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Objective Coronavirus disease 2019 (COVID-19) is associated with olfactory dysfunction, but the evolution of the olfactory loss and timeline to recovery are largely unknown. This study examines changes in smell sensitivity in COVID-19–positive (COVID+) and COVID-19–negative (COVID–) viral illness during the initial weeks after infection. Study Design Cross-sectional cohort comparison. Setting National anonymous surveys. Methods Survey participants were queried about smell sensitivity and general health status at the time of COVID-19 testing and in the weeks that followed. Results In total, 375 (174 COVID+, 201 COVID–) participants completed the survey and 132 (62 COVID+, 70 COVID–) participants completed the 2-week follow-up survey. Normal smell in the COVID+ cohort was less frequent at the time of testing and at follow up ( P < .05). Dynamic changes in smell sensitivity in the COVID+ cohort were more frequent in the initial weeks ( P < .001). In those with normosmia at the start of infection, 38% of the COVID+ cohort reported worsening smell compared to only 8% in the COVID– cohort ( P < .05). Recovery of overall health was associated with normosmia at the time of infection and improvement of smell sensitivity within weeks of infection. Conclusion The COVID+ cohort showed greater dynamic change in smell sensitivity and a higher rate of persistent olfactory dysfunction in the weeks after infection. Normal smell at the time of COVID-19 infection may still worsen before recovery. Overall health recovery after viral illness is associated with improvement in smell sensitivity and the absence of initial anosmia or hyposmia.