{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T09:10:02Z","timestamp":1778749802197,"version":"3.51.4"},"update-to":[{"DOI":"10.12688\/wellcomeopenres.16304.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T00:00:00Z","timestamp":1611532800000}}],"reference-count":25,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T00:00:00Z","timestamp":1611532800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000265","name":"Medical Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000265","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000276","name":"Department of Health & Social Care","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000276","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000269","name":"Economic and Social Research Council","doi-asserted-by":"publisher","award":["ES\/P008321\/1"],"award-info":[{"award-number":["ES\/P008321\/1"]}],"id":[{"id":"10.13039\/501100000269","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000266","name":"Engineering and Physical Sciences Research Council","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000266","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001626","name":"Public Health Agency","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001626","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100014589","name":"Chief Scientist Office, Scottish Government Health and Social Care Directorate","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100014589","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100010756","name":"Health and Social Care Research and Development Division","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100010756","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100010269","name":"Wellcome Trust","doi-asserted-by":"crossref","award":["206602"],"award-info":[{"award-number":["206602"]}],"id":[{"id":"10.13039\/100010269","id-type":"DOI","asserted-by":"crossref"}]},{"name":"Health Data Research UK","award":["LOND1"],"award-info":[{"award-number":["LOND1"]}]}],"content-domain":{"domain":["wellcomeopenresearch.org"],"crossmark-restriction":false},"short-container-title":["Wellcome Open Res"],"abstract":"<ns4:p>\n                    <ns4:bold>Background:<\/ns4:bold>\n                    Diagnostic testing forms a major part of the UK\u2019s response to the current coronavirus disease 2019 (COVID-19) pandemic with tests offered to anyone with a continuous cough, high temperature or anosmia. Testing capacity must be sufficient during the winter respiratory season when levels of cough and fever are high due to non-COVID-19 causes. This study aims to make predictions about the contribution of baseline cough or fever to future testing demand in the UK.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Methods:<\/ns4:bold>\n                    In this analysis of the Bug Watch community cohort study, we estimated the incidence of cough or fever in England in 2018-2019. We then estimated the COVID-19 diagnostic testing rates required in the UK for baseline cough or fever cases for the period July 2020-June 2021. This was explored for different rates of the population requesting tests, four COVID-19 second wave scenarios and high and low baseline cough or fever incidence scenarios.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Results:<\/ns4:bold>\n                    Under the high baseline cough or fever scenario, incidence in the UK is expected to rise rapidly from 250,708 (95%CI 181,095 - 347,080) cases per day in September to a peak of 444,660 (95%CI 353,084 - 559,988) in December. If 80% of these cases request tests, testing demand would exceed 1.4 million tests per week for five consecutive months. Demand was significantly lower in the low cough or fever incidence scenario, with 129,115 (95%CI 111,596 - 151,679) tests per day in January 2021, compared to 340,921 (95%CI 276,039 - 424,491) tests per day in the higher incidence scenario.\n                  <\/ns4:p>\n                  <ns4:p>\n                    <ns4:bold>Conclusions:<\/ns4:bold>\n                    Our results show that national COVID-19 testing demand is highly dependent on background cough or fever incidence. This study highlights that the UK\u2019s response to the COVID-19 pandemic must ensure that a high proportion of people with symptoms request tests, and that testing capacity is sufficient to meet the high predicted demand.