Intended for healthcare professionals

Views And Reviews Primary Colour

Helen Salisbury: Could it be covid?

BMJ 2021; 375 doi: (Published 02 November 2021) Cite this as: BMJ 2021;375:n2652
  1. Helen Salisbury, GP
  1. Oxford
  1. helen.salisbury{at}
    Follow Helen on Twitter: @HelenRSalisbury

Every year, as the weather turns colder, many patients present to their GP with symptoms of a respiratory virus. All GPs have a well rehearsed explanation about why this three day cough accompanied by a sore throat and runny nose is viral, rather than bacterial, and won’t be helped by antibiotics. The routine has been adjusted this year to include an additional question: “Have you done a covid test?” In most cases the answer is no, which is understandable but also alarming.

The government’s coronavirus website still lists the main symptoms of infection as a high temperature, a new continuous cough, and a loss or change in sense of taste or smell.1 If you have these symptoms you can order a PCR test for coronavirus. This list hasn’t been revised, even though we know that these aren’t the main symptoms of the delta variant. Headache, sore throat, and runny nose are the three most common symptoms in unvaccinated people, in data collected through the Zoe Covid Symptom study, which has 4.7 million people logging their symptoms daily.2 Fever and persistent cough are fourth and fifth, and in vaccinated people only one of the original symptoms—persistent cough—makes it into the top five (and only just), being less common than sneezing.

Patients should be forgiven for feeling certain that they don’t have covid (although some have been described as having Schrödinger’s cough—simultaneously severe enough to need antibiotics but not bad enough to be covid). There has been no public messaging stating that these common respiratory symptoms could be caused by coronavirus, despite a much wider range being published in WHO’s case definition nearly a year ago and numerous subsequent calls for a change in UK government guidance.345

If we want to halt the spread of covid, we need to empower people to recognise when they may be infected and enable them to access accurate testing to find out. If they rely on information based on an outdated and inaccurate case definition, they risk infecting vulnerable people and perpetuating the pandemic by mixing freely at school or work and in public.

On a more personal note, patients are currently being encouraged by the press and our politicians to demand to be seen face to face. This puts GPs and their teams at risk, as the screening questions used for possible covid are likely to miss many cases.

There’s a parallel here with the persisting prominence of handwashing in official messages about covid precautions (for example, on the UK Health Security Agency’s Twitter feed). Clean hands are a good idea, but fresh air is far more likely to prevent infection by an airborne virus. I really want to keep my patients safe, but it feels like an uphill struggle when so much of the information they receive from ostensibly trustworthy sources is misleading.