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New Covid variant symptoms not set to prompt Government guidance update


Delta symptoms


Exclusive The Government has indicated that it has no current plans to update its official list of Covid symptoms, despite research indicating the now-dominant Delta variant has more cold-like symptoms.

The Department of Health and Social Care did admit that Covid-19 has a ‘much longer list of symptoms than the ones initially used in the case definition’ and said that it keeps symptoms ‘under review’.

Last month, new research revealed that the Delta variant, which now accounts for the vast majority of the Covid-19 cases in the UK, is not presenting with classic symptoms but is more like a bad cold.

Data from the ZOE COVID study at King’s College London said the top symptoms are headache, followed by a runny nose and sore throat.

But the DHSC has failed to confirm any planned updates to official Covid symptoms used for isolation and testing purposes, although it said that data on symptoms is continuously gathered.

A spokesperson told Pulse: ‘Since the start of the pandemic we have acknowledged that 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.’

They stressed the importance of regular rapid lateral flow testing, adding that ‘around one in three people’ do not show symptoms of Covid.

‘Over 100 million LFDs have been carried out so far with over 200,000 cases identified that would not have been detected otherwise’, they said.

Under current guidance, anyone experiencing the ‘main symptoms’ of a high temperature, new continuous cough or loss or change to sense of smell or taste must get a PCR test and self-isolate immediately.

But both the US Center for Disease Control and Prevention and the World Health Organisation (WHO) provide much longer lists of symptoms, including headache, runny nose or congestion and sore throat.

A WHO spokesperson told Pulse that it has not conducted any research on symptoms specific to the Delta variant.

They said: ‘WHO is aware of media reports of changing symptoms, however the scientific data on this is not yet conclusive. Covid-19 can have varied symptoms, ranging from respiratory symptoms to neurological to gastrointestinal and other symptoms.’

Professor Iain Buchan, executive dean at the Institute of Population Health and chair of public health and clinical informatics at the University of Liverpool, told Pulse that it is ‘very clear’ the Covid case definition should be expanded and that the Delta variant makes this more pressing.

He said: ‘You’ve got a more transmissible virus that is affecting younger people because of vaccination status – and those younger people tend to display a broader range of symptoms earlier in their infection anyway – and early infection is when you’re more likely to pass the virus.

‘So it’s very complex, it’s almost a perfect storm for [the Delta variant’s] effects in younger people and the need to consider a broader symptom definition because of that – it’s not just its absolute level.’

However, he said that amid a lack of PCR test capacity, lateral flow testing for those with ‘even vague symptoms’ is ‘the only way we’re going to reach people in time’.

Professor Buchan said: ‘The ideal situation is you use the lateral flow to gain time with isolation but have a follow-up PCR [for those with positive LFT] so that we’ve got variant surveillance and proper confirmation. 

‘There isn’t enough capacity in the system for everyone with aches and pains or runny noses to have a PCR – it would be very wasteful. But there is a lot of lateral flow capacity in the system.’

But while awaiting policy change, GPs should work closely with local directors of public health to ensure communications ‘raise awareness’ of unofficial symptoms and encourage those who have them to take LFTs, he said.

He added: ‘My colleagues in public health and scientific communities have put the case quite clearly, so it’s being considered. The evidence is there and it has been put to policymakers – we should expect some changes but there’s no need to wait. Communication actions can be taken right now.’

However, former GP and chair of the BMA Public Health Committee Dr Peter English said that updating the case definition would only have a ‘marginal’ benefit.

He told Pulse: ‘[Social distancing and lockdown are] what was doing the heavy lifting. Test and trace was set up in a way that it was going to make practically no difference – at vast cost. 

‘So in that sense, tweaking it slightly to amend the symptoms, it’s logical if you think that Test and Trace is worth it in the first place, but probably it didn’t contribute very much in any case.’

He added: ‘Given that the range of symptoms is now so much wider and so much less specific – it would mean telling a vast number of people to isolate on the basis of very common symptoms.’

GPs have been calling for the Government to include more symptoms in the official case definition of Covid, including a runny nose and a cold, since February.

It comes legal Covid-19 restrictions ended in England earlier this week (19 July), with the Government stating that it does not believe the current rise in infection rates will put unsustainable pressure on the NHS.

The latest daily reported infections stood at more than 46,500 – a 41% increase over the course of the last week. There was also a 38% rise in Covid hospital admissions and a 61% rise in the number of deaths.

READERS' COMMENTS [3]

Vinci Ho 21 July, 2021 10:43 am

(1) If I was a conspiracy theorist , I would have said the government is trying to water down the seriousness of the number of new cases everyday as the real figures of daily incidence could be even higher , against a backdrop of currently high prevalence of upper respiratory tract symptoms in Delta variant . Reality is the death rate is indeed still very low 0.1-0.2% , for argument sake . This is really like deja vu but in an alternate universe ,during the beginning of this pandemic when many had said, ‘ this Covid 19 thing is just like a really bad flu !’
(2) Question is , is it really ?
I don’t have any answer but clearly we are relying on the effectiveness of our western world Covid vaccines (some other vaccines are certainly shown to be ineffective retrospectively in some countries ) .
(3) While I do agree that the sensitivity of lateral flow test remains a big concern , it is still a useful tool when the true number of new cases in the community is very high . Doing it daily or at least alternate day can still retrieve significant number of cases at early stage .
(4) Then , the arguments on whether to expand the list of symptoms consistent with Delta variant reside on (1) education of the public (2) capacity of PCR testing indeed.(3) implications of contacts with a positive case . The common sense perhaps now shifts more towards no isolation as long as a PCR test is proven negative followed by regular LFT .
But it begs the question is , will people follow this yet time consuming steps after having contacts with positive cases ?
Typically , the government and academics fail in educating the public properly, in my opinion .
(5) England is probably the only country which goes with a dare to remove absolutely every restriction despite sky high number of new cases every day . How does the rest of world feel towards this dare?
I can understand why the government wants to ‘gamble’ again ( if increasing the interval between first and second doses were the first gamble ).

God save the Queen . At least , she was not infected by our prime minister when he once insisted to see her daily , according to his most ‘faithful’ advisor at the time 😈

David Church 22 July, 2021 7:56 pm

LFDs should NOT be used if symptoms : they are probably less than half as sensitivity as PCR tests, which are absolutely preferred in presence of symptoms. Sensitivity is dependent on user factors, not just test sensivity, as reported in published Oxford study.
There is no time ‘gain’ from using LFD when PCR is needed since negative LFD does NOT entitle you to break isolation, which is for anyone symptomatic (regardless of vaccination status – until your PCR comes back negative (on the first occasion). Repeated PCR tests until you get a negative, as advocated by some, does not guarantee that viral shedding has stopped and will early release from isolation on a low-sensitivity LFD will result in more spread, more new variants for scientists to study, and more deaths and damaged children’s brains.

Vinci Ho 25 July, 2021 6:59 am

This is the publication in latest edition of BMJ (23/7/2021) on the Innova lateral flow testing kits :
https://www.bmj.com/content/bmj/374/bmj.n1637.full.pdf
Title of the research paper :
Performance of the Innova SARS-CoV-2 antigen rapid lateral flow test in the Liverpool asymptomatic testing pilot: population based cohort study
Marta García-Fiñana,1 David M Hughes,1 Christopher P Cheyne,1 Girvan Burnside,1 Mark Stockbridge,2 Tom A Fowler,2,3 Veronica L Fowler,2 Mark H Wilcox,4
Malcolm G Semple,5,6 Iain Buchan7