Newly Published
Correspondence  |   June 2020
COVID-19 Infection: Perioperative Implications: Reply
Author Notes
  • San Francisco VA Health Care System and University of California (J.R.G.), San Francisco, California. john.greenland@ucsf.edu
  • Accepted for publication May 19, 2020.
    Accepted for publication May 19, 2020.×
Article Information
Correspondence
Correspondence   |   June 2020
COVID-19 Infection: Perioperative Implications: Reply
Anesthesiology Newly Published on June 22, 2020. doi:https://doi.org/10.1097/ALN.0000000000003424
Anesthesiology Newly Published on June 22, 2020. doi:https://doi.org/10.1097/ALN.0000000000003424
We thank Drs. Mahajan, Kapoor, and Prabhakar1  for their response to our review2  and agree that new loss of smell or taste are important, previously unrecognized manifestations of coronavirus disease 2019 (COVID-19). Of symptoms in seroprevalence studies, new loss of taste or smell was the most strongly associated with the detection of SARS-CoV-2 antibodies.3  Thus, these sensory symptoms, which are now included in Centers of Disease Control diagnostic guidelines, may even be more specific for COVID-19 than fever, cough, or dyspnea. Neurologic involvement of COVID-19 might have been expected based on the observations from the 2002 SARS-CoV virus, which was shown to infect brain cells. In mice expressing human angiotensin-converting enzyme 2, the virus entered the brain via the olfactory bulb generating a lethal infection linked to involvement of medullary respiratory centers and secretion of interleukin 6.4  Viral cytopathic effects on the brain could potentially complicate other neurocognitive sequelae of critical illness.