Rapid responses are electronic comments to the editor. They enable our users
to debate issues raised in articles published on bmj.com. A rapid response
is first posted online. If you need the URL (web address) of an individual
response, simply click on the response headline and copy the URL from the
browser window. A proportion of responses will, after editing, be published
online and in the print journal as letters, which are indexed in PubMed.
Rapid responses are not indexed in PubMed and they are not journal articles.
The BMJ reserves the right to remove responses which are being
wilfully misrepresented as published articles or when it is brought to our
attention that a response spreads misinformation.
From March 2022, the word limit for rapid responses will be 600 words not
including references and author details. We will no longer post responses
that exceed this limit.
The word limit for letters selected from posted responses remains 300 words.
The pledge to reintroduce testing and contact tracing in the community is a good development. However, this should be an opportunity to tighten up the definition of what is a possible Covid-19 case and what is the appropriate duration of self-isolation at home.
Our stay at home guidance for the public identifies a new continuous cough and/or high temperature as the only symptoms.(1) Conversely, the US CDC website acknowledges that there can be a wider range of symptoms, whilst cough and fever may not be present.(2) Some Covid-19 patients may present with gastrointestinal symptoms.(3)
The period of self-isolation at home needs to cover the whole duration of infectivity and viral shedding. The UK guidelines put too much emphasis on 7-day self-isolation and the option of extending beyond 7 days for those with a persistent high temperature is buried in the details.(1) The US CDC approach is sounder as there is an clear recommendation to self-isolate for at least 3 days after resolution of the fever and improvement of other symptoms.(4) Similarly the European CDC recommends isolation until 3 days after resolution of fever/symptoms and a minimum of 8 days.(5) The European CDC document (unlike the PHE documents) has references that support this statement: “Viral load persists up to eight days after the onset of symptoms in mild cases and peaks in day 11 in more severe cases”.(5)
When our Prime Minister suffered from the Covid-19 infection it was reported that he had been kept in home isolation even after 7 days, because he was still symptomatic.(6) All households deserve the same high level of protection as the residents of Downing Street.
The length of isolation for household members of symptomatic cases also need to be better defined. The PHE guidelines recommend self-isolation for 14 days starting from the day when the first person in the house became ill.(1) 14 days is indeed thought to be the top end of the incubation time, but the counting should start from the last day of infectivity of the index case. The European CDC advice seems more appropriate: “Caretakers of COVID-19 patients should self-quarantine for 14 days after last contact with sick relative”. (5)
It will be easier to enforce the more stringent US and European guidelines when we start testing all cases in the community, as confirmation of the suspected diagnosis may provide more motivation.
Re: Covid-19: UK pledges to reintroduce contact tracing to fight virus
Dear Editor
The pledge to reintroduce testing and contact tracing in the community is a good development. However, this should be an opportunity to tighten up the definition of what is a possible Covid-19 case and what is the appropriate duration of self-isolation at home.
Our stay at home guidance for the public identifies a new continuous cough and/or high temperature as the only symptoms.(1) Conversely, the US CDC website acknowledges that there can be a wider range of symptoms, whilst cough and fever may not be present.(2) Some Covid-19 patients may present with gastrointestinal symptoms.(3)
The period of self-isolation at home needs to cover the whole duration of infectivity and viral shedding. The UK guidelines put too much emphasis on 7-day self-isolation and the option of extending beyond 7 days for those with a persistent high temperature is buried in the details.(1) The US CDC approach is sounder as there is an clear recommendation to self-isolate for at least 3 days after resolution of the fever and improvement of other symptoms.(4) Similarly the European CDC recommends isolation until 3 days after resolution of fever/symptoms and a minimum of 8 days.(5) The European CDC document (unlike the PHE documents) has references that support this statement: “Viral load persists up to eight days after the onset of symptoms in mild cases and peaks in day 11 in more severe cases”.(5)
When our Prime Minister suffered from the Covid-19 infection it was reported that he had been kept in home isolation even after 7 days, because he was still symptomatic.(6) All households deserve the same high level of protection as the residents of Downing Street.
The length of isolation for household members of symptomatic cases also need to be better defined. The PHE guidelines recommend self-isolation for 14 days starting from the day when the first person in the house became ill.(1) 14 days is indeed thought to be the top end of the incubation time, but the counting should start from the last day of infectivity of the index case. The European CDC advice seems more appropriate: “Caretakers of COVID-19 patients should self-quarantine for 14 days after last contact with sick relative”. (5)
It will be easier to enforce the more stringent US and European guidelines when we start testing all cases in the community, as confirmation of the suspected diagnosis may provide more motivation.
1. Public Health England. Guidance. Stay at home: guidance for households with possible coronavirus (COVID-19) infection. Updated 21 April 2020. https://www.gov.uk/government/publications/covid-19-stay-at-home-guidanc...
2. Centers for Disease Control and Prevention. Symptoms of Coronavirus. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html
3. R Lewis. Digestive Symptoms Tied to Worse COVID-19 Outcomes. https://www.medscape.com/viewarticle/927112
4. Centers for Disease Control and Prevention. What to Do If You Are Sick. https://www.cdc.gov/coronavirus/2019-ncov/if-you-are-sick/steps-when-sic...
5. European Centre for Disease Prevention and Control. Guidance for discharge and ending isolation in the context of widespread community transmission of COVID-19 – first update. 8 April 2020. https://www.ecdc.europa.eu/sites/default/files/documents/covid-19-guidan...
6. K. Proctor. Coronavirus symptoms force Boris Johnson to stay in self-isolation. Despite completing seven days of quarantine, PM to stay inside Downing Street flat. https://www.theguardian.com/politics/2020/apr/03/coronavirus-symptoms-fo...
Competing interests: No competing interests