#MSCOVID19: the new lepers?

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Barts-MS rose-tinted-odometer: ★★★

Early this week my wife came down with a cold. Did she have coronavirus was the immediate question? She asked me for advice and I said she had better get herself swabbed and in the interim we should isolate ourselves. All she had was a mild headache (sinus-type), runny nose, sneezing and a sore throat. She did not have a temperature and only developed a mild cough after a few days. Her nasopharyngeal swab for coronavirus done via the post took almost 72 hours to come back and was fortunately negative. 

Interestingly despite a blocked and runny nose, she did not develop loss of smell or her taste; I tested it with coffee, chocolate and some fine white wine. Although loss-of-taste (ageusia) and smell (anosmia) occur in about 40-60% of subjects with COVID-19 it is really not specific enough to exclude coronavirus infection so don’t rely on it. In addition, it may not occur until several days into the infection, prior to which you could be highly infectious and spreading the virus.

Fortunately, my wife is now much better. I suspect she had rhinovirus infection, a common cause of rhinitis or the ‘common cold’, which is now circulating as it normally does this time of year.

In response to the emerging rhinovirus problem, the BBC and most of the newspapers have run articles or special features to highlight the differences between COVID-19, influenzae and the common cold. If you look at this list of symptoms below it is simply not possible to differentiate mild infections from each virus apart. Surely, it is not about diagnosing which infection you have but making sure you don’t act as a source of coronavirus and spread the infection. 

Therefore everyone with symptoms suggestive of an upper respiratory tract infection, including the common cold, should really consider themselves infected with coronavirus until proved otherwise. This means they need to get themselves swabbed and tested. Therein lies the problem. The UK at the moment does not have enough testing capacity outside of the NHS Trust’s to deal with this emerging problem. Hence anyone with a cold will probably have to self-isolate including their immediate contacts.  

The other thing is the new ‘COVID-19 leper syndrome’. Even if you go outdoors or travel, for example, to work, with a blocked nose and cold-like symptoms people will treat you like a leper and run a mile. This has been happening already before the rhinovirus problem; if anyone sneezes or coughs on the underground they immediately attract dirty looks and space clears around them as if they are radioactive. 

Things are only going to get worse the further we move into Autumn and Winter. In addition, young children are back in school and they are hothouses for acquiring and spreading viruses. The perfect storm is having two highly infectious viruses, which cause overlapping symptoms, circulating at the same time when we are trying to get society moving again. I can only imagine the chaos this going to cause in schools, universities and the workplace. The only solution is for the government to massively increase testing capacity ideally with the emerging point-of-care diagnostics, which can provide an answer within 60-90 minutes whether or not you have COVID-19. 

It is clear to me that an effective coronavirus vaccine can’t come soon enough. 

CoI: multiple

Twitter: @gavinGiovannoni Medium: @gavin_24211

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

15 comments

  • There are two interesting things to consider here:
    1. If everybody is taking infection control precautions we should expect to see a fall in all infections. I will cast no aspergions about the explosion in gonorrhoea cases amongst young people where I live – if everybody is following social distancing, it must have become airborne and highly infectious!
    2. If the best nasopharyngeal swabs are being taken and a negative result is considered just cause to stop isolating, then for every 3 CoVID-19 cases swabbed, one will be falsely reassured that they can stop isolating and return to spreading the infection in the community.

    • Which is why a lot of experts are recommending two negative tests. However, swab negative symptomatic subjects may not be that infectious. The other issue is that many PCR labs are running using over 35 PCR cycles for coronaviruses, which increases the chances of false positives. I am told that 32 PCR cycles is usually the upper limit on most routine viral diagnostic assays. Not sure why diagnostic labs have widened the goalposts for coronaviruses.

      • Even if the relative risk of a false positive increases enormously, the likelihood is so low that the absolute risk increase is small and the consequences of a false positive are insignificant compared to a false negative.

