The smell impairment has been reported to be a common symptom. SARS-CoV-2 invades the central nervous system through the olfactory neuroepithelium and propagates from within the olfactory bulb. This study evaluated the evolution of altered smell or taste in COVID-19. Mildly symptomatic patients rate impairment of smell or taste using a Likeart scale. Altered sense of smell or taste is more frequent in women. Higher severity of smell and taste impairment caused by a more severe injury of the olfactory neuroepithelium was associated with a lower likelihood of recovery at 4 weeks. Postviral anosmia (40% of patients) is one of the most commonly identified causes of olfactory dysfunction; 89% of patients experienced a complete improvement, and only 11% reported that the sense of smell or taste was unchanged or worse. The pathogenesis of olfactory dysfunction in COVID-19 may be secondary to mucosal obstruction, leading to a conductive loss, or may directly affect olfactory mucosa and the olfactory sensory neurons with consequently a sensorineural loss. This latter mechanism seems to be supported by our observation that most patients did not report nasal obstruction. In those who did, the recovery of altered sense of smell or taste was independent from improvement in the blocked nose. The persistence of altered sense of smell or taste was not associated with the SARS-CoV-2 infection's persistence. Thus, unrelated to viral clearance, time is likely needed for the olfactory epithelium to repair and regenerate.