WITH the two metre social distancing rule set to be cut as lockdown measures are relaxed, a Bolton GP is urging people to 'ramp up hygiene' more than ever ­ —and explains why, in some cases, people who test negative for coronavirus should still self-isolate.

The Bolton News:

Family doctor Jane Wilcock, who lives in Harwood, said: "As lockdown eases, we will be in more contact with people, their droplets and possible contaminated surfaces.

"Coronavirus has not died out, it is waiting for human hosts so antigen testing is an important part of covid-19 detection and control.

"In addition, please continue to ramp up hygiene and keep physical distancing. Use a face covering if you are unable to keep a physical distance indoors. This could be a homemade or bought mask or a face visor. Keep your car and your home sanitised so that you and your loved ones keep safe whilst work continues to develop a vaccine and therapy."

The Bolton News:

Dr Wilcock, whose surgery is in Salford, said that large numbers of people have been now been tested for coronavirus, anyone over five-years-old with suspected coronavirus can book for what is known as an ‘antigen’ test.

"This allows us to understand how much coronavirus is in circulation and as lock down opens up, will allow public health to shut down local outbreaks more quickly.

"There are developments to have easy at home antigen testing in the future, but Public Health England does not yet recommend bought tests, due to concerns about test accuracy," said Dr Wilcock.

But the doctor urged people to apply the "duck test" if the test result comes back negative, as she said, estimates show 70 per cent of results are accurate.

The Bolton News:

She explained: "Are the symptoms likely to be due to COVID-19 regardless of test results?

"This is ‘pre-test probability’. So, if it looks and quacks like a duck, and ducks are common in the area, it probably is a duck.

"In the same way during lockdown anyone presenting with flu-like illness, or high temperature, or new cough, reduced or lack of smell or taste as described in my article in The Bolton News on 30th March, and particularly with a cluster of these symptoms is very likely to have COVID-19.

"This clinical judgement depends how common COVID-19 is in the population and how uncommon alternative diagnoses are.

"Whilst schools, many works and shops have been shut, the likelihood of someone getting influenza has dropped so a new flu-like illness is much more likely to be due to COVID-19 at present.

"This will change as lockdown opens up and people mix more. Hopefully, our continuing hygiene and physical distancing measures will prevent a second peak.

"Are people who definitely have COVID-19 getting a positive test 100 per cent of the time? Are any people with COVID-19 testing negative — false negatives — and so possibly not isolating, as the test has falsely reassured them?

"This is called test ‘sensitivity’. If a test has 100 per cent sensitivity it means everyone with COVID-19 is testing positive, we are not missing any cases. However, estimates of antigen test sensitivity vary, but are usually quoted at about 70 per cent. Therefore, in 70 per cent of cases people with mild or more severe symptoms, who test positive will have a true positive test.

"However, the test may be falsely negative because the sample has been poorly taken, timing of the sample in the illness, transport and lab handling of samples, viral shedding rates of people, type of test etc.

"This means that up to 30 per cent of people withCOVID-19 may test antigen negative on one test.

"If antigen tested negative but someone thinks their pre-test probability of COVID-19 is high, he/she may want to discuss this with their GP or isolate anyway for seven days and quarantine the household for 14 days.

"This would prevent unnecessary transmission of whatever infection they had, possibly COVID-19 if they are a false negative case. To go back to the duck analogy, if it looks and quacks like a duck but tests negative, it still may be a duck."

Those with symptoms should be tested in the first five days of possible COVID-19, and better still in the first three days, so that viral shedding is highest. They can have a drive through or home test. Testing is using a cotton bud to swab the back of the throat and the nostrils. People wanting to book an antigen test can do so online through the NHS website. The website is: www.nhs.uk/conditions/coronavirus-covid-19/testing-for-coronavirus/ask-for-a-test-to-check-if-you-have-coronavirus/ or locally through: https://www.bolton.gov.uk/council/coronavirus-covid-19-testing/1