Okay, that’s a definite click-bait title but I have my reasons for asking the question. Over the past couple of weeks, I have had a number of calls about people who clearly have Covid-19 and yet it hasn’t even been considered in the diagnosis. Seriously, not even considered!? We are having between 35,000 and 40,000 cases of Covid-19 every day in the UK, it is almost certainly currently the most common infectious disease in the UK, and yet it is being “forgotten” and still being missed! WHY?!
What the heck do jam donuts have to do with Covid-19 symptoms? Read on to find out...
What are the symptoms of Covid-19?
The most important symptoms of Covid-19 haven’t changed, they are still:
There are other common symptoms such as headache and muscle pains, but UK Government advice is still the same:
“The most important symptoms of COVID-19 are recent onset of any of the following:
There are several other symptoms linked with COVID-19. These other symptoms may have another cause and are not on their own a reason to have a COVID-19 test. If you are concerned about your symptoms, seek medical advice.”
So, the message is STILL very clear. If someone has symptoms of a fever, cough or loss of sense of smell then they should be managed as though they may have Covid-19. In hospitals this means… they should be isolated and treated as positive until the results of a PCR test are available. And yet I am seeing some worrying practice starting to creep in:
So, if it looks like Covid-19 then for goodness sake manage it like Covid-19… at least until you have proven it’s not Covid-19 and have an alternative diagnosis!
But what about recent suggestions that the symptoms of Covid-19 are changing? Are we at risk of over diagnosing Covid-19?
Could we go the other way and over diagnose Covid-19?
A recent study worries me. The ZOE study from the UK suggests that Covid-19 symptoms are changing, and this has been wildly quoted in both the scientific and mass media. The ZOE study is an app-based study by a health sciences company who normally study nutrition, with ties to Imperial College London, who have collected publicly self-reported data about Covid-19 symptoms. They say the most common symptoms of Covid-19 are now:
Now, this might in fact be the case over time, the symptoms of Covid-19 may move more towards “common cold symptoms”, but I do not believe we are there yet! Historically this is probably what other coronaviruses have evolved to become, they cause the symptoms of the “common cold”. Vaccinations may in fact speed up this process, by giving some degree of immunity, which could possibly fast forward changes to milder symptoms. BUT there are other reasons why the self-reported symptoms in the ZOE study may have changed:
I also think one of the main problems with the symptoms list is that lots of people around the country are getting new coughs and colds with different viruses to SARS CoV2. ECIC has had a nasty cold, snotty nose, sore throat and cough… she is attending further education college at present so is taking regular LFTs… and although she was full of symptoms her tests were negative. NB the LFT is very good at predicting negative results. ECIC has clearly had an alternative virus; her symptoms were relieved significantly by eating copious amounts of jam donuts, although this “treatment” hasn’t been validated in a peer reviewed publication… yet! Recently, I wrote a blog about RSV starting in the summer, and we are also seeing cases of Influenza A as well; so there are lots of respiratory symptoms around at the moment which are blurring the lines between what is Covid-19 and what is something else? This is especially true because we are only really testing for SARS CoV2 in these patients…
For example, a person develops a runny nose and starts sneezing. In a “normal” year they would say they had “a cold” and that would be the end of it. However, this year they think “I might have Covid-19 because the ZOE study app. says I might”, so they do an LFT… the test is positive… BING!... another Covid-19 case for the ZOE study saying the symptoms of Covid-19 have changed. Now, what if the person actually had a different virus such as RSV, Influenza A Virus, Adenovirus, Parainfluenza Virus 1, 2 or 3, or a different coronavirus such as OC43, how would we know? We wouldn’t because we don’t look for them… you only find what you are looking for… and what if that is SARS CoV2 using the overly sensitive LFT (high false positive rate). Doing this you will “find” lots of people with “odd symptoms of Covid-19”… even when they don’t actually have Covid-19.
So, I think we need to be balanced in our current approach to Covid-19. We need to continue to think about the diagnosis in anyone with a fever, persistent cough and loss of sense of smell. We need to continue to test these people, initially with an LFT, and then confirm all positives with the far better PCR test, and isolate the true positives to stop them spreading the infection. BUT we also need to be aware that there are lots of other viruses around that cause coughs and colds, and we shouldn’t muddy the Covid-19 waters by mistakenly including “data” related to these other viruses with our Covid-19 data.
As you can tell I am not a fan of “citizen-science” style medical data collection. Covid-19 hasn’t gone away so we need to act responsibly as healthcare professionals, think about the symptoms and diagnosis, test and isolate and treat accordingly. Let’s not join in with misinformation and “hype” from the “social media” driven diagnostic apps….
The most important symptoms of Covid-19 haven’t changed, they are still:
- Fever
- Persistent cough
- Loss of sense of smell (anosmia)
There are other common symptoms such as headache and muscle pains, but UK Government advice is still the same:
“The most important symptoms of COVID-19 are recent onset of any of the following:
- a new continuous cough
- a high temperature
- a loss of, or change in, your normal sense of taste or smell (anosmia)
There are several other symptoms linked with COVID-19. These other symptoms may have another cause and are not on their own a reason to have a COVID-19 test. If you are concerned about your symptoms, seek medical advice.”
