LOSS OF TASTE AND SMELL FINALLY ADDED TO NHS OFFICIAL CORONAVIRUS SYMPTOMS – SO SUFFERERS SHOULD SELF-ISOLATE

LOSS of taste and smell are now official symptoms of coronavirus, England's deputy chief medical officer today announced.


New government guidance means anyone suffering from either will have to self-isolate for seven days and their family remain indoors for 14.


Victims of anosmia - the clinical name for a loss of smell - will also be eligible for Covid testing, even if they don't have other symptoms.


Until now, only Brits with a new fever or persistent cough were told to self-isolate and allowed to get tested.


But scientists and leading experts have repeatedly criticised this narrow set of symptoms, warning it risks missing up to half of cases.


Prof Jonathan Van-Tam, deputy chief medical officer, today said: "Our basic case definition for some time has been a new continuous cough or fever.


"That will change to a new continuous cough, or fever, or anosmia."

He explained that while the clinical terms anosmia refers to a loss of or a change in normal sense of smell, patients may also experience a loss of taste as the two are closely linked neurologically.

SELF-ISOLATE

Those who experience a "new onset of anosmia" should self-isolate for seven days, however, symptoms could persist for weeks after they come on.


Prof-Van Tam said: “Anosmia can continue for days and weeks after you’ve recovered from Covid and that is not in itself - the same as cough - is not a reason to stay home longer than the 7 day isolation period for a suspected case.”


The addition of anosmia to the official symptoms list comes weeks after the US and the World Health Organisation changed their advice.


Scientific advisers had previously warned ministers that as many as a quarter of Brit coronavirus patients may be overlooked because they don't have a cough or a fever.


Members of the New and Emerging Respiratory Virus Threats Advisory Group (Nervtag) have been collecting data on the unusual sign since early in the UK's coronavirus outbreak.


Minutes from a meeting held on March 13 raised concerns that people with other symptoms - such as a loss of smell - may not self-isolate or get tested, according to The Times.

But the Government says that it's only now that they have enough evidence to be able to add anosmia to the official symptom list.

Prof Van-Tam said: "The reason for making the change now is that there has been a signal around the importance of anosmia as a symptom of Covid for a while now.

"It’s been important to continue to look at that and be sure that we consider it and introduce it at the right time when we think it’s going to make a difference to how we pick up cases.

"But let's be clear, this has been quite a difficult piece of science because there's a distinction between whether anosmia can occur with Covid-19 versus whether it occurs early enough to be a useful help in detecting more cases."


He added that estimates on how common anosmia is so far have been variable and there still isn't enough data to suggest how many people have had it - or whether it affects one particular group of people more than another.

UNDER-FIRE

It comes after a major study, published last week by Professor Tim Spector at King's College London, found that people with a positive test result were three times more likely to report loss of smell and taste as a symptom than those who went on to test negative.


He heavily criticised the Government's stance on Monday, saying infected people had been encouraged back to work due to a failure to track symptoms properly.

Prof Spector, head of the department of genetic epidemiology and leader of the Covid symptom study app at King's, said 50,000 to 70,000 people in the UK with Covid-19 were currently not being told to self-isolate even though they had the virus.

He blamed Public Health England (PHE) and the wider strategy, saying an insistence that only fever and cough were the major symptoms was missing thousands of cases.

SYMPTOM CHECKER

Until now, the NHS 111 coronavirus symptom checker has listed high temperature and cough as the symptoms of Covid-19.


Prof Van-Tam said on April 3 that Nervtag had looked at the issue and concluded loss of smell or taste should not be added to the symptom list.


But in the same month, ENT UK, the professional membership body representing ear, nose and throat surgery in the UK, published guidance to patients saying it believed loss of smell and loss of taste were symptoms of coronavirus and that it had shared these details with PHE.


The World Health Organisation (WHO) listed loss of smell and taste as "less common symptoms" several weeks ago and other countries, including the US, added the symptom.


However, Prof Van-Tam today said that by adding anosmia as a symptom to the list, it will pick up just two per cent more cases.

So far, the sensitivity of new case pick up with just new cough and fever is 91 per cent, he said.

But adding loss of smell to the mix should bring that figure up to 93 per cent.

Prof Van-Tam also said it was unclear whether or not loss of sense of taste and smell was acquired prior to other Covid-19 symptoms.

Speaking later at the Downing St press briefing, Prof Jonathan Van-Tam was asked whether the UK had missed diagnosis of coronavirus by failing to add it to the list of symptoms.

He said: "What I can tell you is from the Public Health England data set, called the FF100 - the first few hundred cases - there are actually 229 cases in there, all laboratory-confirmed Covid, all of whom have been studied in considerable detail and 0.44 per cent reported anosmia on its own as a symptom.

