At first, the positive results from Gov. Ralph Northam’s COVID-19 test were the only indication he had been infected. It wasn’t until a couple of days later that the symptoms erupted — like an unrelenting sinus infection that had set the upper part of his throat behind his nose ablaze.
He knew right away he had lost his sense of smell. One morning he stepped into the shower, and noticed his shampoo had no fragrance, even as he lathered it into his hair.
Almost half a year ago, Northam said publicly he had prolonged smell and taste loss following his mild illness. He intended that as a wakeup call for Virginians on the interminable consequences of the coronavirus. Vaccines, which weren’t available when he got sick in September 2020, are the best prevention, he said. But perhaps more surprising was when he recently brought up his symptoms again: Even now, more than a year since his case, he hasn’t regained those senses.
With just three months left in his administration, Northam hopes sharing his experience will persuade some of the vaccine-resistant population to get the shots. He knows many unvaccinated people are young and doubt they could die. In an eleventh-hour push, the nation’s only governor who is a doctor has a parting message.
“I’m 62, and I can deal with this,” he said in an interview with The Virginian-Pilot. “But why take a chance, if you’re 15 or 20 years old or whatever age, of having symptoms that may affect you for the rest of your life? Or, in the worst-case scenario, you get COVID pneumonia and don’t recover and end up losing your life.”
Though Northam’s smell and taste impairment isn’t debilitating, he is among the countless Americans with “long COVID” — post-infection symptoms that have lasted a month or more. Many people who have survived the virus now have chronic breathing problems, fatigue, racing hearts and weakened organs. It’s the formidable public health crisis lurking just beyond the pandemic, threatening to keep people from returning to the lives they once knew.
Medical researchers still don’t fully understand what causes the myriad symptoms long haulers report after COVID-19. In an April survey involving 6,000 adults, 66% of people who had the disease said they had not returned to their previous health more than four weeks later, according to the Centers for Disease Control and Prevention.
After three weeks of isolation, Northam and his wife, Pam Northam, were cleared by the Virginia Department of Health to return to public duty in October 2020. The governor was soon zigzagging the state for meetings and appearances, leaving little time to see a specialist for his lingering health issues.
He expected his senses to return with time.
Rather than come back, the problems morphed. Now, along with the lack of smell and taste, he experiences bouts of parosmia, a condition that causes things to smell and taste different, and phantosmia, brief episodes of smelling something that isn’t there.
Northam’s drink of choice on the road used to be lemonade. That tradition abruptly ended when it began to taste like gasoline.
Ironically, he can no longer smell gas. The governor, who has restored a 1953 Oldsmobile and 1971 Corvette, still works on cars in his spare time, but can’t detect the scent of a leak.
The same goes for smoke. Sometimes he’ll think he’s inhaling noxious fumes for a few seconds when there are none. But when he’s sitting beside his backyard fire pit and the wind changes, he gets nothing.
Medical experts say that’s one of the major concerns for people who have smelling loss: They can’t smell a fire, toxic chemical or gas leak, putting them at risk of not reacting quickly in a life-threatening situation.
The only perk for Northam has been his inability to smell Murphy and Pearl, his Labrador retrievers. That came in handy during one ride with the dogs in the executive Suburban. Two state troopers in his security detail gasped for air, with the first lady begging for someone to roll down the windows. The governor was unfazed.
As a neurologist, Northam has an informed grasp of his problem. He has spent most of his career treating children, but during the height of Operation Desert Storm, he cared for adult neurology patients as an Army medical officer.
When people have changes in sensation, neurologists try to surmise whether it’s a problem of the brain, neurons or something more peripheral. Sinus infections, for example, can wipe out smell and taste because of inflammation of the epithelial cells that line the nose and upper pharynx.
Northam offers this medical explanation, using sophisticated terms. His Eastern Shore drawl makes for an unassuming bedside manner.
Stop me anytime, he says before proceeding.
People’s brains receive messages through their olfactory bulbs, and sensory neurons connect them to the brain. Sustentacular cells provide structural and metabolic support to the neurons. But the neurons don’t seem to be affected by the gene linked to the coronavirus.
“It’s actually the supporting cells, which is kind of encouraging,” Northam said, “because most people think that, in time, they will actually regenerate and heal themselves, versus neurons that are a lot slower, and oftentimes don’t recover.”
Smell or taste returns within six months for four out of five COVID-19 survivors who have lost these senses, according to an ongoing Virginia Commonwealth University study. Those under 40 are more likely to recover them than older adults. About 3,000 people across the United States have participated in the survey, which has been tracking symptoms over time.
But considering hundreds of millions have had the virus worldwide, that 20% who don’t get better means millions could have permanent loss, said Richard Costanzo, founder of the Smell and Taste Disorders Center at VCU Health.
The clinic, one of the few in the country, has seen patients who have experienced dysfunction following other viruses. For people who have had those symptoms for two or three months after an illness, there’s a good chance they’ll recover. But if they haven’t in 12 to 18 months, the probability of getting back to normal would be less than 5%.
People who smell and taste things differently may be having partial recovery because the brain is receiving some information, Costanzo said.
“It’s kind of like looking at a picture, then taking away 80% of the pixels,” he said. “It’s distorted.”
Most of what people think is taste is really smell. The two sensations are closely linked, said Dr. Evan Reiter, an otolaryngologist and medical director of the clinic. People are also smelling what’s in their mouths because the aromas of food drift up into their nasal passages.
One of the concerns for people who have smell impairment is losing their appetite, leading to weight loss or even malnourishment. Reiter encourages them to try different spices and find foods with pleasing textures.
Many people who have lost their senses of smell and taste also report depression.
“It goes back to the fact that smell and taste are the most primitive senses that we have — everything down to an amoeba can smell and taste,” Costanzo said. “These systems are intimately connected to our reproductive system and our survival.”
Shortly after Northam’s illness, he used Flonase, an over-the-counter nasal steroid spray for allergies and congestion. Seeing no improvement, he stopped.
A therapy he has continued is called “olfactory training,” which is exactly what it sounds like: smelling practice. As he pours his cup of decaf, he inhales deeply. He also sniffs peppermint and peanut butter, trying to hone what’s left of his nose.
It hasn’t seemed to help so far, but he keeps at it.
As of today, few treatments exist to help with smell loss caused by a virus. But Costanzo and Dr. Daniel Coehlo are in the early stages of development on a potential solution. Calling it the “cochlear implant of the nose,” the device would use new gas-sensing technologies.
With favorite foods tasting like cardboard these days, Northam eats to live. The experience has made him more attuned to what the pandemic as a whole has brought into focus — that much of life’s enjoyment comes from small things, though you may not realize it until they’re gone.
Like the refreshing jolt a dab of Crest toothpaste used to bring. Instead of mint, he gets metal.
“It’s a god-awful taste is the way we describe things on the shore,” he said. “I’ll put it in more diplomatic terms. It’s a very unpleasant taste.”