  • There are four other circulating coronavirus that can cause the common cold. The question is how do you distinguish coronavirus infection from SARS COV-1?

    Regarding loss of smell in COVID-19 cases, it seems that olfactory epithelium expresses ACE-2 receptor protein in mice. If the same is true in humans then olfactory route may be a source of infection in addition to respiratory epithelium. It seems age may also increase expression of receptor proteins also.
    https://pubs.acs.org/doi/10.1021/acschemneuro.0c00210

  • Hi Prof G, I understand from a friend, that the experience of having a test carried out by a member of NHS, whether it is, back of throat, or the nasal orifice, they are both really unpleasant, uncomfortable & for those of us that have a short gag reflex, not great! So if you have to carry out these tests at home, as the local testing sites are having difficulties, can these home kits be reliable enough.

    I understand, either way if you have symptoms you self isolate – I’m also aware as all the young adults are going back to Uni, College or jobs – the social distancing rules, masks along with bubbles aren’t being carried out properly. The rules are being interpreted differently and a bit lacklustre. Again, my own children are due back to Uni in the next 2 weeks and for those that are 1st years – have an anxious time ahead of them, as they negotiate their new homes & lives! I feel so sorry for them – us oldies can sit at home reading a book, or working online (mostly). How is the virus not going to spread amongst the young adults & how can a parent instruct their child to stay put & not come home to isolate & ensure they are cared for!

    We must have tests – reliable, accessible & regularly to see where the patterns are emerging – not just daily national figures (& obscure local ones). People are being turned away from having tests, as they don’t have a QR code! Surely if we give our contact details when eating out or going for a coffee – can’t they at least be more flexible too for the elderly folk, who are not aware of the a QR code! Especially if they have travelled a distance & are anxious about whether they have the virus – with symptoms so random! I totally agree, bring on the vaccines & if there is a full second wave, please DON’T shut all the hospitals/medical facilities down in case of COVID-19 or if there’s patients their with it – Open up the new Nightingale Hospital and designate it as quarantine hospital for all COVID patients – along with a few other facilities throughout the Country. I believe in the 50/60s TB had special hospital that were quarantined (my Grandfather went into one of them!). It isn’t great for all & staffing issues, I’m sure will be difficult to manage – but it might help to stop the spread in medical facilities and allow all other departments to continue as much as possible.

    If they can build the NH in 4/5 weeks the organisational skills of the Country is amazing & we have the Armed Forces who could help facilitate this too! If the rules aren’t mandatory too – it causes lack of commitment.

  • As someone with progressive MS who could experience permanent damage as a result of “just a common cold”, I can’t honestly say that I worry about people with any respiratory virus being treated as a leper.

    Couldn’t you find something healthier than “fine white wine”?

  • I wouldn’t want to that the Covid-19 test done at a test center but I would be happy to the the test at home by myself. I’ve heard the test centre swabs are extremely uncomfortable.

    • A coughing fit is the best way to get a seat on the tube these days…….historially projective vomiting was also a good way of clearing a carriage:-)

      • I’m on the nationwide covid testing but I dont think they they ask you to ram the swab up for ose so if you are on that stream its not so bad

  • Guardian newspaper today:
    Official death total for Covid 41,759
    UK statistics agencies deaths registered where Covid mentioned on the death certificate 57,500
    So gosh yes everyone with symptoms of any respiratory virus needs to take the precautions of self isolating, and being tested!
    🙏 for an effective vaccine ASAP.

    On a lighter note – please encourage all clinicians to offer their patients chocolate and fine white wine as means of assessing aspects of their health😄

  • With the pcr test producing flawed results, whilst being used to justify new house arrest lock downs, given a false positive result at a minimum of 0.8% and a genuine positive result of 0.1% out of 10,000 tests thats 80 poor souls branded lepers. These stats are from governments own findings, the question to ask is why aren’t the scientists coming up with a better test than the flawed Pillar 2 tests which to be branded a leper????

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