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Open Access

Association between new-onset anosmia and positive SARS-CoV-2 tests among people accessing outpatient testing in Toronto, Ontario: a retrospective cross-sectional study

Braden O’Neill, Sumeet Kalia, Peter Gill, Susan Hum, Carla Moran-Venegas, Rebecca Stoller, Michelle Greiver, Payal Agarwal, Abirami Kirubarajan, Samuel DeKoven, David Eisen, Andrew Pinto and Sheila Dunn
December 07, 2021 9 (4) E1134-E1140; DOI: https://doi.org/10.9778/cmajo.20210085
Braden O’Neill
MAP Centre for Urban Health Solutions (O’Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O’Neill, Pinto), St. Michael’s Hospital, Unity Health; Department of Family and Community Medicine (O’Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women’s College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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Sumeet Kalia
MAP Centre for Urban Health Solutions (O’Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O’Neill, Pinto), St. Michael’s Hospital, Unity Health; Department of Family and Community Medicine (O’Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women’s College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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Peter Gill
MAP Centre for Urban Health Solutions (O’Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O’Neill, Pinto), St. Michael’s Hospital, Unity Health; Department of Family and Community Medicine (O’Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women’s College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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Susan Hum
MAP Centre for Urban Health Solutions (O’Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O’Neill, Pinto), St. Michael’s Hospital, Unity Health; Department of Family and Community Medicine (O’Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women’s College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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Carla Moran-Venegas
MAP Centre for Urban Health Solutions (O’Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O’Neill, Pinto), St. Michael’s Hospital, Unity Health; Department of Family and Community Medicine (O’Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women’s College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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Rebecca Stoller
MAP Centre for Urban Health Solutions (O’Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O’Neill, Pinto), St. Michael’s Hospital, Unity Health; Department of Family and Community Medicine (O’Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women’s College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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Michelle Greiver
MAP Centre for Urban Health Solutions (O’Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O’Neill, Pinto), St. Michael’s Hospital, Unity Health; Department of Family and Community Medicine (O’Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women’s College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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Payal Agarwal
MAP Centre for Urban Health Solutions (O’Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O’Neill, Pinto), St. Michael’s Hospital, Unity Health; Department of Family and Community Medicine (O’Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women’s College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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Abirami Kirubarajan
MAP Centre for Urban Health Solutions (O’Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O’Neill, Pinto), St. Michael’s Hospital, Unity Health; Department of Family and Community Medicine (O’Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women’s College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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Samuel DeKoven
MAP Centre for Urban Health Solutions (O’Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O’Neill, Pinto), St. Michael’s Hospital, Unity Health; Department of Family and Community Medicine (O’Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women’s College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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David Eisen
MAP Centre for Urban Health Solutions (O’Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O’Neill, Pinto), St. Michael’s Hospital, Unity Health; Department of Family and Community Medicine (O’Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women’s College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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Andrew Pinto
MAP Centre for Urban Health Solutions (O’Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O’Neill, Pinto), St. Michael’s Hospital, Unity Health; Department of Family and Community Medicine (O’Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women’s College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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Sheila Dunn
MAP Centre for Urban Health Solutions (O’Neill, Pinto), Li Ka Shing Knowledge Institute; Department of Family and Community Medicine (O’Neill, Pinto), St. Michael’s Hospital, Unity Health; Department of Family and Community Medicine (O’Neill, Kalia, Greiver, Agarwal, Eisen, Pinto, Dunn), Temerty Faculty of Medicine, University of Toronto; SickKids Research Institute (Gill), Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning; Department of Family and Community Medicine (Hum, Agarwal, Dunn), Women’s College Hospital; North York General Hospital (Moran-Venegas); Department of Family and Community Medicine (Stoller, Greiver, Eisen), North York General Hospital; Postgraduate Medical Education (Kirubarajan, DeKoven), Temerty Faculty of Medicine, University of Toronto, Toronto, Ont.
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    Figure 1:

    Diagnostic measures of COVID-19 symptoms recorded at North York General Hospital and Women’s College Hospital (point estimates in blue, 95% confidence intervals in red). Note: LR = likelihood ratio, NPV = negative predictive value, PPV = positive predictive value. Abdominal pain

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    Figure 2:

    Diagnostic measures of COVID-19 symptoms recorded at Women’s College Hospital (point estimates in blue, 95% confidence intervals in red). Note: LR = likelihood ratio, NPV = negative predictive value, PPV = positive predictive value.

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    Figure 3:

    Odds ratios (ORs) for positive SARS-CoV-2 swab test, by patient characteristic (95% confidence intervals in red, dotted line shows OR = 1; results adjusted for age, sex, travel history and common symptoms available at both study sites: anosmia, cough and/or shortness of breath, diarrhea and/or abdominal pain).

