Impact of baseline cases of cough and fever on UK COVID-19 diagnostic testing rates: estimates from the Bug Watch community cohort study [version 1; peer review: 1 approved, 1 approved with reservations]

Max T. Eyre*, Rachel Burns, Victoria Kirkby, Catherine Smith, Spiros Denaxas, Vincent Nguyen, Andrew Hayward, Laura Shallcross, Ellen Fragaszy, Robert W. Aldridge

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: Diagnostic testing forms a major part of the UK’s 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. Methods: In this analysis of the Bug Watch prospective 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 and four COVID-19 second wave scenarios. Estimates were then compared to current national capacity. Results: The baseline incidence of cough or fever in the UK is expected to rise rapidly from 154,554 (95%CI 103,083 - 231,725) cases per day in August 2020 to 250,708 (95%CI 181,095 - 347,080) in September, peaking at 444,660 (95%CI 353,084 - 559,988) in December. If 80% of baseline cough or fever cases request tests, average daily UK testing demand would exceed current capacity for five consecutive months (October 2020 to February 2021), with a peak demand of 147,240 (95%CI 73,978 - 239,502) tests per day above capacity in December 2020. Conclusions: Our results show that current national COVID-19 testing capacity is likely to be exceeded by demand due to baseline cough and fever alone. This study highlights that the UK’s response to the COVID-19 pandemic must ensure that a high proportion of people with symptoms request tests, and that testing capacity is immediately scaled up to meet this high predicted demand

Original languageEnglish
Pages (from-to)1-20
Number of pages20
JournalWellcome Open Research
Publication statusPublished - 2020
Externally publishedYes

Bibliographical note

Funding Information:
Grant information: 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]. The 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.

Publisher Copyright:
© 2020. Eyre MT et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited


  • cough
  • COVID-19
  • diagnostic testing capacity
  • fever
  • swab test
  • United Kingdom


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