A quarter of people with symptoms consistent with COVID-19 don’t get tested and 40% of survey respondents could not identify the three ‘classic’ COVID symptoms of persistent cough, fever, or loss or change in sense of smell, according to a new study which has been submitted to a major journal.

Researchers at King’s College London and the ZOE COVID Symptom Study found that knowledge was heavily age dependent, with more than 50% of people over 65 unable to identify the classic symptoms of COVID, compared to less than 30% in the 18-45 age groups.

The research also found that older people and those with fewer years of education were more likely not to know where to get tested. The research suggests that more needs to be done to improve public knowledge and access to testing.

Effective testing and isolation of COVID-19 cases is crucial to controlling the pandemic as vaccination rolls out and restrictions start to ease across the UK. NHS testing is currently available to anyone experiencing any of the three classical symptoms. But the success of this  programme based on limited symptoms depends on people knowing when and how to access a  test.

To explore the extent of public awareness of symptoms and access to testing, Dr Mark Graham and his colleagues first analysed nearly 250 million daily health reports submitted by more than 4 million contributors to the ZOE COVID Symptom study app, along with the results of any COVID tests.

Despite the UK having substantial testing capacity through late 2020 into 2021, the researchers found that up to one in four app contributors logging at least one test-qualifying COVID- associated symptom did not report getting a test in the app during this time. 

An online survey was sent to this group during November and December 2020, to which 1,237 people responded, asking them what symptoms they had experienced in the past month,  whether they thought any of these symptoms qualified them for an NHS COVID test, and whether they had managed to get tested.The results showed that people experiencing only one of the three core symptoms or experiencing symptoms for only a day or two were less likely to get a test, while just under half of people experiencing any of the three main symptoms didn’t realise that this qualified them for an NHS test. The older the respondent, the less likely they were to know that these symptoms qualified them for a test.

To find out more about the underlying reasons preventing people accessing testing, the researchers looked at responses from 1,956 people across the UK to the University of Maryland Facebook COVID Symptom Survey who had wanted a COVID test but not been able to get one. 

A quarter of respondents (25.6%) said they had tried to get a test but were unable to. Around a third (32.4%) said they didn’t know where to go, closely followed by being unable to get to the test location (29.1%) due to factors such as cost, safety or physical limitations. People who were older or had fewer years of education were less likely to know where to get tested.

Other common answers included being worried about negative consequences of having a positive test for themselves or their family (18.4%), or not having time to get tested (13.3%).

These findings suggest the British public are still unaware of the key classical symptoms of COVID-19, particularly older age groups who are most at risk. On top of this, the public don’t know where or how to get tested. 

Mark Graham, Research Fellow at King’s College London: “It’s concerning that there is still such a lack of knowledge about the symptoms of COVID-19 at this point in the pandemic. More needs to be done to raise public awareness of the importance of getting tested. Even if people are experiencing just one symptom or only feel ill for a short time, they could still be infectious and pass the disease on to others. Spotting cases early is going to be essential as the UK starts to lift restrictions.”

Dr Claire Steves, Reader at King’s College London and lead scientist on the ZOE COVID Symptom Study: “Focusing NHS testing solely on people experiencing cough, fever and loss or change in smell risks missing many thousands of cases, who could be passing on the infection to their loved ones and wider community. We continue to urge the government to expand the list of COVID-19 Symptoms and send a clear message to the public: if you feel unwell, it could be COVID-19 and you should get a test.” 

The ZOE COVID Symptom Study app invites contributors logging any of more than 20 known COVID-19 symptoms for a test. 

‍
Recent work from the KCL and ZOE team has shown that while the current NHS testing criteria of cough, fever and loss of smell picks up around 69% of symptomatic COVID-19 cases, adding fatigue, headache, sore throat and diarrhoea to the list would detect 96% of cases.