Adherence to the test, trace, and isolate system in the UK: results from 37 nationally representative surveys

Smith, Louise; Potts, Henry W W; Amlôt, Richard; Fear, Nicola T.; Michie, Susan; Rubin, G James

doi:10.1136/bmj.n608

Cited by 216 publications

(300 citation statements)

References 25 publications

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“…Previous research indicates that knowledge of COVID-19 symptoms among the UK public is low, with only about half able to identify all three main symptoms (4,16). In our study, while recognition of symptoms was reasonably good, it was clear that recognition alone was not always sufficient to trigger a decision to seek a test.…”

Section: Discussionmentioning

confidence: 99%

Is my cough a cold or covid? A qualitative study of COVID-19 symptom recognition and attitudes towards testing in the UK

Mowbray

Woodland

Smith

et al. 2021

Preprint

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Objective Key to reducing the spread of COVID-19 in the UK is increased use of the NHS Test and Trace (NHSTT) system. This study explored one of the main issues that determine whether people engage with NHSTT, how people understand symptoms that may indicate the presence of COVID-19 and that should trigger a request for a test. Methods In this qualitative study, a series of semi-structured telephone interviews were conducted with 40 people (21 members of the general population, 19 students). There was nearly an equal split between male and female participants in both populations. Data were collected between 30 November and 11 December 2020 and explored using thematic analysis. There was substantial similarity in responses for both populations so we combined our results and highlighted where differences were present. Results Participants generally had good knowledge of the main symptoms of COVID-19 (high temperature, new, persistent cough, anosmia) but had low confidence in their ability to differentiate them from symptoms of other illnesses. Attribution of symptoms to COVID-19 was most likely where the symptoms were severe, many symptoms were present, symptoms had lasted for some time and when perceived risk of exposure to infection was high due to previous contact with others. Participants felt encouraged to engage in testing where symptoms were present and had persisted for several days, though many had concerns about the safety of testing centres and the accuracy of test results. Students had mixed feelings about mass asymptomatic testing, seeing it as a way to access a more normal student experience, but also a potential waste of resources. Conclusions This study offers novel insights into how people attribute symptoms to COVID-19 and barriers and facilitators to engaging with testing. Participants had positive views of testing, but there is a need to improve not just recognition of each main symptom, but also understanding that even single, mild symptoms may necessitate a test rather than a wait and see approach, and to address concerns around test accuracy to increase testing uptake.

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Section: Discussionmentioning

confidence: 99%

Is my cough a cold or covid? A qualitative study of COVID-19 symptom recognition and attitudes towards testing in the UK

Mowbray

Woodland

Smith

et al. 2021

Preprint

Self Cite

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“…Data from behavioural surveys in England show only 51% of participants knew the symptoms that testing is recommended for, only 18% sought testing if they had the symptoms and only 42.5% fully adhered to self-isolation. Engagement was lower in younger people and amongst those in financial hardship 12 . Engagement with population level asymptomatic testing using lateral flow testing has also been shown to be low, particularly in socioeconomically disadvantaged areas 13 .…”

Section: Discussionmentioning

confidence: 93%

Symptom profiles and accuracy of clinical definitions for COVID-19 in the community. Results of the Virus Watch community cohort

Fragaszy

Shrotri

Geismar

et al. 2021

Preprint

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Background: Understanding the symptomatology and accuracy of clinical case definitions for COVID-19 in the community is important for the initiation of Test, Trace and Isolate (TTI) and may, in future, be important for early prescription of antivirals. Methods: Virus Watch is a large community cohort with prospective daily recording of a wide range of symptoms and self-reporting of swab results (mainly undertaken through the UK TTI System). We compared frequency, severity, timing, and duration of symptoms in test positive and test negative cases. We compared the test performance of the current UK case definition used by TTI (any one of: new continuous cough, high temperature or loss of or change in sense of smell or taste) with a wider definition that also included muscle aches or chills or headache or loss of appetite. Findings: We included results from 8213 swabbed illnesses, 944 of which tested positive for COVID-19. All symptoms were more common in swab positive than swab negative illnesses and symptoms were also more severe and of longer duration. Common symptoms such as cough, headache, fatigue, muscle aches and loss of appetite occurred early in the course of illness but were also very common in test-negative illnesses. Rarer symptoms such as fever or loss or altered sense of smell or taste were often not present but were markedly more common in swab positive compared to swab negative cases. The current UK definition had a sensitivity and specificity of 81% and 47% respectively for symptomatic COVID-19 compared to 93% and 26% for the broader definition. On average cases met the broader case definition one day earlier than current definition. 1.7-fold more illnesses met the broader definition than the current case definition. Interpretation: COVID-19 is difficult to distinguish from other respiratory infections and common ailments on the basis of symptoms. Broadening the list of symptoms used to encourage engagement with TTI could moderately increase the number of infections identified and shorten delays but with a large increase in the number of tests needed and in the number of people and contacts who do not have COVID-19 but might need to self-isolate whilst awaiting results.

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“…March 18, 2020, in 24 Survey data from the United Kingdom found that non-adherence to public health guidelines for patients with COVID-19 was associated with factors including dependent children in the household, lower socioeconomic status, and being an essential worker. 25 Financial support, and wrap around services, are in particular associated with improved ability to self-isolate. 25,26 Figure 2 shows risk factors for influenza-like illness among a nationally representative sample of 2,042 adults from the United States during the H1N1 influenza pandemic in 2009.…”

Section: Evidence For the Effectiveness Of Paid Sick Leavementioning

confidence: 99%

“…25 Financial support, and wrap around services, are in particular associated with improved ability to self-isolate. 25,26 Figure 2 shows risk factors for influenza-like illness among a nationally representative sample of 2,042 adults from the United States during the H1N1 influenza pandemic in 2009. 27 Inability to work from home and absence of paid sick leave were associated with an approximately 50% increase in the risk of influenza-like illness.…”

Section: Evidence For the Effectiveness Of Paid Sick Leavementioning

confidence: 99%

Benefits of Paid Sick Leave During the COVID-19 Pandemic

Thompson¹,

Stall²,

Born³

et al. 2021

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Multiple jurisdictions have adopted or adapted paid sick leave policies to reduce the likelihood of employees infected with SARS-CoV-2 presenting to work, which can lead to the spread of infection in workplaces. During the COVID-19 pandemic, paid sick leave has been associated with an increased likelihood of workers staying at home when symptomatic. Paid sick leave can support essential workers in following public health measures. This includes paid time off for essential workers when they are sick, have been exposed, need to self-isolate, need time off to get tested, when it is their turn to get vaccinated, and when their workplace closes due to an outbreak. In the United States, the introduction of a temporary paid sick leave, resulted in an estimated 50% reduction in the number of COVID-19 cases per state per day. The existing Canada Recovery Sickness Benefit (CRSB) cannot financially protect essential workers in following all public health measures, places the administrative burden of applying for the benefit on essential workers, and neither provides sufficient, nor timely payments. Table 1 lists the characteristics of a model paid sick leave program as compared with the CRSB. Implementation of the model program should be done in a way that is easy to navigate and quick for employers.

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Adherence to the test, trace, and isolate system in the UK: results from 37 nationally representative surveys

Cited by 216 publications

References 25 publications

Is my cough a cold or covid? A qualitative study of COVID-19 symptom recognition and attitudes towards testing in the UK

Is my cough a cold or covid? A qualitative study of COVID-19 symptom recognition and attitudes towards testing in the UK

Symptom profiles and accuracy of clinical definitions for COVID-19 in the community. Results of the Virus Watch community cohort

Benefits of Paid Sick Leave During the COVID-19 Pandemic

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