"What do loss of smell and taste and diminished reactions have to do with disaster management? Unfortunately, quite a lot..."

According to current estimates, at least 400 million people worldwide are affected by Long Covid. This corresponds to about 6-7% of the global population. It is important to note that these estimates may not accurately reflect the actual number, which is likely much higher since many cases are unreported and not recognized. Additionally, there are millions of people with ME/CFS, MCS, and countless neurological disorders. People with Parkinson's and other neurodegenerative diseases also often suffer from smell and taste disorders. The global use of medications has increased significantly, and this can also trigger smell and taste disorders. For example, Methotrexate, Diltiazem, Nifedipine, Streptomycin, Codeine, Pyrazinamide, Propylthiouracil, Enalapril, Lisinopril, Terbinafine, Lovastatin, among others. This fact alone shows that medications from ACE inhibitors, thyrostatics, chemotherapeutics, antibiotics, antifungals, statins, psychotropic drugs, sympathomimetics, and antirheumatics are affected, and this issue should be high on the agenda of disaster management.

Approximately 60% of patients infected with SARS-CoV-2 in 2021 partially lost their sense of smell. Of these patients, about 25% have not fully regained their sense of smell. The loss of smell can last for several months to years. (1) Some studies show that the sense of smell in some patients has not fully returned even after more than four years. Research suggests that the persistent loss of smell is associated with a continuous immune response in the nasal area. (2)

There are already some approaches like smell training, where affected individuals regularly smell different scents to restore their sense of smell. (3)

BUT there are currently no specific approaches to smell training in the context of disaster management. This area, particularly in connection with the many Long Covid, ME/CFS, and MCS sufferers and the many neurodegenerative diseases, has enormous potential to develop new strategies.

The global rise in painkiller consumption is an issue that cannot be neglected, just like the continuously increasing worldwide consumption of sleeping pills. According to a study by the market research company Market Research Future, the global market for painkillers and sleeping pills is expected to grow to USD 1.62 trillion by 2030, with an annual growth rate of 7.22 %. (4) This increase is driven by the daily growing number of people suffering from chronic pain and sleep disorders, as well as the increasing availability of these medications. Painkillers, including antibiotics, antidepressants, chemotherapeutics, and antihypertensives, can also lead to disruptions in smell and taste. Sleeping pills, in particular, can play a dual role in the context of disaster management. On one hand, they can help alleviate anxiety and stress. On the other hand, they can also have massive side effects (drowsiness, dizziness, confusion, and coordination problems, as well as dependency issues with restricted access), which can be very problematic and dangerous in disaster and emergency situations.

And we haven't even considered the countless pharmacokinetic interactions that can lead to serious and unforeseen adverse drug reactions (ADRs) and drug-drug interactions (DDIs). Pharmacogenomics (PGx) still does not receive the attention it urgently needs.

Why must we not lose sight of this in the HERE and NOW?

Scenario 1: Gas Leak in a Residential Area

Situation: A gas leak occurs in a residential area. Normally, the pungent smell of the gas would alert residents.

Dramatic impacts due to loss of smell and other pathologies

Residents might not notice the leak and continue normal activities, leading to an increased risk of explosion. It could result in carbon monoxide poisoning, which is odorless and very dangerous.
Elderly individuals and people with chronic illnesses might react more slowly and have difficulties evacuating in time. People with limited mobility might struggle to flee quickly.
Long Covid, ME/CFS: Individuals with respiratory issues could be particularly at risk and react much more slowly due to extreme fatigue and weakness. Inhaling gas can immediately worsen breathing problems and the exhaustion could massively delay evacuation. MCS: Individuals with chemical sensitivities might exhibit immediate and severe reactions, meaning instant health reactions to even minor gas leaks. Neurodegenerative diseases: Individuals with cognitive impairments might not understand or process warnings.
Without timely evacuation, many people could be seriously injured or lose their lives.
Potential measures: Installation of smart gas detectors that trigger automatic alarms when a gas leak is detected and inform residents via apps or smart devices, and public awareness campaigns about the importance of such necessary devices. Installation of alarms tailored specifically for different age groups and mobility levels. Integration of warnings through the television signal to reach all households. Regular inspections and maintenance by local authorities or utility companies. Regular emergency drills specifically adapted to the needs of vulnerable groups. Establishment of local support groups that can quickly provide assistance in emergencies.

