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Los Angeles, Apr 28: People who experience loss of smell as one of the COVID-19 symptoms are likely to have a mild to moderate clinical course of the disease, according to a study which may help health care providers determine which patients require hospitalisation.

The findings, published in the journal International Forum of Allergy & Rhinology, follows an earlier study that validated the loss of smell and taste as indicators of infection with the novel coronavirus, SARS-CoV-2.

According to the scientists from the University of California (UC) San Diego Health in the US, patients who reported loss of smell were 10 times less likely to be hospitalised for COVID-19 compared to those without the symptom.

"One of the immediate challenges for health care providers is to determine how to best treat persons infected by the novel coronavirus," said Carol Yan, first author of the current study and rhinologist from the UC San Diego Health.

"If they display no or mild symptoms, can they return home to self-quarantine or will they likely require hospitalisation? These are crucial questions for hospitals trying to efficiently and effectively allocate finite medical resources," Yan said.

The findings, according to the researchers, suggest that loss of smell may be predictive of a milder clinical course of COVID-19.

"What's notable in the new findings is that it appears that loss of smell may be a predictor that a SARS-CoV-2 infection will not be as severe, and less likely to require hospitalisation," Yan said.

"If an infected person loses that sense, it seems more likely they will experience milder symptoms, barring other underlying risk factors," she added.

Risk factors for COVID-19 previously reported by other studies include age, and underlying medical conditions, such as chronic lung disease, serious heart conditions, diabetes, and obesity.

In the current study, the scientists made a retrospective analysis between March 3 and April 8 including 169 patients who tested positive for COVID-19 at UC San Diego Health.

They assessed olfactory and gustatory data for 128 of the 169 patients, 26 of whom required hospitalisation.

According to the researchers, patients who were hospitalised for COVID-19 treatment were significantly less likely to report anosmia or loss of smell -- 26.9 per cent compared to 66.7 per cent for COVID-19-infected persons treated as outpatients.

Similar percentages were found for loss of taste, known as dysgeusia, they said.

"Patients who reported loss of smell were 10 times less likely to be admitted for COVID-19 compared to those without loss of smell," said study co-author Adam S. DeConde.

"Moreover, anosmia was not associated with any other measures typically related to the decision to admit, suggesting that it's truly an independent factor and may serve as a marker for milder manifestations of Covid-19," DeConde said.

The researchers suspect that the findings hint at some of the physiological characteristics of the infection.

"The site and dosage of the initial viral burden, along with the effectiveness of the host immune response, are all potentially important variables in determining the spread of the virus within a person and, ultimately, the clinical course of the infection," DeConde said.

If the SARS-CoV-2 virus initially concentrates in the nose and upper airway, where it impacts olfactory function, that may result in an infection that is less severe and sudden in onset, decreasing the risk of overwhelming the host immune response, respiratory failure, and hospitalisation, the scientists added.

"This is a hypothesis, but it's also similar to the concept underlying live vaccinations," DeConde explained.

"At low dosage and at a distant site of inoculation, the host can generate an immune response without severe infection," he added.

Loss of smell, according to the study, might also indicate a robust immune response which has been localised to the nasal passages, limiting effects elsewhere in the body.

Citing the limitations of the study, the scientists said they relied upon self-reporting of anosmia from participants, which posed a greater chance of recall bias among patients once they had been diagnosed with COVID-19.

They added that patients with more severe respiratory disease requiring hospitalisation may not be as likely to recognise or recall the loss of smell.

So the researchers said more expansive studies are needed for validating the results.

Denser places, assumed by many to be more conducive to the spread of the coronavirus that causes COVID-19, are not linked to higher infection rates, say researchers.

The study, led by Johns Hopkins University, published in the Journal of the American Planning Association, also found that dense areas were associated with lower COVID-19 death rates.

"These findings suggest that urban planners should continue to practice and advocate for compact places rather than sprawling ones, due to the myriad well-established benefits of the former, including health benefits," says study lead author Shima Hamidi from Johns Hopkins Bloomberg School of Public Health in the US.

For their analysis, the researchers examined SARS-CoV-2 infection rates and COVID-19 death rates in 913 metropolitan counties in the US.

When other factors such as race and education were taken into account, the authors found that county density was not significantly associated with county infection rate.

The findings also showed that denser counties, as compared to more sprawling ones, tended to have lower death rates--possibly because they enjoyed a higher level of development including better health care systems.

On the other hand, the research found that higher coronavirus infection and COVID-19 mortality rates in counties are more related to the larger context of metropolitan size in which counties are located.

Large metropolitan areas with a higher number of counties tightly linked together through economic, social, and commuting relationships are the most vulnerable to the pandemic outbreaks.

According to the researchers, recent polls suggest that many US citizens now consider an exodus from big cities likely, possibly due to the belief that more density equals more infection risk.

Some government officials have posited that urban density is linked to the transmissibility of the virus.

"The fact that density is unrelated to confirmed virus infection rates and inversely related to confirmed COVID-19 death rates is important, unexpected, and profound," said Hamidi.

"It counters a narrative that, absent data and analysis, would challenge the foundation of modern cities and could lead to a population shift from urban centres to suburban and exurban areas," Hamidi added.

The analysis found that after controlling for factors such as metropolitan size, education, race, and age, doubling the activity density was associated with an 11.3 per cent lower death rate.

The authors said that this is possibly due to faster and more widespread adoption of social distancing practices and better quality of health care in areas of denser population.

The researchers concluded that a higher county population, a higher proportion of people age 60 and up, a lower proportion of college-educated people, and a higher proportion of African Americans were all associated with a greater infection rate and mortality rate.

With the scrapping of Mitron and Remove China Apps from its Play Store gaining a lot of attention in India, Google on Thursday said that it removed a video app "for a number of technical policy violations", while adding that it also does not allow an app that "encourages or incentivizes users into removing or disabling third-party apps".

Both the apps became immensely popular in India within a short span of time due to the prevailing anti-China sentiment amid border tensions between India and China in Ladakh and calls by Indian activists to boycott Chinese products.

Reports suggested that the Mitron app is a repackaged version of TicTic, which is a TikTok clone.

The Remove China Apps was designed to help users identify applications of Chinese origin.

Without naming the apps, Google hinted that the Mitron app may make a comeback on the Play Store once it fixes some technical issues, but the chances of the Remove China Apps are thin.

"We have an established process of working with developers to help them fix issues and resubmit their apps. We've given this developer (of the video app) some guidance and once they've addressed the issue the app can go back up on Play," Sameer Samat, Vice President, Android and Google Play, said in a statement.

Google said that its Android app store was designed to provide a safe and secure experience for the consumers while also giving developers the platform and tools they need to build sustainable businesses.

Samat said that Google Play recently suspended a number of apps for violating the policy that it does not allow an app that "encourages or incentivizes users into removing or disabling third-party apps or modifying device settings or features unless it is part of a verifiable security service".

"This is a longstanding rule designed to ensure a healthy, competitive environment where developers can succeed based upon design and innovation. When apps are allowed to specifically target other apps, it can lead to behaviour that we believe is not in the best interest of our community of developers and consumers," Samat said.

"We've enforced this policy against other apps in many countries consistently in the past - just as we did here," he added.