Intended for healthcare professionals


Covid-19: Runny nose, headache, and fatigue are commonest symptoms of omicron, early data show

BMJ 2021; 375 doi: (Published 16 December 2021) Cite this as: BMJ 2021;375:n3103

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  1. Gareth Iacobucci
  1. The BMJ

The UK government has been urged to update its list of symptoms for covid-19, after early data showed that cold-like symptoms were the most commonly reported by people with the new omicron variant.

Data released on 16 December by the Covid Symptoms Study,1 run by the health science company Zoe and King’s College London, show that the top five symptoms reported in the app for omicron infection were runny nose, headache, fatigue (either mild or severe), sneezing, and sore throat. This initial analysis was based on positive cases in London, which was selected because of its higher prevalence of omicron than in other parts of the UK.

The government still lists fever, cough, and loss of sense of smell or taste—which were the most common with the alpha variant—as the covid symptoms to watch out for.

Tim Spector, lead scientist on the Zoe Covid Study app, who has been calling for the list of symptoms to be updated since the emergence of the delta variant,2 said a change was overdue.

“The messaging from the government is just not clear on this,” he said. “I think most people know what cold-like symptoms are. I would probably just add [to the list]: ‘Have you got cold-like symptoms?’ We need to educate people, go back to the basics, and say that if you’ve got cold-like symptoms keep away from people. You shouldn’t be waiting for the three classic symptoms.”

To compare delta and omicron, London data were selected from a week where delta was dominant (a sample of 363 cases from 3-10 October 2021) and compared with the most recent data (847 cases from 3-10 December 2021). This initial analysis found no clear differences between delta and omicron in the early symptoms (three days after testing).

Spector said it was vital that members of the public were aware of the symptoms to look out for, particularly in areas such as London that have very high rates of omicron infection. “If you do have symptoms of a mild or bad cold, it’s highly likely that you’ve got covid if you’re in an area like London at the moment,” he said.

Spector said the UK was now an international exception in not listing cold-like symptoms as likely indicators of covid infection, noting that the US Centers for Disease Control and Prevention, the World Health Organization, and European countries such as Spain and France had all updated their advice.

“The UK is the odd one out,” he said. “They should amend it if the majority are presenting that way.”

The Department of Health and Social Care for England said that the main symptoms listed had been carefully selected to capture the people most likely to have covid-19 while not including a large number of people who did not. A spokesperson said, “Since the start of the pandemic we have acknowledged covid-19 has a much longer list of symptoms than the ones used in the case definition, and experts keep the list of symptoms under review.”

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