\n                  <\/ns4:p>","DOI":"10.12688\/wellcomeopenres.16304.2","type":"journal-article","created":{"date-parts":[[2021,1,25]],"date-time":"2021-01-25T03:25:06Z","timestamp":1611545106000},"page":"225","update-policy":"https:\/\/doi.org\/10.12688\/wellcomeopenres.crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of baseline cases of cough and fever on UK COVID-19 diagnostic testing rates: estimates from the Bug Watch community cohort study"],"prefix":"10.12688","volume":"5","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9847-8632","authenticated-orcid":false,"given":"Max T.","family":"Eyre","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9559-2867","authenticated-orcid":false,"given":"Rachel","family":"Burns","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0610-2318","authenticated-orcid":false,"given":"Victoria","family":"Kirkby","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3959-8479","authenticated-orcid":false,"given":"Catherine","family":"Smith","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9612-7791","authenticated-orcid":false,"given":"Spiros","family":"Denaxas","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3549-6232","authenticated-orcid":false,"given":"Andrew","family":"Hayward","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1713-2555","authenticated-orcid":false,"given":"Laura","family":"Shallcross","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0178-6098","authenticated-orcid":false,"given":"Ellen","family":"Fragaszy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0542-0816","authenticated-orcid":false,"given":"Robert W.","family":"Aldridge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2021,1,25]]},"reference":[{"key":"ref-1","article-title":"Check if you or your child has coronavirus (COVID-19) symptoms - NHS"},{"key":"ref-2","article-title":"Get a free NHS test today to check if you have coronavirus (COVID-19) - NHS"},{"key":"ref-3","article-title":"When to self-isolate and what to do - Coronavirus (COVID-19) - NHS"},{"key":"ref-4","article-title":"Guidance and standard operating procedure - COVID-19 virus testing in NHS laboratories (Version 1.0 VIRUS TESTING 16 March 2020)","year":"2020"},{"key":"ref-5","article-title":"Foreign Secretary\u2019s statement on coronavirus (COVID-19): 16 April 2020 - GOV.UK","year":"2020"},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"e1997","DOI":"10.1002\/rmv.1997","article-title":"Can we distinguish respiratory viral infections based on clinical features? A prospective pediatric cohort compared to systematic literature review.","volume":"28","author":"X Ma","year":"2018","journal-title":"Rev Med Virol."},{"key":"ref-7","doi-asserted-by":"publisher","first-page":"e028676","DOI":"10.1136\/bmjopen-2018-028676","article-title":"Symptom reporting, healthcare-seeking behaviour and antibiotic use for common infections: protocol for Bug Watch, a prospective community cohort study.","volume":"9","author":"C Smith","year":"2019","journal-title":"BMJ Open."},{"key":"ref-8","article-title":"Unpublished. Incidence, healthcare-seeking behaviours, antibiotic use and natural history of common infection syndromes in England: Results from the Bug Watch community cohort study","author":"C Smith"},{"key":"ref-9","article-title":"Impact of baseline cases of cough and fever on UK COVID-19 diagnostic testing rates: estimates from the Bug Watch community cohort study - Supplementary material, code and data","author":"M Eyre","year":"2020"},{"key":"ref-10","article-title":"Surveillance of influenza and other respiratory viruses in the UK Winter 2018 to 2019","year":"2019"},{"key":"ref-11","article-title":"Population estimates for the UK, England and Wales, Scotland and Northern Ireland"},{"key":"ref-12","article-title":"Package \u2018survey\u2019: Analysis of Complex Survey Sample","author":"T Lumley","year":"2019"},{"key":"ref-13","article-title":"Coronavirus cases in the UK: daily updated statistics - GOV.UK","year":"2020"},{"key":"ref-14","first-page":"79","article-title":"Preparing for a 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COVID19","year":"2020"},{"key":"ref-21","doi-asserted-by":"publisher","first-page":"e21-e29","DOI":"10.1016\/S2468-2667(20)30269-3","article-title":"Detecting COVID-19 infection hotspots in England using large-scale self-reported data from a mobile application: a prospective, observational study.","volume":"6","author":"T Varsavsky","year":"2020","journal-title":"Lancet Public Health."},{"key":"ref-22","doi-asserted-by":"publisher","first-page":"1305-1309","DOI":"10.15585\/mmwr.mm6937a6","article-title":"Decreased Influenza Activity During the COVID-19 Pandemic \u2014 United States, Australia, Chile, and South Africa, 2020.","volume":"69","author":"S Olsen","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep."},{"key":"ref-23","article-title":"Surveillance of influenza and other respiratory viruses in the United Kingdom: Winter 2019 to 2020","year":"2020"},{"key":"ref-24","doi-asserted-by":"publisher","first-page":"2000632","DOI":"10.2807\/1560-7917.ES.2020.25.18.2000632","article-title":"Estimating number of cases and spread of coronavirus disease (COVID-19) using critical care admissions, United Kingdom, February to March 2020.","volume":"25","author":"M Jit","year":"2020","journal-title":"Euro Surveill."