LETTERS BMJ: first published as 10.1136/bmj.n283 on 29 January 2021. Downloaded from Chrisp Street Health Centre, London E14 6PG, UK OPEN LETTER [email protected] Cite this as: BMJ 2021;372:n283 Open letter to Chris Whitty and Susan Hopkins: change covid-19 case http://dx.doi.org/10.1136/bmj.n283 Published: 29 January 2021 definition in line with WHO to save lives Alex Sohal general practitioner I hope this letter sharing 140 (and counting) general infectious.8 Thus test more of those with symptoms,9 practitioners’ clinical experiences of patients with identify more infectious cases, and reduce spread, covid-19 will encourage you to adopt our proposal—to implementing SAGE advice10 and saving lives. This change the covid case definition and testing criteria will help to get—and keep—us out of this indefinite in step with the World Health Organization, thus lockdown, as covid-19 becomes increasingly endemic decreasing the spread of covid-19. globally. Ignoring this will be at our peril. As GPs, we regularly review patients with mild AS is also health equity lead for Tower Hamlets and honorary clinical senior symptoms—for example, a runny or blocked nose, lecturer in primary care, Queen Mary University of London. sore throat, hoarseness, myalgia, fatigue, and headache—who subsequently turn out to be covid-19 Competing interests: None declared. positive. These symptoms are often inadvertently Full response at: https://www.bmj.com/content/371/bmj.m4851/rr-4. picked up while dealing with patients’ other more pressing health issues. These patients have frequently 1 WHO. WHO covid-19 case definition. https://www.who.int/publica- not even considered that they may have covid-19 and tions/i/item/WHO-2019-nCoV-Surveillance_Case_Definition-2020.2 have not self-isolated in the crucial early days when 2 Department of Home Affairs. Australian Government. Health. they were most infectious. The national publicity https://covid19inlanguage.homeaffairs.gov.au/health campaign focuses on cough, high temperature, and 3 Government of Canada. Testing for covid-19: diagnosing and how we test. loss of smell or taste as symptoms to be aware https://www.canada.ca/en/public-health/services/diseases/2019-novel- coronavirus-infection/symptoms/testing/diagnosing.html#a1 of—only patients with these symptoms are able to 4 NHS. How long to self-isolate. https://www.nhs.uk/conditions/coronavirus- access a covid-19 test online through the NHS test covid-19/self-isolation-and-treatment/how-long-to-self-isolate/ booking site. GPs have to advise patients to be 5 Royal College of paediatrics and Child Health. COVID-19—talking to children

dishonest to get a covid-19 test. and families about returning to school: guiding principles. 2020. http://www.bmj.com/ https://www.rcpch.ac.uk/sites/default/files/generated-pdf/document/COVID- The World Health Organization’s case definition of 19---talking-to-children-and-families-about-returning-to-school%253A- covid-19 includes coryza, sore throat, vomiting, and guiding-principles.pdf diarrhoea.1 The government website of Australia lists 6 Swann OV, Holden KA, Turtle L, etalISARIC4C Investigators. Clinical 2 characteristics of children and young people admitted to hospital with these symptoms, and that of Canada includes mild covid-19 in United Kingdom: prospective multicentre observational cohort 3 symptoms. NHS guidance states that patients should study. BMJ 2020;370:m3249. doi: 10.1136/bmj.m3249 pmid: 32960186 keep self-isolating for more than 10 days if they have 7 Wells PM, Doores KJ, Couvreur S, etal. Estimates of the rate of infection 4 and asymptomatic COVID-19 disease in a population sample from SE a runny nose or sneezing. The Royal College of on 30 September 2021 by guest. Protected copyright. Paediatrics and Child Health guidance for schools England. J Infect 2020;81:931-6. doi: 10.1016/j.jinf.2020.10.011. pmid: 33068628 states that a cold does not require covid-19 testing.5 8 Cevik M, Tate M, Lloyd O, Maraolo AE, Schafers J, Ho A. MERS-CoV Viral Yet children with laboratory confirmed SARS-CoV-2 load dynamics, duration of viral shedding, and infectiousness: a systematic have presented with vomiting, sore throats, and review and meta-analysis. The Lancet Microbe 2021;2. runny noses.6 Much of our existing data on covid-19 doi: 10.1016/S2666-5247(20)30172-5. come from hospital settings,7 not the cases I see in 9 Pollock A, Lancaster J. Asymptomatic transmission of covid-19. BMJ 2020;371:m4851doi: 10.1136/bmj.m4851. the community every day. 10 SAGE 56th meeting on covid-19, 10 Sep 2020. https://assets.publishing.ser- Many of our patients are included in the estimated vice.gov.uk/government/uploads/system/uploads/attachment_da- eight million people in the UK who cannot work from ta/file/928699/S0740_Fifty-sixth_SAGE_meeting_on_Covid-19.pdf home, many in public facing jobs, with their children attending school, as part of key worker provision. This article is made freely available for use in accordance with BMJ's website Their employers, managers, and teachers are mostly terms and conditions for the duration of the covid-19 pandemic or until otherwise determined by BMJ. You may use, download and print the article for any lawful, unaware of the significance of mild symptoms. The non-commercial purpose (including text and data mining) provided that all media focus on severe cases makes it difficult to copyright notices and trade marks are retained. 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 the bmj | BMJ 2021;372:n283 | doi: 10.1136/bmj.n283 1