When should I do a Covid test in England and do I still have to isolate if positive?

The official list of Covid-19 symptoms on the NHS has been extended to cover nine new symptoms, including sore throat, fatigue and headache and comes days after the provision of free testing kits for the public came to an end in England. The latest moves, combined with the lack of rules on masks and vague guidance on self-isolating, has left some wondering how to navigate the latest wave of infections.

What are the symptoms?

The government has updated its official list of Covid-19 symptoms on the NHS to include nine new symptoms, that join the previous three of a fever, a new and persistent cough, and a loss or change in taste or smell, according to nhs.uk.

Extending the list may help reduce infections by helping people detect whether they may have Covid; however, it coincides with the end of the offer of free universal Covid-19 tests in England to help people confirm whether they have the virus.

The new signs are:

A note on the website states: “The symptoms are very similar to symptoms of other illnesses, such as colds and flu.”

The latest data from the Zoe app suggests the most common current symptom for those with Covid is a runny nose (reported by eight out of 10 people), followed by fatigue, a sore throat, headache and sneezing. Far fewer people are reporting an altered sense of taste or smell in the latest wave.

When should I do a test – if at all?

The official end of free testing kits (although they have been hard to come by for some time) means people who are not shielding have to pay about £2 a test from a chemist or supermarket. There is no legal requirement to test, but given that Covid symptoms overlap with seasonal respiratory infections and hay fever, without testing there is no clear way to know if you’re infected.

Paul Hunter, a professor of medicine at the University of East Anglia, suggests taking a test, if possible, if you have symptoms. “I’d partly do this because once I’ve had it, I’ll be more comfortable about my risk going forward,” he said.

While for most individuals Covid is now less of a risk than seasonal flu, this is not the case for everybody – older people and those who are immunocompromised remain at particular risk. This is especially the case for those who had their last vaccine dose six months ago and are now due a booster. So testing before meeting indoors with people who may be at greater risk is worth considering – especially until the next rollout of booster doses.

For children, the advice is that testing is not recommended unless you are directed to do so by a health professional.

When should I wear a mask?

Masks are no longer mandatory, but there is evidence that they reduce transmission in crowded indoor spaces and when in prolonged proximity to others, such as on public transport. The extra layer of protection also means that if you are exposed to Covid, you are likely to receive a lower dose of the virus, which could reduce the severity of symptoms you experience if infected. “The evidence for this isn’t cast-iron, but it’s likely to be the case,” said Hunter.

For many, there is also an element of etiquette. “If I go into a shop and it’s crowded I’ll put on a face covering,” said Hunter. “If it’s not really crowded but lots of other people are wearing masks, I’ll still put one on as a courtesy. I don’t want to make people feel uncomfortable and there will be people who will feel they have to carry on wearing masks to be safer.”

What should I do if I have symptoms?

There is no longer a legal requirement for people to test or self-isolate, but if you have any of the main symptoms or a positive test result, the public health advice is to stay at home, avoid contact with other people and to try to work from home. For children, the advice is that those with mild symptoms (runny nose, slight cough) can continue to attend school, but those who have a temperature or are feeling unwell should stay at home until they feel better.

Do I need to self-isolate and, if so, how long for?

The requirement to self-isolate for five full days (which was previously 10 days) has been replaced with advice to avoid others “until you no longer have a high temperature (if you had one) or until you no longer feel unwell”.

Hunter says this is broadly sensible since people tend to be at their most infectious in the early stage of infection and while symptomatic. “I’d isolate as long as I was quite ill,” he said. “If I wasn’t that ill, I’d expect three to five days or until I was well on the way to getting over it before I’d go back into society.”

However, the advice becomes a bit stricter for those who actually confirm infection with a test. In this case the guidance is to try to stay at home and avoid contact with other people for five days after the day you took your test, or three days for children.

“It’s worth remembering that we’re only picking up about one in eight infections through testing,” Hunter adds. “Whatever I do, there are seven other people wandering around with no clue that they’ve got Covid so even isolating everybody who knows they are positive isn’t going to make a massive difference.”

Those who want to really minimise their risk of infecting others could stick with the previous guidance of ending isolation on the back of two consecutive negative tests starting from day five and six. After day 10, it is possible that lateral flow tests will continue to show a positive result, but the chances of still being infectious are extremely low.