Will a cough ever be 'just a cough' again?

A man coughing - Moyo Studio/ Getty
A man coughing - Moyo Studio/ Getty

In pre-pandemic times, you’d never have called the office and said: “Sorry, I’ve got a bad case of human rhinovirus A.” A cold was a cold, and you’d probably have gone into work coughing and spluttering. Now we have swung to the other extreme: not only would a tickle in the throat make us think twice about leaving the house, but we’re armchair experts on precisely what variant of the coronavirus we think has infected us.

Just this week, we learned of a new omicron strain; BA.2. Evidence so far is that it will continue to be a mostly mild illness in vaccinated people. While Covid has been a serious and, in many cases, fatal disease, the evidence shows it is no longer the threat it was: a patient infected with omicron is up to 70 per cent less likely to be admitted to hospital than a patient infected with delta, according to UK Health Security Agency analysis.

Despite these encouraging signs, many people remain obsessed with their viral status. Could it be true that the pandemic has made us so health conscious, we are verging on the hypochondriacal? Will a cough ever be “just a cough” again?

There may be some positives to our new hyper-awareness of any physical symptoms: a greater understanding among us all of how to stop illness of any kind spreading is one. We are less likely to stagger into work, breathing our germs over fellow commuters and colleagues. But has our self-monitoring gone too far?

Psychologists agree that many of us have become more focused on our own health and are worrying over the meaning of each cough or sniffle in case it turns out to be something with a scary scientific name. “We are sensitised to these symptoms and it causes us a shock of the stress hormone cortisol,” says clinical psychologist Linda Blair. “We’re overreacting and many people will then catastrophise.”

Perhaps this is to some degree down to our recent obsession with testing ourselves. Many a Christmas hinged on a single line on a lateral flow test, and we still aren’t out of the habit. But high absence rates in education and the workplace, and the low risk of severe illness for healthy, vaccinated children and workers, raises the question of how beneficial our current mass testing programme – the biggest in Europe – really is.

The UK has upped its capacity for delivery of lateral flow tests to seven million a day, while 100,000 more PCR booking slots per day have been made available since mid-December. But is all this preventing us from, rather than helping us to, get back to normal?

Chris Smith, a consultant virologist and lecturer at the University of Cambridge, argues it depends on the context. “There are circumstances where testing and self-isolation are very useful and some where it’s a blunderbuss approach,” he says.

“Testing has its place and is very useful in outbreak situations and healthcare management situations because you can then control who’s got what and where you put them. But at a population level, when you’re at a [point] where [infections] are either rare or trivial, then its utility is much less clear.”

We don’t screen for the common cold, for instance, since the cost of doing so would vastly outweigh the benefits. Covid, admittedly, isn’t quite the same: the UK reported a further 439 deaths only yesterday.

But it seems there are signs our focus on testing is ending and that we are already heading towards a mode of living with Covid that involves less self-monitoring: from February 11, double-jabbed travellers arriving in the UK will no longer have to do either a lateral flow or a PCR.

Still, if we stop testing ourselves, we won’t know whether we need to self-isolate or not. (The current self-isolation regulations run out on March 24 and are not expected to be renewed.) Does it matter if we don’t find out if we have Covid and don’t stay at home? It depends on what impact our failure to isolate would have, argues Dr Smith.

“It’s not a black and white thing,” he says. “One case in a care home could quite quickly turn into 20 cases and 20 deaths. One case in a classroom could turn into 20 cases with no consequences whatsoever.” In the end, says Dr Smith, it’s down to common sense. If you’re going to travel on public transport and sit in meetings with colleagues all day, it is probably better not to go in and spread your germs around, he suggests. Likewise if you’re going to meet vulnerable relatives.

Other experts remain adamant the only way to get back to normal is by suppressing Covid infections themselves, rather than suppressing the detection and reporting of them. “The virus multiplies when it infects somebody. To remove that multiplication you’ve got to test,” says Dr Bharat Pankhania, a senior clinical lecturer in medicine at the University of Exeter. “When you remove [it] little by little you eventually reach a state where humans are not found [by the virus]. Then you can stop testing. But right now we’re not in that place where we can say ‘actually we can stop testing’.”

As for whether scrapping testing will instantly allay our newfound health anxiety, Blair is doubtful. “Health anxiety is not logical,” she says. “[But] it will fade with time.”