Nine newly recognised COVID-19 symptoms

UK Covid cases have reached a new high watermark in recent days with surveys suggesting that millions of infections have occurred over the last week. This coincides with the cessation of free testing and the publication of a new list of symptoms that might earmark a case of coronavirus. There are now nine things on that list. So why this switch, and why now? Tim Spector, at King’s College London, has led the ZOE initiative that’s logged Covid symptoms throughout the pandemic. Chris Smith caught up with him and started by asking, what is the most likely giveaway of a covid infection in 2022...

Tim - Based on your symptoms at the moment, most with COVID are presenting cold-like symptoms, number one being sneezing, runny nose, headaches, fatigue, and sore throat. After that, you may have some of these other symptoms which often appear a bit later, which might be a cough, fever and some distortion of your taste, although unlikely to be loss of smell. Plus, a whole range of other muscular aches and pains et cetera. So, at the moment, with COVID levels approaching about one in 14 people, it's more likely if you have cold-like symptoms that you have COVID than a cold.

Chris - That's quite a turnaround from the Holy Trinity that we've been using to diagnose this from the get go, which was the fever, the cough and the loss of sense of smell and taste. Why the switch all of a sudden?

Tim - Well, we've been lobbying the government probably for 18 months now to change the list and they have steadfastly refused although this evidence has been building up over 18 months and most other countries in the world have changed over a year ago. My belief is that the government did this to stop complaints that they couldn't meet demand with their free testing. That's why, on the 1st of April, when they abolished free testing, they came out with this new expanded list of symptoms in line with virtually every other country in the world.

Chris - What sort of impact is this going to have then?

Tim - It depends how widely it's used and promoted by the government. I think the key here is about employers and I think that's where it is going to have an effect, which coincides with the government stopping payments for sick pay for COVID and has led to this rather muddled guidance.

Chris - I found this as an infection control doctor, I found this somewhat confusing, where the message appears to be, 'if you can get out of bed and get out the door, you can go to work.' Does it not say the same thing to you?

Tim - It does. The only exception is if you've got a proven fever, which is what I remember as a kid at school, desperately hoping I had a fever so I didn't have to go to school. It's completely contradictory to say there is this list of symptoms, but then the guidance for going to work essentially says, 'if you've got a runny nose, a sore throat, and you are sneezing all over the place, if you feel well enough to go to work, go there and sneeze all over your colleagues or sneeze on the tube.' And nowhere does it say, 'do as much as possible to mitigate spreading it to a hundred people.'

Chris - Do you think in the grand scheme of things it is actually going to make much of a difference, though. If we assume that COVID has turned into a much more mild illness, because talking to some of the infection control nurses at the hospital I work at, they were saying that they've got people routinely in their nineties who are being picked up by screening, completely asymptomatic. What a turnaround from two years ago. They are saying, actually, we are in danger paralysing systems because we are trying to control the uncontrollable and perhaps the approach of accepting that now we have done our best to minimise the threats and the threats are low. Now it is time to regard this more as a cold rather than COVID?

Tim - I can see that point of reasoning, but a colleague of mine did some modelling. It showed that if you reduced the self isolation from five days to two days, this would have a huge knock-on effect on the numbers of infections and the number of hospitalisations in the next six months. So, what sounds like a fairly trivial difference in guidance can have a very big difference. We're currently at 2000 admissions a day, although all those are not directly due to COVID, there's still a big burden, and that would push it much higher and would actually cause extra deaths. I think you've got to look at the whole picture. I think it is unwise to just say, 'we're not going to bother at all', and let people who are highly infected, just by keeping them at home for a few days, you could really reduce the number of infections in that workplace or hospitalisations. I think we have to find some halfway house between 'there's no point in bothering' and further tough restrictions.