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Cited by 305SARS-CoV-2 and COVID-19 ResearchCOVID-19 epidemiological studiesCOVID-19 Clinical Research Studies

The DOI matches its Crossref record; 24 of the 25 references it cites were found in a registry or an index, and 1 are not checked yet; none of the 18 sources its claims cite is checked for support yet.

Changes in symptomatology, reinfection, and transmissibility associated with the SARS-CoV-2 variant B.1.1.7: an ecological study

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Graham, Mark S, Sudre, Carole H, May, Anna, Antonelli, Michela, Murray, Benjamin, Varsavsky, Thomas, Kläser, Kerstin, Canas, Liane S, Molteni, Erika, Modat, Marc, Drew, David A, Nguyen, Long H, Polidori, Lorenzo, Selvachandran, Somesh, Hu, Christina, Capdevila, Joan, Koshy, Cherian, Ash, Amy, Wise, Emma, Moore, Nathan, Mori, Matilde, Cortes, Nick, Lynch, Jessica, Kidd, Stephen, Fairley, Derek J, Curran, Tanya, McKenna, James P, Adams, Helen, Fraser, Christophe, Golubchik, Tanya, Bonsall, David, Hassan-Ibrahim, Mohammed O, Malone, Cassandra S, Cogger, Benjamin J, Wantoch, Michelle, Reynolds, Nicola, Warne, Ben, Maksimovic, Joshua, Spellman, Karla, McCluggage, Kathryn, John, Michaela, Beer, Robert, Afifi, Safiah, Morgan, Sian, Marchbank, Angela, Price, Anna, Kitchen, Christine, Gulliver, Huw, Merrick, Ian, Southgate, Joel, Guest, Martyn, Munn, Robert, Workman, Trudy, Connor, Thomas R, Fuller, William, Bresner, Catherine, Snell, Luke B, Patel, Amita, Charalampous, Themoula, Nebbia, Gaia, Batra, Rahul, Edgeworth, Jonathan, Robson, Samuel C, Beckett, Angela H, Aanensen, David M, Underwood, Anthony P, Yeats, Corin A, Abudahab, Khalil, Taylor, Ben EW, Menegazzo, Mirko, Clark, Gemma, Smith, Wendy, Khakh, Manjinder, Fleming, Vicki M, Lister, Michelle M, Howson-Wells, Hannah C, Berry, Louise, Boswell, Tim, Joseph, Amelia, Willingham, Iona, Jones, Carl, Holmes, Christopher, Bird, Paul, Helmer, Thomas, Fallon, Karlie, Tang, Julian, Raviprakash, Veena, Campbell, Sharon, Sheriff, Nicola, Blakey, Victoria, Williams, Lesley-Anne, Loose, Matthew W, Holmes, Nadine, Moore, Christopher, Carlile, Matthew, Wright, Victoria, Sang, Fei, Debebe, Johnny, Coll, Francesc, Signell, Adrian W, Betancor, Gilberto, Wilson, Harry D, Eldirdiri, Sahar, Kenyon, Anita, Davis, Thomas, Pybus, Oliver G, du Plessis, Louis, Zarebski, Alex E, Raghwani, Jayna, Kraemer, Moritz UG, Francois, Sarah, Attwood, Stephen W, Vasylyeva, Tetyana I, Escalera Zamudio, Marina, Gutierrez, Bernardo, Torok, M. Estee, Hamilton, William L, Goodfellow, Ian G, Hall, Grant, Jahun, Aminu S, Chaudhry, Yasmin, Hosmillo, Myra, Pinckert, Malte L, Georgana, Iliana, Moses, Samuel, Lowe, Hannah, Bedford, Luke, Moore, Jonathan, Stonehouse, Susanne, Fisher, Chloe L, Awan, Ali R, BoYes, John, Breuer, Judith, Harris, Kathryn Ann, Brown, Julianne Rose, Shah, Divya, Atkinson, Laura, Lee, Jack CD, Storey, Nathaniel, Flaviani, Flavia, Alcolea-Medina, Adela, Williams, Rebecca, Vernet, Gabrielle, Chapman, Michael R, Levett, Lisa J, Heaney, Judith, Chatterton, Wendy, Pusok, Monika, Xu-McCrae, Li, Smith, Darren L, Bashton, Matthew, Young, Gregory R, Holmes, Alison, Randell, Paul Anthony, Cox, Alison, Madona, Pinglawathee, Bolt, Frances, Price, James, Mookerjee, Siddharth, Ragonnet-Cronin, Manon, Nascimento, Fabricia F., Jorgensen, David, Siveroni, Igor, Johnson, Rob, Boyd, Olivia, Geidelberg, Lily, Volz, Erik M, Rowan, Aileen, Taylor, Graham P, Smollett, Katherine L, Loman, Nicholas J, Quick, Joshua, McMurray, Claire, Stockton, Joanne, Nicholls, Sam, Rowe, Will, Poplawski, Radoslaw, McNally, Alan, Martinez Nunez, Rocio T, Mason, Jenifer, Robinson, Trevor