So, the message is STILL very clear. If someone has symptoms of a fever, cough or loss of sense of smell then they should be managed as though they may have Covid-19. In hospitals this means… they should be isolated and treated as positive until the results of a PCR test are available. And yet I am seeing some worrying practice starting to creep in:
- Staff and patients not isolating when they have symptoms and therefore exposing other staff and patients
- Tests not being done when the symptoms are highly suggestive and so infectious people don’t know they are infectious and do not isolate
- Antibacterials being used to treat this viral infection
- People refusing vaccines because everyone else has been vaccinated
- People getting the wrong treatments because we seem to have forgotten the phases of the disease process
So, if it looks like Covid-19 then for goodness sake manage it like Covid-19… at least until you have proven it’s not Covid-19 and have an alternative diagnosis!
But what about recent suggestions that the symptoms of Covid-19 are changing? Are we at risk of over diagnosing Covid-19?
Could we go the other way and over diagnose Covid-19?
A recent study worries me. The ZOE study from the UK suggests that Covid-19 symptoms are changing, and this has been wildly quoted in both the scientific and mass media. The ZOE study is an app-based study by a health sciences company who normally study nutrition, with ties to Imperial College London, who have collected publicly self-reported data about Covid-19 symptoms. They say the most common symptoms of Covid-19 are now:
- Headache
- Runny nose
- Sneezing
- Sore throat
Now, this might in fact be the case over time, the symptoms of Covid-19 may move more towards “common cold symptoms”, but I do not believe we are there yet! Historically this is probably what other coronaviruses have evolved to become, they cause the symptoms of the “common cold”. Vaccinations may in fact speed up this process, by giving some degree of immunity, which could possibly fast forward changes to milder symptoms. BUT there are other reasons why the self-reported symptoms in the ZOE study may have changed:
- The ZOE study has changed its definition about what is illness – if you change, and broaden, the symptoms which you are looking for you cannot then say that more people are reporting the new symptoms… of course they are, you are now asking for them to report wider symptoms when you didn’t before… this is sample bias
- The study now includes lateral flow tests (LFT) as positive results as well as PCRs – if you change the test to prove the diagnosis, especially if you use a test known to have high false positives, then you are at risk of capturing data on people who don’t actually have Covid-19, they just have a positive LFT
- They are capturing vaccination status – OK in itself collecting this data isn’t a problem, but as most of the unvaccinated group are children who experience “different” or “milder” symptoms the study should not combine the data to infer “milder” symptoms in all age groups or suggest symptoms are changing
I also think one of the main problems with the symptoms list is that lots of people around the country are getting new coughs and colds with different viruses to SARS CoV2. ECIC has had a nasty cold, snotty nose, sore throat and cough… she is attending further education college at present so is taking regular LFTs… and although she was full of symptoms her tests were negative. NB the LFT is very good at predicting negative results. ECIC has clearly had an alternative virus; her symptoms were relieved significantly by eating copious amounts of jam donuts, although this “treatment” hasn’t been validated in a peer reviewed publication… yet! Recently, I wrote a blog about RSV starting in the summer, and we are also seeing cases of Influenza A as well; so there are lots of respiratory symptoms around at the moment which are blurring the lines between what is Covid-19 and what is something else? This is especially true because we are only really testing for SARS CoV2 in these patients…
For example, a person develops a runny nose and starts sneezing. In a “normal” year they would say they had “a cold” and that would be the end of it. However, this year they think “I might have Covid-19 because the ZOE study app. says I might”, so they do an LFT… the test is positive… BING!... another Covid-19 case for the ZOE study saying the symptoms of Covid-19 have changed. Now, what if the person actually had a different virus such as RSV, Influenza A Virus, Adenovirus, Parainfluenza Virus 1, 2 or 3, or a different coronavirus such as OC43, how would we know? We wouldn’t because we don’t look for them… you only find what you are looking for… and what if that is SARS CoV2 using the overly sensitive LFT (high false positive rate). Doing this you will “find” lots of people with “odd symptoms of Covid-19”… even when they don’t actually have Covid-19.
So, I think we need to be balanced in our current approach to Covid-19. We need to continue to think about the diagnosis in anyone with a fever, persistent cough and loss of sense of smell. We need to continue to test these people, initially with an LFT, and then confirm all positives with the far better PCR test, and isolate the true positives to stop them spreading the infection. BUT we also need to be aware that there are lots of other viruses around that cause coughs and colds, and we shouldn’t muddy the Covid-19 waters by mistakenly including “data” related to these other viruses with our Covid-19 data.
As you can tell I am not a fan of “citizen-science” style medical data collection. Covid-19 hasn’t gone away so we need to act responsibly as healthcare professionals, think about the symptoms and diagnosis, test and isolate and treat accordingly. Let’s not join in with misinformation and “hype” from the “social media” driven diagnostic apps….
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