NHS COVID Symptom List 'Impedes Transmission Control'

Peter Russell

July 01, 2021

Health officials say they are keeping the official list of COVID symptoms under review after a group of scientists argued it should be expanded because the existing one could "miss many COVID-19 cases".

The main symptoms listed on the NHS website are a high temperature, a new continuous cough, and a loss or change to the sense of smell or taste.

However, the most common symptoms listed in the latest infection survey by the Office for National Statistics were cough, fatigue, and headache.

The ZOE COVID Symptom Study recently reported that headache, sore throat, and runny nose were the three main symptoms reported by unvaccinated users of its app, while loss of smell ranked only ninth on the list.

'Hampering Efforts to Interrupt Transmission'

Writing in The BMJ , biomedical researcher Alex Crozier from University College London, and colleagues, said that the three symptoms listed by the NHS "are just a few of many described by those infected with SARS-CoV-2", and that other symptoms "often manifest earlier".

They argue that the "UK's decision to adopt a narrow case definition" could lead to people with other symptoms being missed, "hampering efforts to interrupt transmission". They add that people with symptoms not listed can "bypass the rules to get a test” and say “legitimising this choice could be helpful”.

The authors acknowledge that "testing people with a single, non-specific symptom" might "overwhelm or waste capacity", but that could be avoided by using "combinations of symptoms" to "help identify more cases sooner".

Commenting on the analysis for the Science Media Centre, Dr Hamish Houston, clinical research fellow at Imperial College London, said the authors had made a "strong argument" for the list to be updated to reduce public reliance on lateral flow tests, which "should not be used as tests to rule out COVID-19 infection in individuals with symptoms given their low sensitivity and potential to miss infectious cases".

Jon Deeks, professor of biostatistics at the University of Birmingham, said: "Lateral flow tests are not provided to test people who present with COVID-19 symptoms, but there are many reports on social media of individuals resorting to using them when they are unwell, but not with the key symptoms. They are not well suited, as they often fail to identify early stages of infection as they cannot detect low viral loads common at this time."

He said it was important for people at high risk of infection to be able to access PCR testing as quickly as possible, "which requires these changes to be made".

'Under Review'

A spokesperson for the Department of Health and Social Care, said in an emailed statement: "Since the start of the pandemic we have acknowledged COVID-19 has a much longer list of symptoms than the ones initially used in the case definition and our experts keep the list of symptoms under review.

"Anyone experiencing the key symptoms – a high temperature, a new continuous cough, or a loss or change to sense of smell or taste – should get a PCR test as soon as possible and immediately self-isolate along with their household.

"With around 1 in 3 people not showing symptoms of COVID-19, we have made regular, rapid testing available twice a week for free for everyone in England. Over 100 million LFDs have been carried out so far with over 200,000 cases identified that would not have been detected otherwise."

Other authors of the BMJ article include Selina Rajan, a public health specialist registrar from the London School of Hygiene & Tropical Medicine, Malcolm Semple, professor of outbreak medicine and child health at the University of Liverpool, and Iain Buchan, professor of public health and clinical informatics, also from the University of Liverpool.

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