Q After recovering from COVID-19, I have barely been able to smell anything for two months now. Why does COVID-19 cause loss of smell as a lingering symptom?
A The COVID-19 virus enters through the ACE2 receptors on the supporting cells of the nasal lining. When these supporting cells are damaged, the olfactory receptor neurons cannot function properly and regeneration of the entire olfactory epithelium slows, resulting in loss of smell. About 85% of post-COVID smell disorders recover naturally within a few months.
Detailed Answer
SARS-CoV-2 preferentially invades the sustentacular (supporting) cells that support the olfactory receptors in the uppermost layer of the nasal lining. The ACE2 and TMPRSS2 proteins on these supporting cells act as the binding lock for the virus; when these cells are damaged, the olfactory receptor neurons lose their proper environment and signal transmission breaks down. In addition, micro-inflammation in the surrounding nerve tissue disrupts the pathway leading to the olfactory bulb.
Korean Medicine Clinic Perspective
At Dongjedang, we view post-COVID smell disorder as a condition in which viral invasion has simultaneously depleted lung qi (pyegi) and body fluids (jinaek). When lung qi loses its power to open the nasal passages (bigyu), the sense of smell declines accordingly. We use heat-clearing and detoxifying (cheongyeol-haedok) methods to address any remaining heat toxin, combined with lung-tonifying (bopye) prescriptions that support recovery of vital energy and mucosal regeneration.
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