UK government advice for coronavirus self-isolation at odds with WHO and latest evidence

The UK government’s advice on ending self-isolation after displaying signs of coronavirus (Covid-19) symptoms is at variance not only with that recommended by the World Health Organisation (WHO) but also with the latest clinical evidence.

UK government guidance

The UK government recommends that a person who appears to have become infected with Covid-19 can end their period of self-isolation seven days from commencement of symptoms.

The guidance says:

if you live alone and you have symptoms of coronavirus illness (COVID-19), however mild, stay at home for 7 days from when your symptoms started.

It adds:

if living with others, then all household members who remain well may end household-isolation after 14 days. The 14-day period starts from the day illness began in the first person to become ill. Fourteen days is the incubation period for coronavirus; people who remain well after 14 days are unlikely to be infectious.

After 7 days, if the first person to become ill feels better and no longer has a high temperature, they can return to their normal routine. If any other family members become unwell during the 14-day household-isolation period, they should follow the same advice – that is, after 7 days of their symptoms starting, if they feel better and no longer have a high temperature, they can also return to their normal routine.

WHO recommendations

But the recommendations from the WHO are that a person who displays Covid-19 symptoms should continue to remain self-isolated for two weeks after the end of those symptoms.

WHO director general Dr Tedros Adhanom Ghebreyesus said (emphasis added):

People infected with Covid-19 can still infect others after they stop feeling sick, so these measures should continue for at least two weeks after symptoms disappear. Visitors should not be allowed until the end of this period.

Latest evidence

And the UK government guidelines are also at odds with the latest clinical evidence.

Researchers in China undertook a retrospective clinical study of a small cohort of patients who had contracted the virus. Patients were treated with alpha-interferon and other antiviral drugs.

The researcher found that half of the patients treated for just mild Covid-19 infection were still infected for up to eight days after symptoms disappeared.

In a summary of the study, Science Daily stated:

The time from infection to onset of symptoms (incubation period) was five days among all but one patient. The average duration of symptoms was eight days, while the length of time patients remained contagious after the end of their symptoms ranged from one to eight days.

This backs up the more conservative approach adopted by WHO.

Testing vital

These variations further highlight the need for antigen (or antibody) testing as soon as possible. Such tests, says the New Scientist:

detect the antibodies our bodies produce to kill the virus, which we keep producing even after the virus is eliminated. These tests can reveal who has been infected even after they have recovered. Handheld tests that require only a drop of blood can give results in 10 minutes, and can be mass produced quickly and cheaply.

whether large numbers of mild infections have gone unnoticed. It would be great news if this is the case, allowing many to return to work and meaning that the infection fatality rate is lower than thought.