Intended for healthcare professionals

Rapid Response:

Re: Coronavirus disease 2019 (covid-19): a guide for UK GPs

Dear Editor,

I believe that your advice to “Consider covid-19 infection in anyone with cough, fever, or breathlessness who has had contact with someone with covid-19 or has returned from a high risk area…” is not accurate any more.

The incubation period for COVID-19 is about 5–6 days. Anderson et al argue that there might be considerable pre-symptomatic infectiousness (1).

More recently, the European Centre for Disease Prevention and Control (ECDC) has stated that it is plausible that a proportion of transmissions occur from cases with mild symptoms that do not provoke healthcare-seeking behaviour (2).

Thus, any person presenting with respiratory symptoms should be suspected of infection with Covid-19, whether they have been in contact with a case or not. Only then will the true picture of the number of infected cases emerge and appropriate measures advised for interruption of community transmission.

Your guidance should be updated accordingly.

References
1. Anderson R, Heesterbeek H, Klinkenberg D, Hollingsworth TD. How will country-based mitigation measures influence the course of the COVID-19 epidemic? Lancet 2020. (Published online March 6, 2020). https://doi.org/10.1016/S0140-6736(20)30567-5
2. European Centre for Disease Prevention and Control. Daily risk assessment on Covid-19. https://www.ecdc.europa.eu/en/current-risk-assessment-novel-coronavirus-... (published online March 13, 2020).

Competing interests: No competing interests

16 March 2020
Raymond F O'Connor
General practitioner and Senior Research Fellow
Department of General Practice, Graduate Entry Medical School, University of Limerick
University of Limerick, Plassey, Limerick