Concerns are being raised that people isolating at home with worsening Covid-19 symptoms may not call for medical help early enough when they enter the second, more severe, phase of the virus, possibly reducing their chances of survival. The NHS does not have a proper monitoring system for those suspected of having coronavirus, said Dr Bharat Pankhania, a senior clinical lecturer at the University of Exeter medical school. “If a patient is developing pneumonia, it can get progressively worse very quickly and hence early admission upon the first signs of difficulty with breathing are very important,” he said. “It is important for people recovering at home that there be a monitoring system in place too. Something that we have thus far not introduced.” There is a danger that people will arrive in hospital only when their symptoms are very severe, with more of a risk that they will end up in critical care and possibly die, he said. The early symptoms of mild disease are a persistent dry cough, a raised temperature and shortness of breath. The advice to anyone with those symptoms is to self-isolate at home. They are not told to inform the health service. Most people recover within a week, but if their symptoms worsen or they still have a high temperature at the end of that time, the instruction is to fill in a form on the NHS 111 coronavirus website if they can – and to call NHS 111 only if they cannot do that. Depending on their answers, they may get a visit from a doctor or be admitted to hospital. Covid-19 is said to be mild to moderate in 80% of people, but can cause viral pneumonia. In the most serious cases, the immune system fighting the virus overreacts. If that happens, what is known as a cytokine storm attacks their organs. The individual will need ventilation in hospital to take over their breathing and possibly mechanical support for their heart, liver or kidneys. People with symptoms at home will not get medical help unless they ask for it, unlike in some other countries, which have testing for people with symptoms and monitoring for them while at home. Health authorities in the southern German city of Heidelberg have introduced a “corona taxi” service, which allows medical personnel to visit patients with the virus at home and assess their progress. This was introduced after virologists and other doctors recognised that it often comes in two waves and that typically on the eighth day, patients’ health can take a turn for the worse. Patients with confirmed infections or suspected to have coronavirus are being called on a regular basis by student doctors manning phone lines, and based on their accounts, a taxi crew can then arrange to visit them. Four of the taxis – small buses usually used for school runs – are constantly travelling around the city visiting patients. “These daily phone calls and house visits would totally overwhelm the doctors here,” said Uta Merle, a medical director for gastroenterology and infections at Heidelberg University hospital, which is why medical students are being drafted in. Eight hundred have so far volunteered. Hans-Georg Kräusslich, the head of virology at the hospital, told Frankfurter Allgemeine Zeitung the visits are necessary because “often patients don’t have the courage to ring up the clinic and don’t actually take their worsening state seriously”. Thanks to the taxis, he said, “our colleagues have discovered quite a few patients who they were able to protect from a drastic worsening of their conditions”. Many have been brought into hospital and put on ventilators as a result. That crucial move made just in time is believed to have saved many lives in Germany. The taxi crews have received letters of thanks from patients, crediting them with saving their lives. Pankhania said people in the UK are no longer going to hospital for conditions other than Covid-19 in the sort of numbers that would be expected. “For whatever reason, we have frightened off the patient. Those things we should be seeing are not turning up. These people are soldiering on,” he said. He has himself heard of cases where people were very sick with symptoms resembling those of Covid-19, but did not seek medical help and died at home. He said it was possible that some people were put off from calling NHS 111 when their symptoms worsened or if they still had a fever after a week – which are the first clues that their condition may be becoming severe. He also does not think it is satisfactory for people with symptoms not to be tested. “I don’t think that is good enough,” he said. “I used to be a GP. I would want to know who my patients with Covid-19 were. I would call them and ask them how they were. Unfortunately, that doesn’t happen. The GP may or may not be aware of the patient.” The Office for National Statistics has recently begun to include deaths from Covid-19 in the community, including care homes. They show the total was more than 20% higher than the figure for hospital deaths alone.