Intended for healthcare professionals

Rapid Response:

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

Dear Editor,

I decided to write a letter to the BMJ and if you think it’s appropriate please publish it.

It is to do with this Corona Virus and getting tested for it.

A person phoned my wife over two weeks ago on returning to England from a holiday to a country within the EU.

The country was not one of the countries on the Government’s list of countries which people are advised not to visit.

Very soon after returning to England this person developed a very bad cough and felt ill, and described how another person had been coughing in the shuttle bus taking the airline passengers to the plane for the flight back to the UK.

This person was asking my wife (who used to be a nurse) what is best to do what with this corona virus spreading, and my wife said it would be sensible to phone 111 and ask their advice regarding getting tested for corona virus and the need to self-isolate.

The person called 111 and after a wait of 24 hours advice was give--namely, that there was nothing to fear because the visited country was not on any risk-list and there was therefore no need to self-isolate and no need to be tested. So no test was done. But the person felt so ill as to stay in bed for a week, at the end of which time symptoms had slightly improved and the person again phoned my wife to say the illness was a bit better, but not fully. Once again my wife suggested that it really might be sensible again to call 111 and to ask again regarding getting tested and whether or not to self-isolate for longer. So another phone call was made to 111. Again the advice came from 111 saying that there was no need to have a test, and no need to self-isolate, and the basis for such advice was possibly, I guess, because the visited country was not on any risk-list.

This person then moved to another town, still with symptoms of cough, raised temperature and feeling poorly, by this time having had such symptoms for over a week.

A few days later there was another phone call to my wife saying that the illness continued, still coughing and feeling unwell, and that 111 had again been approached and this time the 111 official had said that the test was not needed, “But you can have a coronavirus test if you want”. 111 had promised to phone back within 24 hours to inform where to get the test done, but after 72 hours had not phoned back.

Apparently 111’s advice had been that the covid-test did not need to be done, but could be done if wanted. But there was no call-back as had been promised to say where to get the test done.

All this has been relayed to me by my wife, and as I listen to such a tale I become concerned that possible cases of coronavirus, such as the person in this story, are being advised that there’s no need to self-isolate at all, or that it’s just a cold and it’s best to stay home but only for seven days, because the visited country is not on any list, and no need to have a test, and so we have a possibly Covid-infected person in a town feeling ‘a bit better’ and having self-isolated for only seven days, but now going about daily business, even perhaps visiting museums and concerts.

Without doing the test we have no idea whether the symptoms were ‘just a cold’ or if they were, and are, coronavirus, do we?

And if it happens to have been CV then only seven days of isolation has been performed rather than the fourteen days which is required for CV cases. That is a difference of seven whole days of someone going about the country whilst still covid-infected, isn’t it?

I have heard Health Officials and Ministers saying "We are doing all we can", but is that really so? Why exclude a person from having the test if they are ill, febrile, coughing, but if the reason (presumably on the 111 computer programme) for not doing the test is simply that the country they visited was not on a government risk-list?

For a ‘common cold’ the government’s advice is, I think, to stay in isolation at home for merely seven days. If you have the CV then I think the advice is to self-isolate at home for fourteen days. That’s a difference of seven whole days! And all without doing the Test!

So very probably there are thousands of people who have been refused a test, or told “You do not need a test” and who may (or may not) be self-isolating but for merely seven days, and then going out and about during the subsequent seven days which we are told are still infectious if the illness should chance to be coronavirus!

Yours

Dr John Hawson, Bowness on Windermere.

Competing interests: No competing interests

13 March 2020
John P Hawson
retired
Bowness on Windermere