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    Table 1:

    Demographic characteristics and symptoms of people who underwent a SARS-CoV-2 test at COVID-19 assessment centres at NYGH and WCH

    VariableSARS-CoV-2 swab test; no. (%)*Total, no.
    NegativePositive
    Demographic characteristics
    Site
     NYGH (site 1)52 272 (97.7)1207 (2.3)53 479
     WCH (site 2)29 531 (98.6)433 (1.4)29 964
    Age group, yr
     0–94563 (99.0)46 (1.0)4609
     10–195093 (98.1)98 (1.9)5191
     20–2918 488 (97.8)425 (2.2)18 913
     30–3916 602 (98.2)312 (1.8)16 914
     40–4911 617 (97.4)306 (2.6)11 923
     50–5911 446 (97.8)262 (2.2)11 708
     60–698570 (98.4)140 (1.6)8710
     ≥ 705419 (99.1)51 (0.9)5470
     Missing5 (100.0)5
    Sex
     Female47 646 (98.1)918 (1.9)48 564
     Male34 157 (97.9)722 (2.1)34 879
    Travel†
     No80 090 (98.1)1586 (1.9)81 676
     Yes1713 (96.9)54 (3.1)1767
    Symptoms
    Anosmia
     No80 152 (98.3)1414 (1.7)81 566
     Yes1651 (88.0)226 (12.0)1877
    Cough and/or shortness of breath
     No71 329 (98.5)1076 (1.5)72 405
     Yes10 474 (94.9)564 (5.1)11 038
    Fever
     No76 370 (98.4)1232 (1.6)77 602
     Yes5433 (93.0)408 (7.0)5841
    Diarrhea and/or abdominal pain
     No76 225 (98.1)1474 (1.9)77 699
     Yes5578 (97.1)166 (2.9)5744
    Pulse rate, beats/min
     Missing56 657 (98.7)761 (1.3)57 418
     20–601470 (97.4)39 (2.6)1509
     61–9019 006 (96.9)618 (3.1)19 624
     ≥ 914670 (95.5)222 (4.5)4892
    Body temperature
     Missing51 558 (99.0)496 (0.9)52 054
     93–97.9°F (33.9–36.6°C)21 711 (96.8)717 (3.2)22 428
     98–98.9°F (36.7–37.2°C)7474 (96.1)307 (3.9)7781
     ≥ 99°F (≥ 37.3°C)1060 (89.8)120 (10.2)1180
    Respiratory rate, breaths/min
     Missing55 707 (98.8)666 (1.2)56 373
     ≤ 2425 856 (96.4)964 (3.6)26 820
     > 24240 (96.0)10 (4.0)250
    Systolic blood pressure, mm Hg
     Missing59 368 (99.0)624 (1.0)59 992
     ≤ 1102596 (96.1)104 (3.8)2700
     > 11019 839 (95.6)912 (4.4)20 751
    Saturated oxygen, %
     Missing51 204 (99.0)495 (1.0)51 699
     ≤ 9262 (89.9)7 (10.1)69
     > 9230 537 (96.4)1138 (3.6)31 675
    Total81 803 (98.0)1640 (2.0)83 443
    • Note: NYGH = North York General Hospital, WCH = Women’s College Hospital.

    • ↵* This is a row percentage.

    • ↵† Travel outside Canada within last 14 days (relative to screening test date).

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Association between new-onset anosmia and positive SARS-CoV-2 tests among people accessing outpatient testing in Toronto, Ontario: a retrospective cross-sectional study
Braden O’Neill, Sumeet Kalia, Peter Gill, Susan Hum, Carla Moran-Venegas, Rebecca Stoller, Michelle Greiver, Payal Agarwal, Abirami Kirubarajan, Samuel DeKoven, David Eisen, Andrew Pinto, Sheila Dunn
Oct 2021, 9 (4) E1134-E1140; DOI: 10.9778/cmajo.20210085

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Association between new-onset anosmia and positive SARS-CoV-2 tests among people accessing outpatient testing in Toronto, Ontario: a retrospective cross-sectional study
Braden O’Neill, Sumeet Kalia, Peter Gill, Susan Hum, Carla Moran-Venegas, Rebecca Stoller, Michelle Greiver, Payal Agarwal, Abirami Kirubarajan, Samuel DeKoven, David Eisen, Andrew Pinto, Sheila Dunn
Oct 2021, 9 (4) E1134-E1140; DOI: 10.9778/cmajo.20210085
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