The COVID-19 pandemic is the most devastating infectious disease outbreak in a century, particularly in
underserved and minoritized communities. In 2020 alone, it will cost a million lives. It continues to wreak
economic havoc worldwide. Therefore, it is critical to develop new tools that can mitigate the spread of SARS-
CoV-2, the virus that causes COVID-19. Rapid screening tools can identify potentially infected individuals who
can then be isolated/quarantined from the uninfected and directed towards further testing and treatment.
Unfortunately, definitive viral testing for SARS-CoV-2 has proven difficult to implement in many countries,
including the US, due to technical, financial and governmental hurdles to universal access and timely
processing. Symptom-based screening offers a valuable, albeit imperfect, complement to viral testing that can
help identify many individuals with the disease for isolation as well as treatment. A major challenge with
symptomatic testing is that COVID-19 is highly protean: the heterogeneity of symptoms means no single
symptom or constellation of symptoms is definitive diagnostically. Still, there is growing evidence that sudden
partial or complete olfactory loss – even more than other symptoms such as fever or dry cough – is the single
best predictor of COVID-19. In this proposal, we will develop and implement objective, self-administered smell
tests for the purpose of identifying individuals with COVID-19 prior to, or in the absence of, viral testing, as well
as for use in population-level surveillance of COVID-19 spread. Several kinds of objective tests have been
used in clinical or laboratory settings to assess an individual's olfactory ability, including those that test the
ability to identify or discriminate odors as well as procedures to determine the lowest concentration an
individual can reliably perceive (i.e., odor detection threshold). Each approach has technical and logistical
advantages and disadvantages, and each captures different aspects of olfactory dysfunction. Regarding
COVID-19, it is unknown what type of measure has the highest specificity or sensitivity. In Aim 1, we will use
self-administered objective testing of odor identification and odor detection threshold in SARS-CoV-2-tested
individuals to determine which olfactory measure is the best predictor of COVID-19. In Aim 2, we will use
objective smell testing to assess whether population monitoring of olfactory loss in university, municipal or
other community settings can serve as a sentinel of COVID-19 community spread. Together, our studies will
provide a rapid, remote-friendly, cost-effective, scalable, non-intrusive method to screen for COVID-19 at the
individual level and to assess prevalence in communities, especially those that have been traditionally
underserved by the health care system and public health infrastructure.