Helen Macdonald: Covid-19—what is a new and continuous cough?

Helen Macdonald explores how guidance on the symptoms of covid-19 can be tricky to interpret and apply

Since 12 March 2020 Public Health England has recommended that people self-isolate if they have either a high temperature or a new continuous cough. Their guidance says that you can self diagnose your fever by how you feel or with a thermometer (>37.8). But a “new continuous cough” seems a bit trickier to define and identify. How new is new? And what is continuous? I suspect that different people would judge the same cough differently.

For example: does a continuous cough mean that you are coughing all of the time? Or that you consider it to be intrusive? Does it mean that you have prolonged episodes of coughing? Does it mean having any kind of cough which continues from one day to another—tickly, croupy, dry, or productive? Is it important how the cough relates to other symptoms? Is any cough with a cold a new, continuous cough? Even if you are just coughing nasal secretions? What if your cough is a recurrence of a usual cough that you get—for example, from seasonal tree pollen, or as part of asthma? 

Another tricky area is how this relates to young children. My WhatsApp lit up very quickly with friends and family questioning and discussing their coughing children; it seems like a permanent condition in young children through winter. It can be hard to pick where one cough stops and a new one starts. 

I don’t have answers. But some definition and perhaps examples of which new coughs are continuous might help people to isolate more confidently. It might also help them to feel more confident to explain why in their case isolation is not needed. 

This morning the situation for our family changed because my 5 year old is wheezy. It is likely that he has viral induced wheeze because his brother had a cold last week and it is much reduced by his salbutamol. This is a new cough. Whether it is continuous or not, I’m not sure. But it is noticeable, nocturnal, and I think would sound worrying to others if he was out and about. So today my family begins 14 days in isolation. 

My husband and I can divide the working day between us to each work a part of it and look after the children for a part of it. My work for The BMJ means that I can work remotely easily. My husband, however, is a GP partner and unless testing policies for healthcare workers are reconsidered, he will be unable to attend work for 14 days. If we were able to test our oldest child, the only one of us with a cough, then potentially my husband could be back at work within days.

Helen Macdonald is The BMJ‘s UK research editor. Twitter @drhelmac