expeditious spread of the Omicron can still lead to a significant number of patients with olfactory dysfunction.