Here's Why The Official Covid-19 Symptoms List Needs Expanding

The UK recognises three main Covid symptoms where other countries list up to 11.

Continuous cough, fever, a loss of taste or smell. By now we all know these are the three key symptoms of Covid-19 that warrant a test in the UK.

But we also know they aren’t the only symptoms of coronavirus. In fact, the World Health Organisation (WHO) lists multiple signs of infection including tiredness, aches and pains, sore throat, diarrhoea, conjunctivitis, headache, chest pain, difficulty breathing and rashes.

For some time now, there have been calls for the UK government and public health bodies to expand the list so that more people can access testing.

But so far there have been few signs of movement

There have been more calls for the official Covid symptoms list to be expanded.
There have been more calls for the official Covid symptoms list to be expanded.

Independent Sage, a group of scientists providing independent scientific advice to the UK government and public during the Covid-19 crisis, believe the symptoms list should be expanded.

The thinking goes that expanding the official list would not only raise awareness around the full list of possible Covid-19 symptoms, but also enable more people to access testing. If the public is more aware that mild signs such as a runny nose or sore throat could also signal Covid, people may also be more inclined to self isolate when feeling ill, rather than going about business as normal and potentially spreading the virus to others during its most infectious stage.

Dr Zubaida Haque, a member of Independent Sage, tells HuffPost UK it is “astonishing” that the symptoms list is so limited, given what GPs see and symptoms surveys have highlighted.

She previously suggested in a virtual Independent Sage meeting, shared on Twitter, that “part of the reason the government hasn’t expanded the definition of Covid symptoms is because they put politics and wealth before health” – citing the investment of over £22bn in a “failing” test and trace system.

Another GP suggested patients are being advised to lie in order to get Covid-19 tests, due to the strict three symptoms criteria.

In an open letter to England’s chief medical officer Professor Chris Whitty and Public Health England’s Susan Hopkins published in January, Dr Alex Sohal, a GP based in London, called for a change to the case definition and testing criteria for 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,” said Dr Sohal.

Covid-19 symptoms are often identified by GPs while dealing with patients’ other more pressing health issues, she added. These patients hadn’t always considered they might have Covid-19, nor had they self-isolated as a result.

Because of the strict criteria for accessing tests, “GPs have to advise patients to be dishonest to get a Covid-19 test,” she wrote in the BMJ.

Good Morning Britain’s Kate Garraway challenged health secretary Matt Hancock over the Covid-19 symptoms in February and her concerns that by only listing three key signs on the government’s website, those who experience other symptoms of coronavirus are being overlooked.

“If you go onto any government website, or any situation where you need to find out facts, it says, ‘symptoms: cough, temperature or loss of smell’,” she said.

“So people think, ‘I haven’t got that, I haven’t got Covid’, and I don’t think that has been helpful in terms of looking at how people have suffered and died, or indeed how it’s spread. What are you doing to address that?”

Hancock responded that GPs know the longer list of symptoms and said anyone with symptoms “for anything that’s making you ill” should see their GP.

But later in the show, Ben Shephard read a message from one viewer who said her GP had refused to see her as she was showing symptoms that weren’t among the three official ones. “That’s my concern,” said Garraway. “No one wants to overburden the NHS, but by the government overlooking those symptoms, I fear people are being missed.”

Multiple studies have determined other symptoms are linked to Covid-19 and many other countries have been quick to update citizens on the longer list of possible symptoms.

The Centers for Disease Control and Prevention (CDC) in America, for example, lists 11 symptoms of the virus, adding that the list is not exhaustive.

Recently shared data from the Office for National Statistics (ONS) suggests coughs, sore throats, fatigue and muscle pain are more commonly reported symptoms of the new UK coronavirus variant, with fewer people experiencing a loss of taste or smell (one of the three official key symptoms).

An analysis of data gathered from the Zoe Covid Symptom Study app suggested that adding fatigue, sore throat, headache and diarrhoea to the symptoms list would help pick up around a third more cases of Covid-19.

The findings, published in the Journal of Infection, suggest that restricting testing to the three classic symptoms may have led to “millions of missed cases” in the UK over the course of the pandemic, giving the virus free rein to spread.

PCR swab testing is the most reliable way to tell whether someone is infected with SARS-CoV-2 – the virus that causes Covid-19. But currently only those with the three main symptoms are officially eligible for these tests (though some local authorities in England are now offering lateral flow testing, even to those who are asymptomatic).

Data from the Zoe app shows that 31% of people who are ill with Covid-19 don’t have any of the three official symptoms in the early stages of the disease, which is when they are most infectious.

A team led by researchers at King’s College London and the Coalition for Epidemic Preparedness Innovations (CEPI), analysed data from more than 122,000 UK adult users of the Symptom Study app.

They suggested that testing people with any of the three ‘classic’ symptoms would have unearthed 69% of symptomatic cases. However, testing people with any of seven key symptoms – cough, fever, anosmia, fatigue, headache, sore throat and diarrhoea – in the first three days of illness would help identify 96% of symptomatic cases.

Researchers now want to see the official list of symptoms expanded. Dr Claire Steves, reader at King’s College London and lead scientist on the Zoe Covid Symptom Study app, pointed out that when PCR testing was scarcely available, it made sense to restrict it, but testing is now more widely available.

“We urge the government to expand the testing criteria so that anyone with new symptoms that might be Covid-19 should be able to get a test to help stop the spread of the virus,” said Dr Steves.

Professor Tim Spector, Zoe Covid Symptom Study project lead, added: “We identified anosmia as a symptom back in May and our work led to the government adding it to the list, it is now clear that we need to add more.

“By inviting any users who log any new symptoms to get a test, we confirmed that there are many more symptoms of Covid-19. This is especially important with new variants that may cause different symptoms.

“For us, the message for the public is clear: if you’re feeling newly unwell, it could be Covid and you should get a test.”

Imperial College London’s React study of more than one million people in England revealed chills, a loss of appetite, headaches and muscle aches could be additional symptoms of coronavirus.

Their research, which hasn’t yet been peer-reviewed, is based on swab tests and questionnaires collected between June 2020 and January 2021.

Earlier this year, HuffPost UK spoke to the parents behind the Long Covid Kids campaign group, which is raising awareness of long-term symptoms of the virus in children. The group has called on the government to create an awareness campaign to teach parents about the symptoms to look out for in kids and want to see these symptoms acknowledged by the NHS so tests can be accessed.

Common symptoms in children, according to the Symptom Study app, are fatigue, headache, fever, sore throat and loss of appetite. One in six children also present with an unusual skin rash. Accessing testing can be hit and miss, as children don’t always present with the three official symptoms.

When HuffPost UK asked whether the symptoms could be changed or updated, a spokesperson for NHS Digital explained the power to do this lies in Professor Chris Whitty’s hands: “The NHS website’s description of the main symptoms of coronavirus is based on the Chief Medical Officers’ statement of May 2020 which defined, on behalf of the UK Government, the Covid-19 symptoms requiring action from the UK public.”

Should the Chief Medical Officer for England update or qualify this definition, the change will be reflected on the NHS website, they added.

When we asked the Department of Health and Social Care (DHSC) whether it would be expanding the symptoms list – and if not, why – a spokesperson said: “An expert scientific group keeps the symptoms of Covid-19 under review. The main symptoms have been carefully selected to capture those most likely to have Covid-19, while not capturing a great number of people who do not.

“Anyone experiencing the main symptoms – a high temperature, a new continuous cough, or a loss or change to sense of smell or taste – should get a test as soon as possible and immediately self-isolate along with their household.”