"So, the point about anosmia is it doesn't always come as the first symptom.

"Even if it does, it is followed by the cough, the fever and many of the other symptoms I have talked about, referring to the WHO definition.

"So you don't miss those cases.

"The important thing was to work out if this would add any sensitivity to the diagnostic cluster we were using and the answer is that it makes a small - a very small - difference and we have therefore decided to do it."

MORE SIGNS

Earlier, Prof Spector said there are even more symptoms - such as tiredness, stomach pain or diarrhoea - that could be included as possible coronavirus symptoms.

He said: "We list about 14 symptoms which we know are related to having a positive swab test.

"These are not being picked up by the NHS. This country is missing them all and not only underestimating cases, but also putting people at risk and continuing the epidemic.

"There's no point telling people to be alert if they don't know the symptoms."

Prof Van-Tam said scientists had had to "work out very carefully" how valid loss of taste or smell were in counting cases and where in the course of an illness the symptoms might occur.

He said Prof Spector's paper cited loss of smell and taste as being more frequent in people who test positive "but very much in the presence of other symptoms".

He added: "The question for Nervtag has always been: at what point can we be sure that by adding anosmia (loss of smell) or adding anything else, frankly - there's plenty of other things such as fatigue, diarrhoea loss of appetite - at what point would adding any of these definitely improve and help us to pick up cases?

"That work has now been completed. And that's why we've got to the position we have now, not just about whether or not anosmia exists - it's about what role it plays in identifying cases, and that's taken time to work through those data."

Peter Openshaw, professor of experimental medicine at Imperial College London, told The Telegraph: “In the self-reported symptoms, as discovered by the apps, anosmia, the loss of sense of smell, comes out as a very, very frequent one.

"But in terms of how often that would actually lead to a diagnosis of Covid, that’s not quite clear.”

He added: “I think it is important that people do have a wider perception of how it may present. The original, very restrictive definition, I think was not picking up a lot of people who actually might have Covid.”

In a statement today, all four UK Chief Medical Officers said now is the right time to update guidance on coronavirus symptoms.

They said: “From today, all individuals should self-isolate if they develop a new continuous cough or fever or anosmia.


All individuals should self-isolate if they develop a new continuous cough or fever or anosmiaBritain's Chief Medical Officers

“Anosmia is the loss or a change in your normal sense of smell. It can also affect your sense of taste as the two are closely linked.

“We have been closely monitoring the emerging data and evidence on COVID-19 and after thorough consideration, we are now confident enough to recommend this new measure.

“The individual’s household should also self-isolate for 14 days as per the current guidelines and the individual should stay at home for 7 days, or longer if they still have symptoms other than cough or loss of sense of smell or taste.”

'MORE WOMEN AFFECTED'

Early in the pandemic, the Global Consortium for Chemosensory Research (GCCR) launched a survey in response to anecodtal reports of people losing their sense of smell or taste.

They were surprised to find that more women in their 30s and 40s were reporting the symptom.

Professor Carl Philpott, a smell expert at the University of East Anglia and one of the research members, said: “We are collecting data on Covid-19 from people in 50 countries all around the world – and it all points to the fact that smell loss is a symptom.

“We have found that it particularly affects some demographics, such as women in their 30s and 40s.

"This is different to what we would normally see when people present with anosmia following a virus - that tends to be people who are in an older age group, more commonly in their 60s and 70s.

“Our research and that from many other centres shows that for some, it can be the only symptom, or accompanied by or precede other mild symptoms."

Prof Philpott welcomed the fact the symptom has now been added to the official list but pointed out it was "much later than other European counterparts and at least two weeks after the WHO added it to their list".


Prof Barry Smith from the University of London, the UK lead for the GCCR, said: “If enough people are able to tells us about their sudden loss of smell or taste, this will provide vital clues that could be part of the story about the prevalence of the virus in the population – information the Government can all upon before mass antibody testing is available.”

Dr Sarah Jarvis, GP and clinical director of Patient Access, told the Sun Online: "This is still a new virus and we are learning more all the time. A few weeks ago, a group of Ear, Nose and Throat (ENT) specialists highlighted that they were seeing many patients with loss of sense of smell that they thought was linked to COVID-19 infection.

"Several app programmes have now been developed which allow patients to report their own symptoms, including the Patient Access surveillance programme in collaboration with the University of Oxford and the Royal College of GPs.

"These apps have been providing invaluable information on the sort of symptoms patients get.

"It is becoming increasingly clear that many patients develop loss of sense of smell and taste with coronavirus infection.

"This can be on top of other key symptoms (fever or new cough) or on its own.