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More symptoms need to be included in UK case definition of COVID-19

Runny nose (coryza) and other indicative symptoms should be added as possible signs of COVID-19 infection, so that more people can access NHS covid tests, according to a Queen Mary academic writing in The BMJ, in an open letter to the Chief Medical Officer, supported by 140 east London general practitioners and health care professionals.

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Dr Alex Sohal, Honorary Clinical Senior Lecturer in Primary Care at Queen Mary University of London, describes her experience as a GP in Tower Hamlets, regularly reviewing patients with mild symptoms—for example, a runny/blocked nose, sore throat, hoarseness, muscle pain, fatigue, and headache—who subsequently turn out to be covid positive.

She writes: “These patients have frequently not even considered that they may have covid-19 and have not self-isolated in the crucial early days when they were most infectious.”

Some patients have to be dishonest to access COVID-19 tests

“The national publicity campaign focuses on cough, high temperature, and loss of smell or taste as symptoms to be aware of—only patients with these symptoms are able to access a covid-19 test online through the NHS test booking site. GPs have to advise patients to be dishonest to get a covid-19 test.”

Dr Sohal highlights the World Health Organization’s case definition of covid includes other symptoms such as coryza, sore throat, vomiting, and diarrhoea, while NHS guidance states that patients should keep self-isolating for more than ten days if they have a runny nose or sneezing.

Coryza/cold should now be added to COVID case definition

“It is vital to now change the UK covid-19 case definition and test criteria to include coryza and cold, making them consistent with WHO,” she writes.

“Tell the public, especially those who have to go out to work and their employers, that even those with mild symptoms (not only a cough, high temperature, and a loss of smell or taste) should not go out, prioritising the first five days of self-isolation when they are most likely to be infectious.”

Dr Sohal concludes: “This will help to get—and keep—us out of this indefinite lockdown, as covid-19 becomes increasingly endemic globally. Ignoring this will be at our peril.”

More information

  • Letter: ‘Open letter to Chris Whitty and Susan Hopkins: change covid-19 case definition in line with WHO to save lives’. Alex Sohal. BMJ 2021; 372 doi: 10.1136/bmj.n283. Available here: 

For media information, contact:

Joel Winston
Faculty Communications Manager (Medicine and Dentistry)
email: j.winston@qmul.ac.uk