Scenario 2: Chemical Accident in a Factory

Situation: A dangerous substance is released in a chemical factory.

Impacts due to loss of smell and other pathologies

Vulnerable Groups: Workers with long working hours (these workers might be tired and less alert, impairing their ability to detect and respond to an accident), workers with compromised health (they might be more susceptible to the effects of toxic fumes), and nearby residents (they might not be informed about the proper measures and therefore not know how to protect themselves). Long Covid, ME/CFS and MCS Patients: Individuals with weakened immune systems and respiratory problems, as well as high sensitivity to chemicals. Workers and nearby residents might not notice the release and could be massively exposed to toxic fumes. Acute and chronic health damages might occur.
Immediate worsening of respiratory issues. Exhaustion could lead to immobility. Severe reactions to chemical fumes. Long-term consequences like respiratory diseases or poisoning might occur.
Possible measures: Distribution of portable chemical detectors to workers in vulnerable areas. Portable detectors for at-risk individuals as well. Use of alarm and detection systems, regular safety drills, and clear emergency protocols. Deployment of drones for monitoring and detecting chemical leaks and to provide immediate warnings. Utilization of VR technology for realistic emergency drills and training. Implementation of regular breaks and rest periods for workers to increase their alertness. Use of health monitoring devices to continuously track the health of workers. Conducting information campaigns for nearby residents to inform them about the correct actions in case of an accident. Emergency drills to prepare for chemical accidents.

Scenario 3: House Fire at Night

Imagine a fire breaks out suddenly in your house or apartment. Mentally take five to seven breaths to get a sense that, in the event of a fire, you could already become unconscious due to the toxic smoke during those seven breaths. If you then take two, three, or four more breaths, you could already be dead. This is how life-threatening the situation would be!

Situation: A house fire breaks out in the middle of the night.

Impacts due to loss of smell and other pathologies

Vulnerable groups to consider: infants, children, elderly people, people with limited mobility, people with hearing problems. Residents may not detect the fire by the smell of smoke and may not evacuate in time. Elderly people may react more slowly and have difficulty hearing the alarm. People with limited mobility may have difficulty evacuating quickly. For people with Long COVID, ME/CFS, and MCS, breathing problems may worsen significantly, extreme exhaustion may prevent escape, and immediate and severe reactions to smoke may be deadly, i.e., life-threatening situations due to smoke inhalation.
The smoke could suffocate people in their sleep before they wake up and even have a chance to react.

Important measures to take in advance

Are fire extinguishers, fire blankets, and smoke detectors present in the household?
Are all safety tips, such as safe baking, grilling, fondue, raclette, etc., followed to prevent fires in the first place?
Install alarms that provide visual and vibratory warning signals to reach people with hearing problems, not just acoustic, but also visual and vibratory warning signals.
Networked smoke detectors that can make emergency calls.
Use smoke detectors that are directly connected to smart home systems and emergency services and can automatically make emergency calls.
Install floor lighting that indicates the safest escape route in an emergency.
Raise awareness among the population about these measures and the importance of having functioning batteries in smoke detectors.
Create individual emergency plans for elderly people, people with limited mobility and the already mentioned vulnerable groups (Long COVID, ME/CFS, MCS, and neurodegenerative diseases).
Always keep stairwells clear, as they are your most important escape routes and also essential access points for firefighters.
If you currently have everything cluttered with flower pots, shoe cabinets, shoes, strollers and other decorative items, you should definitely clear it out to make space, as it could be your vital escape route and provide access for emergency services.

Call the fire department emergency number!!! And always remember the important W-questions

Where is the fire?
What is burning?
How many injured are there?
Who is calling?

From now on, every second/minute counts in the rescue: Please bring the injured and all vulnerable groups out of the danger zone first. If a person's clothing is already on fire, make sure they do not run, and smother the flames with clothing items. Alternatively, help the person roll on the ground to extinguish the flames.

Always be aware of dangers such as smoke, damaged power lines, and gas during a rescue.

If it is safe, try to extinguish the fire with available fire extinguishers. Always remember that attempting to extinguish a fire can be life-threatening if there is heavy smoke. So, prioritize escaping the fire area!
What should you consider when escaping a fire area? Close doors, windows, and also the house or apartment entrance door when leaving the fire to prevent the spread of smoke. Do NOT use elevators! Inform your immediate neighbors. Guide the fire department when they arrive.

But what if escape is no longer possible?

