Intended for healthcare professionals

Letters Open letter

Open letter to Chris Whitty and Susan Hopkins: change covid-19 case definition in line with WHO to save lives

BMJ 2021; 372 doi: (Published 29 January 2021) Cite this as: BMJ 2021;372:n283
  1. Alex Sohal, general practitioner
  1. Chrisp Street Health Centre, London E14 6PG, UK
  1. ahsohal{at}

I hope this letter sharing 140 (and counting) general practitioners’ clinical experiences of patients with covid-19 will encourage you to adopt our proposal—to change the covid case definition and testing criteria in step with the World Health Organization, thus decreasing the spread of covid-19.

As GPs, we regularly review patients with mild symptoms—for example, a runny or blocked nose, sore throat, hoarseness, myalgia, fatigue, and headache—who subsequently turn out to be covid-19 positive. These symptoms are often inadvertently picked up while dealing with patients’ other more pressing health issues. These patients have frequently not even considered that they may have covid-19 and have not self-isolated in the crucial early days when they were most infectious. The national publicity campaign focuses on cough, high temperature, and loss of smell or taste as symptoms to be aware of—only patients with these symptoms are able to access a covid-19 test online through the NHS test booking site. GPs have to advise patients to be dishonest to get a covid-19 test.

The World Health Organization’s case definition of covid-19 includes coryza, sore throat, vomiting, and diarrhoea.1 The government website of Australia lists these symptoms,2 and that of Canada includes mild symptoms.3 NHS guidance states that patients should keep self-isolating for more than 10 days if they have a runny nose or sneezing.4 The Royal College of Paediatrics and Child Health guidance for schools states that a cold does not require covid-19 testing.5 Yet children with laboratory confirmed SARS-CoV-2 have presented with vomiting, sore throats, and runny noses.6 Much of our existing data on covid-19 come from hospital settings,7 not the cases I see in the community every day.

Many of our patients are included in the estimated eight million people in the UK who cannot work from home, many in public facing jobs, with their children attending school, as part of key worker provision. Their employers, managers, and teachers are mostly unaware of the significance of mild symptoms. The media focus on severe cases makes it difficult to convince patients that their mild illness could be covid-19.

It is vital to now change the UK covid-19 case definition and test criteria to include coryza and cold, making them consistent with WHO. Tell the public, especially those who have to go out to work and their employers, that even those with mild symptoms (not only a cough, high temperature, and a loss of smell or taste) should not go out, prioritising the first five days of self-isolation when they are most likely to be infectious.8 Thus test more of those with symptoms,9 identify more infectious cases, and reduce spread, implementing SAGE advice10 and saving lives. This will help to get—and keep—us out of this indefinite lockdown, as covid-19 becomes increasingly endemic globally. Ignoring this will be at our peril.


  • AS is also health equity lead for Tower Hamlets and honorary clinical senior lecturer in primary care, Queen Mary University of London.

  • Competing interests: None declared.

  • Full response at:

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