Dr Paul Nelson: What on earth are ”symptoms” when you have a stiff upper lip?

Dr Paul Nelson considers the challenges posed by asymptomatic COVID-19

The commercially devastating news of the last few days of a confirmed second wave and new lockdown measures across the high street and beyond for the next six months at least drive home to us all how high the stakes are for all of us to comply with necessary measures to slow the spread of C19. The threat from the PM that if R0 remains above 1 after that, the full lock down will follow is sobering. Yet we received wisdom is that up to eight out of ten C19 cases report no symptoms at all. It all seems so hopeless if we can’t identify C19, even in ourselves, then how can we keep each other safe and how can the NHS do track and trace?

Yet case studies describe ‘asymptomatic’ people who, once diagnosed with C19, recalled some sort of symptoms that they had initially failed to recognise or had dismissed.

Even before C19, it was standard practice to ignore symptoms. After all, who has time to contemplate being sick? The consequences of having to take time out from work are too significant and who wants to be accused of “Man flu”? So as a nation, we have learned just to keep calm and carry on. We have learned to ignore our bodies until we are laid low by them.

This mindset existed even before the global pandemic where the individual stakes of admitting symptoms and sickness were considerably less significant that now with the threat of enforced self-isolation, inconvenience and often deprivation due to loss of income.

So what does asymptomatic (no symptoms) mean? Most of us merely dare not ask ourselves the question “Do I have symptoms?” for as long as we possibly can.

The answer is that- we don’t know what asymptomatic means – and we need to find out. For C19 eradication purposes, we need to assess people for signs of a fever in economically vulnerable spaces, and we all need to retrain ourselves to consider each day consciously if we may have symptoms. We need to go so far as to take our temperatures at home each morning before we brush our teeth, even if we don’t consciously feel unwell.

It may turn out to be true that unless I think about it and are even are asked by someone else about it; I am not best placed to know if I have symptoms. Amid a resurgence of C19 this winter I, and you must take responsibility to see if we are a risk to someone else by objectively measuring and in economically vulnerable spaces allowing ourselves to be assessed for a raised body temperature. We must slow down and check-in with ourselves each day sufficiently to genuinely consider if we have other symptoms of C19.

Notes: (Advice from NHS Scotland correct for 16/09/2020)
The main symptoms of coronavirus (COVID-19) are:

● a high temperature – this means you feel hot to touch on your chest or back (you do not need to measure your temperature)
● a new, continuous cough – this means coughing a lot for more than an hour, or three or more coughing episodes in 24 hours (if you usually have a cough, it may be worse than usual)
● a loss or change to your sense of smell or taste – this means you’ve noticed you cannot smell or taste anything, or things smell or taste different to normal
● To protect others, do not go to places like a GP surgery, pharmacy or hospital if you have any of these symptoms. Get a test to check if you have coronavirus and stay at home until you get your result.