Stay calm: Panic worsens the situation.
Stay in the room: Close the door and seal all cracks and openings to prevent smoke from entering.
Make yourself noticeable: Call for help from a window or use a flashlight or phone to draw attention.
Get low to the ground: Stay as close to the floor as possible, where the air is less smoky.
Wet cloths: Cover your mouth and nose with a damp cloth to make it harder for smoke to enter.
Wait for help: Stay calm and wait for the rescue teams to arrive. Use a phone to report your location.
Avoid inner rooms: Try to stay in a room as far away from the fire as possible, preferably with a window to be seen and rescued.
Keep escape routes open: Keep windows and doors that are not in the fire room open to let fresh air in, but be careful not to let smoke in.
Call the fire department: If it is safe, try to inform the fire department so they know where you are.

Scenario 4: Food Poisoning

Situation: Food contaminated by bacteria or chemicals is consumed in households.

Impacts due to loss of taste and other pathologies

Vulnerable groups: Children with Long Covid, for example, might not be able to recognize spoiled food and could be severely harmed. People might not detect spoiled food by taste and consume it. Individuals with chronic illnesses could be much more susceptible to the effects of food poisoning, with severe consequences. Long Covid, ME/CFS and MCS Patients: These individuals already have massively weakened immune systems and high sensitivity to food chemicals, leading to possible immediate and severe reactions and a significantly increased risk of serious food poisoning.
It could result in gastrointestinal diseases, severe food poisoning or even fatalities.
Possible measures: Awareness campaigns about proper food storage and handling and recognizing other signs of spoilage such as appearance or texture. Development of refrigerators with built-in sensors that monitor the freshness of food and warn if something is spoiled. Apps that use barcode scanning to monitor expiration dates and issue warnings. Establishment of neighborhood programs for monitoring and assistance.

Scenario 5: Natural Disasters

Situation: After a natural disaster such as an earthquake, damaged buildings and contaminated water sources remain.

Impacts due to loss of smell and other pathologies

People might not detect the presence of dangerous substances like sewage or chemicals near water sources. Long Covid, ME/CFS and MCS Patients: Breathing problems could be severely exacerbated by dust and debris, extreme exhaustion could prevent quick evacuation, severe reactions to environmental toxins, and difficulties in following evacuation instructions.
The risk of severe infections and illnesses could increase.
Possible measures: Establishment of emergency water filtration systems and regular monitoring of water sources for contamination. Installation of sensors in water treatment plants and sources that constantly monitor water quality and trigger alarms. Provision of mobile water purification stations in affected areas. Training of local volunteers to assist in checking and securing water sources. Devices to clean the air that affected individuals can carry. Development of individualized emergency plans for people with limited mobility and chronic illnesses such as Long Covid, ME/CFS, MCS and all neurodegenerative diseases, tailored specifically to the needs of these groups. Regular emergency drills for affected individuals to improve their responsiveness.

NOTE: Also consider the use of technologies such as text-to-speech apps and translation services to ensure that everyone understands what to do.

And in all these scenarios, we haven't even mentioned the many invisible dangers that continue to weaken our many vulnerable target groups day by day.

At first glance, all of this may seem a bit bleak, but we don't want to give up prematurely, because there are always ways to act proactively and find new and innovative solutions. Newly developed innovative technologies can play a significant role in this. Just like the well-thought-out establishment of neighborhood and community programs to strengthen overall societal resilience (worldwide). Awareness, education, investments in research to develop new methods and technologies to support disaster management for the many vulnerable target groups, strong new partnerships, and much more.

(1) https://www.yalemedicine.org/news/when-loss-of-smell-and-taste-occurs-with-long-covid "When Loss of Smell and Taste Occurs with Long COVID" (Accessed: 25.01.2025)

(2) https://hms.harvard.edu/news/why-loss-smell-can-persist-after-covid-19 "Why Loss of Smell Can Persist After COVID-19" (Accessed: 25.01.2025)

(3) https://www.nhsinform.scot/long-term-effects-of-covid-19-long-covid/signs-and-symptoms/long-covid-loss-of-smell-or-taste/ NHS inform "Long COVID: Loss of smell or taste" (Accessed: 25.01.2025)

(4) https://www.marketresearchfuture.com/de/reports/pain-relief-medication-market-8431 "Marktüberblick über Schmerzmittel" (Accessed: 25.01.2025)