},{"key":"ref-25","first-page":"69","article-title":"Beyond the data: Understanding the impact of COVID-19 on BAME groups About Public Health England","year":"2020"}],"container-title":["Wellcome Open Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/5-225\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/5-225\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/5-225\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,2,17]],"date-time":"2021-02-17T10:38:24Z","timestamp":1613558304000},"score":1,"resource":{"primary":{"URL":"https:\/\/wellcomeopenresearch.org\/articles\/5-225\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,25]]},"references-count":25,"URL":"https:\/\/doi.org\/10.12688\/wellcomeopenres.16304.2","relation":{"has-review":[{"id-type":"doi","id":"10.21956\/wellcomeopenres.18263.r42288","asserted-by":"subject"},{"id-type":"doi","id":"10.21956\/wellcomeopenres.18263.r42288","asserted-by":"object"}],"has-preprint":[{"id-type":"doi","id":"10.1101\/2020.09.03.20187377","asserted-by":"object"}]},"ISSN":["2398-502X"],"issn-type":[{"value":"2398-502X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,25]]},"assertion":[{"value":"Indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/5-225\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.21956\/wellcomeopenres.18263.r42288, Cheryl Cohen, Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases of the National Health Laboratory Service, Johannesburg, South Africa, 17 Feb 2021, version 2, indexed","URL":"https:\/\/wellcomeopenresearch.org\/articles\/5-225\/v2#referee-response-42288","order":0,"name":"referee-response-42288","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.21956\/wellcomeopenres.17916.r40603, Angela Raffle, Consultant in Public Health, The NHS Screening Programmes, University of Bristol Medical School Population Health Sciences, Bristol, UK, 19 Oct 2020, version 1, 1 approved, 1 approved with reservations","URL":"https:\/\/wellcomeopenresearch.org\/articles\/5-225\/v1#referee-response-40603","order":1,"name":"referee-response-40603","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Max Eure<\/b>; \n<i>Posted: 15 Jan 2021<\/i>; Many thanks for the time you have spent reviewing our paper and your very helpful and constructive comments on the paper. We have tried to address all of the points you have raised and to update the paper as much as is reasonably possible within the rapidly changing context. There is now an additional analysis which explores a lower (73% lower) cough or fever incidence scenario based on preliminary estimates from the Virus Watch cohort study we are running at UCL. We provide numbered point by point responses to your comments below.  \n<b>Reviewer comment 1:&nbsp;<\/b> Abstract - If possible within the word count, it would be good to include that the pillars 1 plus 2 capacity estimate being used is 1.4 million tests\/week.&nbsp;  \n<b>Author response 1:&nbsp;<\/b> This has been added. We have also made clear that this was the capacity in August 2020. \n<b>&nbsp;<\/b> \n<b>Reviewer comment 2:&nbsp;<\/b> Introduction - \u2018The NHS Test and Trace service will trace and notify close recent contacts of anyone who tests positive for coronavirus to self-isolate for 14 days.\u2019 It would be more correct to say that they \u2018aim to\u2019 rather than they \u2018will\u2019. Also, adding the words \u2018instructing them\u2019 to self-isolate would be less cryptic. Last paragraph, would it not be more correct to say \u2018Bug Watch allows us to estimate\u2019&nbsp; (rather than quantify), as said later. The sample was 873 participants, with potential for selection bias, so extrapolating to the entire population and to different years gives only an estimate.  \n<b>Author response 2:&nbsp;<\/b> Thank you for these suggestions, we have added both of these corrections into the introduction.  \n<b>Reviewer comment 3:&nbsp;<\/b> Methods - There should be mention in the methods or results sections of whether, and potentially how, selection bias may have skewed the measured incidence rates in Big Watch. This is touched on in the discussion, but it would be better to state it earlier in the paper.  \n<b>Author response 3:&nbsp;<\/b> Thank you for this comment, we have highlighted the potential for selection bias and commented on its potential skew in the methods section. \n<b>&nbsp;<\/b> \n<b>Reviewer comment 4:&nbsp;<\/b> Methods - Baseline incidence of cough or fever in England -&nbsp; I found this paragraph hard to follow. I could not quite grasp how the term \u2018follow-up\u2019 was being used. Is this about excluding days from the denominator?  \n<b>Author response 4:&nbsp;<\/b> It should hopefully be clearer now that we excluded the first ten days for all participants after they entered the study - \u201cThe first ten days of follow-up after each participant was recruited into the study were excluded to remove prevalent infection syndromes.\u201d \n<b>&nbsp;<\/b> \n<b>Reviewer comment 5:&nbsp;<\/b> Methods - Also, was cough or fever defined as any mention of these symptoms i.e. one day of reporting only? This needs to be specified in the methods section because this could be quite a \u2018low bar\u2019 for defining cough or fever. There is mention in the discussion, but I found it a bit ambiguous \u2013 was the \u2018continuous\u2019 cough definition used? This needs to be clear in the methods section.  \n<b>Author response 5:&nbsp;<\/b> Thank you for pointing this out - we have clarified that a single day of reporting the symptom counts as a case of cough or fever. The symptom definition used for cough is described in the first paragraph of the methods section.  \n<b>Reviewer comment 6:&nbsp;<\/b> Methods - Also, mention of whether 2018\/19 a high, low, or medium year for respiratory illnesses in general, would be helpful.  \n<b>Author response 6:&nbsp;<\/b> Thank you for this helpful suggestion. Please see the sentence we have added in the methods section: \u201cPublic Health England reported that there were \u201clow to moderate levels of influenza activity\u201d in the 2018-2019 influenza season, which was comparable to the 2017-2018 season and higher than all other seasons since 2010-2011\u201d.  \n<b>Reviewer comment 7:&nbsp;<\/b> Methods - Is it possible to use general practice morbidity data to add further insight into the relationship between the incidence of new cough or fever from the Bug Watch study, compared with GP consultation rates? This could give some insight into whether the 40, 60, or 80 percent seeking testing is most likely to be accurate. This is not an essential change, but would be a 'nice to have'.  \n<b>Author response 7:&nbsp;<\/b> We have added a new reference in the discussion section which estimates&nbsp; \u201cthat only about 40% of those who report classic COVID-19 symptoms go on to receive a test\u201d. We then comment on the implications of this on COVID-19 control and our results, and stress the importance of future studies looking at test-seeking behaviour and comment on how they can be structured.  \n<b>Reviewer comment 8:&nbsp;<\/b> Discussion - At one point the term \u2018antigen\u2019 testing is used \u2013 does this mean PCR testing for viral RNA? It is potentially confusing to refer to this as antigen testing.&nbsp;  \n<b>Author response 8:&nbsp;<\/b> This has been corrected. \n<b>&nbsp;<\/b> \n<b>Reviewer comment 9:&nbsp;<\/b> Discussion - The discussion only considers the need for greater testing capacity. It would be worth also mentioning the need to use tests to best effect. For example, as data develops on the predictive value of certain symptoms for ruling in and ruling out SARS-CoV-2 there may be scope for refining who should be offered a test e.g. cough with phlegm was presumably included in Bug Watch but is a dry cough more indicative of SARS-C0V-2? Also the timing of the test matters \u2013 if there is a delay in seeking a test then the result would not shorten the isolation period and it is too late to effectively act on all the contacts etc. Also, there has been considerable criticism of Test and Trace, so perhaps a phrase emphasising that a test alone is pointless. Testing must form part of a well-coordinated system that reliably leads to effective contact tracing, to prompt local action for dealing with clusters, and to support for those who are needing to self-isolate.&nbsp;&nbsp;  \n<b>Author response 9:&nbsp;<\/b> We have addressed this important point by inserting some additional text in the discussion which highlights that testing is only useful when accompanied by an effective contact tracing and a system which supports people to self-isolate.","URL":"https:\/\/wellcomeopenresearch.org\/articles\/5-225\/v2#referee-comment-4485","order":2,"name":"referee-comment-4485","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"This study was supported by the Wellcome Trust through funding to Health Data Research UK and a Wellcome Trust Clinical Research Career Development Fellowship to RWA [206602].\n\nThe work was supported by Health Data Research UK [LOND1], which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation and Wellcome Trust. This work is also supported by the Economic and Social Research Council [ES\/P008321\/1], as part of the Preserving Antibiotics through Safe Stewardship (PASS) project. MTE is supported by an MRC studentship. SD is supported by an Alan Turing Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.","order":3,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}