COVID causes more than just three symptoms, more research has shown.
A study of more than one million people in England has revealed it's not just a cough, fever, and loss of taste or smell that people should watch out for.
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Chills, loss of appetite, headache and muscle aches were together most strongly linked with being infected.
Having any of these other symptoms alone was associated with Covid, or in combination with the classic signs.
The more symptoms people showed the more likely they were to test positive.
The findings come from swab tests and questionnaires collected between June 2020 and January 2021 as part of the Imperial College London-led REACT study.
People in England are currently encouraged to take a Covid-19 test if they have at least one of the classic symptoms.
The researchers said based on their findings, current testing would pick up around half of all symptomatic Covid cases if everyone eligible were tested.
But this would rise to three-quarters of symptomatic cases if testing eligibility expanded to those with symptoms such as chills.
Professor Paul Elliott, director of the REACT programme at Imperial, said: “These new findings suggest many people with Covid-19 won't be getting tested – and therefore won't be self-isolating – because their symptoms don’t match those used in current public health guidance to help identify infected people.
"We understand that there is a need for clear testing criteria, and that including lots of symptoms which are commonly found in other illnesses like seasonal flu could risk people self-isolating unnecessarily.
"I hope that our findings on the most informative symptoms mean that the testing programme can take advantage of the most up-to-date evidence, helping to identify more infected people.”
The found symptoms of Covid varied with age.
Chills were found in people of all ages. But headaches were most common in children and teenagers.
Those ages five to 17 years old were also less likely to report fever, persistent cough and appetite loss compared with adults.
Appetite loss was more common in adults of all ages, while muscle aches were found in those aged 18-54.
Those ages five to 17 years old were also less likely to report fever, persistent cough and appetite loss compared with adults.
The research also found the new UK strain of coronavirus, which first emerged in Kent, has a slightly different set of symptoms.
Scientists worked this out by comparing symptoms reported in January – when the variant become dominant – with those reported in November and December.
Loss of smell was not as common in January compared to the end of 2020, but a cough was more frequently reported.
The findings are in line with the Office for National Statistics, which found a cough was found in 35 per cent of people who tested positive for the Kent strain, compared to 28 per cent in people with the original strain.
A loss of taste or a loss of smell was reported by only 15 per cent of Kent Covid cases each, compared to 19 per cent of original cases.
Dr Joshua Elliott, from Imperial College London’s School of Public Health, said: “As the epidemic progresses and new variants emerge, it’s essential that we keep monitoring how the virus affects people so that testing programmes meet changing needs.
"We hope that our data will help inform testing guidance and the development of systems which could help better identify people who should take a Covid-19 test based on their symptoms.”
British doctors have long called for the official set of coronavirus symptoms to be made longer so that cases are not missed.
The Chief Medical Officer sets the official advice on symptoms, reflected on the NHS website. For England, this is Professor Chris Whitty.
The Department of Health and Social Care says it has acknowledged that Covid causes a long list of symptoms.
But it chooses to list the main three in order to strike a balance and "capture those most likely to have Covid-19, while not capturing a great number of people who do not".
Writing to the Chief Medical Officer in the British Medical Journal in January, doctors pleaded for a runny nose, sore throat, hoarseness, muscle pain, fatigue and headache to be added to the NHS list.
Dr Alex Sohal, a lecturer in primary care at Queen Mary University of London, wrote the letter with the backing of 140 east London GPs and medics.
She said: “These patients have frequently not even considered that they may have Covid-19 and have not self-isolated in the crucial early days when they were most infectious.
“It is vital to now change the UK covid-19 case definition and test criteria to include coryza and cold, making them consistent with WHO [The World Health Organization]."
The World Health Organization’s definition of Covid includes a runny nose, sore throat, vomiting, and diarrhoea.
The Centres for Disease Control and Prevention (CDC), America’s health agency, also lists these symptoms, as well as officials in Australia and Canada.
Research by the ZOE Covid Symptom Study, led by King's College London, has found the most frequent symptoms for adults are fatigue (87 per cent), headache (72 per cent), loss of smell (60 per cent), persistent cough (54 per cent) and a sore throat (49 per cent).
Coronavirus is still circulating at high levels across the country at a time when people are also catching a cold and flu.
Symptoms of a common cold include sneezing, running nose and a sore throat – the first two are less common with Covid.
A cold doesn't usually cause a high temperature – which is one of the NHS's key Covid symptoms to look out for.
For many people having the flu will feel like an exaggerated cold.
But some of the symptoms – a high temperature, an aching body and fatigue – are similar to the coronavirus.
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