UK study reports on attitudes to COVID-19 symptoms and testing

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In the United Kingdom (UK), a key part of the Government’s response strategy to COVID-19 was NHS Test and Trace (NHSTT). Anyone experiencing a fever, a new and persistent cough, or loss or change of smell or taste has to self-isolate and request a test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Close contacts of the person are then contacted and asked to self-isolate.

Although this system is a valuable tool, it relies on high testing rates, high adherence to self-isolation, and successful contact tracing.

A new study found that only about half the people correctly identified COVID-19 symptoms, and only about 18% requested a test. Uncertainty in interpreting symptoms may be a reason for not getting tested.

In addition, there is a large proportion of people who are asymptomatic. Several universities in the UK started regular mass testing. However, even this requires high testing levels and sticking to self-isolation if the test result is positive. Concerns about the effect of self-isolation on mental health and its effect on others if one tests positive have been a barrier in high mass testing.

Researchers from King’s College London and Public Health England studied how people engage with the NHSTT, in particular, how people recognize symptoms and get tested. They reported their results in a paper published on the medRxiv* preprint server.

Recognizing symptoms

The researchers interviewed 40 participants in England selected based on their age, gender, region, ethnicity, and where they lived. They included people who had experienced any symptoms in the week before the interview. The interview questions were open-ended to understand their perceptions of COVID-19 symptoms and testing.

The participants, who were almost equally split between male and female, described what they thought about COVID-19 symptoms and how confident they felt attributing them to COVID-19 rather than to other illnesses. This led to a conversation about when to get a COVID-19 test, hurdles to getting tested, and their experiences getting tested. They also spoke about how testing impacted their daily lives and the impact when they thought people were not following guidelines.

Based on the survey, the team found that participants generally had a good awareness of the three main symptoms listed by the UK government. They also pointed out other symptoms like sore throat and stomach complaints they had experienced or had heard about. There was some understanding that different people experience symptoms differently.

Participants often feel unsure if the symptoms alone could indicate COVID-19, although this also varied depending on the symptoms. Most felt a loss of smell or taste was specific to COVID-19, while having a fever or a cough was difficult to attribute specifically to COVID-19. In general, most felt having more symptoms or more severe symptoms pointed to COVID-19. People also attributed symptoms to COVID-19 based on their risk or likelihood of being exposed to COVID-19.

Getting tested

Regarding testing for COVID-19, most knew that anybody experiencing symptoms was eligible to take the test, and most were sure about how they could access a test. Some participants mentioned they would get tested as soon as they had symptoms, but most said they would wait and see how the symptoms developed over a few days.

Thus, getting tested depended not only on recognizing symptoms but also on symptom severity and their interpretation of symptoms. Hence, public communications on COVID-19 testing should highlight that even mild symptoms, a single symptom, and waiting to see how symptoms develop are risky behavior.

Most participants said they would stay at home if they had symptoms. Some said if their symptoms were mild they would go out shopping for essentials or spend time outdoors taking all the proper precautions. All said they were frustrated by people who did not get tested or isolate themselves when needed.

The findings revealed that people were generally confident of how to get tested via the NHSTT or via university if students. Most felt mass asymptomatic testing was a good idea, but there was hesitancy toward getting tested because of concerns that the test may be inaccurate or wasting resources that could be used for people who may need it more. It will be useful to provide reassurance on the importance of asymptomatic testing as they contribute to a large proportion of cases.

Therefore, public communication should not only emphasize symptom recognition but also encourage those who are experiencing mild symptoms to seek a test regardless of whether they have been exposed or not.

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:

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