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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.

As millions of people get hooked to online dating platforms, their proliferation has led to online romance scams becoming a modern form of fraud that have spread in several societies along with the development of social media like Facebook Dating, warn researchers.

For example, extra-marital dating app Gleeden has crossed 10 lakh users in India in COVID-19 times while dating apps like Tinder and Bumble have gained immense popularity.

According to researchers from University of Siena and Scotte University Hospital led by Dr Andrea Pozza, via a fictitious Internet profile, the scammer develops a romantic relationship with the victim for 6-8 months, building a deep emotional bond to extort economic resources in a manipulative dynamic.

"There are two notable features: on the one hand, the double trauma of losing money and a relationship, on the other, the victim's shame upon discovery of the scam, an aspect that might lead to underestimation of the number of cases," the authors wrote in a paper published in the journal Clinical Practice & Epidemiology in Mental Health.

Around 1,400 dating sites/chats have been created over the last decade in North America alone. In the UK, 23 per cent of Internet users have met someone online with whom they had a romantic relationship for a certain period and even 6 per cent of married couples met through the web.

"The online dating industry has given rise to new forms of pathologies and crime, said the authors.

The results showed that 63 per cent of social media users and 3 per cent of the general population reported having been a victim at least once.

Women, middle-aged people, and individuals with higher tendencies to anxiety, romantic idealization of affective relations, impulsiveness and susceptibility to relational addiction are at higher risk of being victims of the scam.

Online romance scams are, in other words, relationships constructed through websites for the purpose of deceiving unsuspecting victims in order to extort money from them.

The scammer always acts empathetically and attempts to create the impression in the victim that the two are perfectly synced in their shared view of life.

"The declarations of the scammer become increasingly affectionate and according to some authors, a declaration of love is made within two weeks from initial contact," the study elaborated.

After this hookup phase, the scammer starts talking about the possibility of actually meeting up, which will be postponed several times due to apparently urgent problems or desperate situations such as accidents, deaths, surgeries or sudden hospitalizations for which the unwitting victim will be manipulated into sending money to cover the momentary emergency.

Using the strategy of "testing-the-water", the scammer asks the victim for small gifts, usually to ensure the continuance of the relationship, such as a webcam, which, if successful, leads to increasingly expensive gifts up to large sums of money.

When the money arrives from the victim, the scammer proposes a new encounter.

The request for money can also be made to cover the travel costs involved in the illusory meeting. In this phase, the victim may start having second thoughts or showing doubt about the intentions of the partner and gradually decide to break off the relationship.

"In other cases, the fraudulent relationship continues or even reinforces itself as the victim, under the influence of ambivalent emotions of ardor and fear of abandonment and deception, denies or rationalizes doubts to manage their feelings," said the study.

In some cases, the scammer may ask the victim to send intimate body photos that will be used as a sort of implicit blackmail to further bind the victim to the scammer.

Once the scam is discovered, the emotional reaction of the victim may go through various phases: feelings of shock, anger or shame, the perception of having been emotionally violated (a kind of emotional rape), loss of trust in people, a sensation of disgust towards oneself or the perpetrator of the crime and a feeling of mourning.

"Understanding the psychological characteristics of victims and scammers will allow at-risk personality profiles to be identified and prevention strategies to be developed," the authors suggested.

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.