Covid online symptom checker 'may delay treatment'

The NHS Covid symptom checker has been criticised by a study which found it may not pick up some people who are seriously ill.

By being told to stay at home rather than consult a doctor, they may not receive treatment quickly enough.

NHS Digital says the 111 online service, used more than 3.9 million times in the past year, is not a diagnostic tool.

The symptom checker has been constantly revised and updated, it adds.

The NHS 111 online Covid symptom checker asks a series of set questions about symptoms in order to offer people advice on their condition and what to do next.

The study, in BMJ Health and Care Informatics, used 50 simulated cases to compare online checkers used during the pandemic from four countries - UK, US, Japan and Singapore.

It found the symptom checkers used by the UK and US were half as likely to advise people to consult a doctor as the systems used in Japan and Singapore.

Japan and Singapore also had the lowest case fatality rates of the four nations.

Despite improvements in the safety of the NHS 111 symptom checker since the research was carried out in April, the researchers said they still have "ongoing concerns".

Dr Daniel Goyal, from the University of Gibraltar who was lead author of the study, said these related to "trying to qualify the severity of illness using a patient-led system".

"There have been improvements with NHS 111 online over the course of the year," he said.

"But I do not think it would consistently pick up silent hypoxia and could not replace clinical contact."

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Silent hypoxia occurs when oxygen levels in the blood drop to dangerously low levels without the patient noticing, a feature of Covid-19.

As a result, patients can arrive at hospital dangerously ill, and sometimes too late to be treated effectively.

The scenarios tested on the online symptom checker included someone with:

• a cough and fever

• shortness of breath and fever

• an underlying condition, cough and fever

Their age, how severe the symptoms were and how long they lasted were then varied.

NHS Digital says people with Covid symptoms and underlying conditions are referred for further clinical assessment, and are not advised to self-care.

Anyone with breathlessness as a main symptom, with or without symptoms of coronavirus, will be referred for a further clinical assessment by a GP or other primary care clinician, it adds.

And it always advises people to call 111 for further help if they experience worsening symptoms or anything changes.

Dr Goyal said, ideally, everyone aged over 60 with Covid should be seen by a doctor because online symptom checkers cannot predict who will become seriously ill and Covid infections can mimic other common conditions.

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Online symptom checkers have been used in many countries during the pandemic to help identify people with coronavirus infections and those needing medical care.

NHS Digital, which runs the service, said NHS 111 online allows people to assess their symptoms and signposts to other NHS services as required.

"Over the past year it has been continually revised and updated in response to new scientific information, government guidance and public health strategies."

Since March 2020, there have been more 3.9 million online assessments for coronavirus (COVID-19) and around 1.5 million via the phone services NHS 111 or 999.

The researchers say their findings support the idea that symptom checkers should go through the same level of quality assurance as diagnostic tests before being rolled out.