I, O'Toole, Elaine, Watts, Joanne, Breen, Cassie, Cowell, Angela, Sluga, Graciela, Machin, Nicholas W, Ahmad, Shazaad S Y, George, Ryan P, Halstead, Fenella, Sivaprakasam, Venkat, Hogsden, Wendy, Illingworth, Chris J, Jackson, Chris, Thomson, Emma C, Shepherd, James G, Asamaphan, Patawee, Niebel, Marc O, Li, Kathy K, Shah, Rajiv N, Jesudason, Natasha G, Tong, Lily, Broos, Alice, Mair, Daniel, Nichols, Jenna, Carmichael, Stephen N, Nomikou, Kyriaki, Aranday-Cortes, Elihu, Johnson, Natasha, Starinskij, Igor, da Silva Filipe, Ana, Robertson, David L, Orton, Richard J, Hughes, Joseph, Vattipally, Sreenu, Singer, Joshua B, Nickbakhsh, Seema, Hale, Antony D, Macfarlane-Smith, Louissa R, Harper, Katherine L, Carden, Holli, Taha, Yusri, Payne, Brendan AI, Burton-Fanning, Shirelle, Waugh, Sheila, Collins, Jennifer, Eltringham, Gary, Rushton, Steven, O'Brien, Sarah, Bradley, Amanda, Maclean, Alasdair, Mollett, Guy, Blacow, Rachel, Templeton, Kate E, McHugh, Martin P, Dewar, Rebecca, Wastenge, Elizabeth, Dervisevic, Samir, Stanley, Rachael, Meader, Emma J, Coupland, Lindsay, Smith, Louise, Graham, Clive, Barton, Edward, Padgett, Debra, Scott, Garren, Swindells, Emma, Greenaway, Jane, Nelson, Andrew, McCann, Clare M, Yew, Wen C, Andersson, Monique, Peto, Timothy, Justice, Anita, Eyre, David, Crook, Derrick, Sloan, Tim J, Duckworth, Nichola, Walsh, Sarah, Chauhan, Anoop J, Glaysher, Sharon, Bicknell, Kelly, Wyllie, Sarah, Elliott, Scott, Lloyd, Allyson, Impey, Robert, Levene, Nick, Monaghan, Lynn, Bradley, Declan T, Wyatt, Tim, Allara, Elias, Pearson, Clare, Osman, Husam, Bosworth, Andrew, Robinson, Esther, Muir, Peter, Vipond, Ian B, Hopes, Richard, Pymont, Hannah M, Hutchings, Stephanie, Curran, Martin D, Parmar, Surendra, Lackenby, Angie, Mbisa, Tamyo, Platt, Steven, Miah, Shahjahan, Bibby, David, Manso, Carmen, Hubb, Jonathan, Chand, Meera, Dabrera, Gavin, Ramsay, Mary, Bradshaw, Daniel, Thornton, Alicia, Myers, Richard, Schaefer, Ulf, Groves, Natalie, Gallagher, Eileen, Lee, David, Williams, David, Ellaby, Nicholas, Harrison, Ian, Hartman, Hassan, Manesis, Nikos, Patel, Vineet, Bishop, Chloe, Chalker, Vicki, Ledesma, Juan, Twohig, Katherine A, Holden, Matthew T.G., Shaaban, Sharif, Birchley, Alec, Adams, Alexander, Davies, Alisha, Gaskin, Amy, Plimmer, Amy, Gatica-Wilcox, Bree, McKerr, Caoimhe, Moore, Catherine, Williams, Chris, Heyburn, David, De Lacy, Elen, Hilvers, Ember, Downing, Fatima, Shankar, Giri, Jones, Hannah, Asad, Hibo, Coombes, Jason, Watkins, Joanne, Evans, Johnathan M, Fina, Laia, Gifford, Laura, Gilbert, Lauren, Graham, Lee, Perry, Malorie, Morgan, Mari, Bull, Matthew, Cronin, Michelle, Pacchiarini, Nicole, Craine, Noel, Jones, Rachel, Howe, Robin, Corden, Sally, Rey, Sara, Kumziene-SummerhaYes, Sara, Taylor, Sarah, Cottrell, Simon, Jones, Sophie, Edwards, Sue, O'Grady, Justin, Page, Andrew J, Mather, Alison E, Baker, David J, Rudder, Steven, Aydin, Alp, Kay, Gemma L, Trotter, Alexander J, Alikhan, Nabil-Fareed, de Oliveira Martins, Leonardo, Le-Viet, Thanh, Meadows, Lizzie, Casey, Anna, Ratcliffe, Liz, Simpson, David A, Molnar, Zoltan, Thompson, Thomas, Acheson, Erwan, Masoli, Jane AH, Knight, Bridget A, Ellard, Sian, Auckland, Cressida, Jones, Christopher R, Mahungu, Tabitha W, Irish-Tavares, Dianne, Haque, Tanzina, Hart, Jennifer, Witele, Eric, Fenton, Melisa Louise, Dadrah, Ashok, Symmonds, Amanda, Saluja, Tranprit, Bourgeois, Yann, Scarlett, Garry P, Loveson, Katie F, Goudarzi, Salman, Fearn, Christopher, Cook, Kate, Dent, Hannah, Paul, Hannah, Partridge, David G, Raza, Mohammad, Evans, Cariad, Johnson, Kate, Liggett, Steven, Baker, Paul, Bonner, Stephen, Essex, Sarah, Lyons, Ronan A, Saeed, Kordo, Mahanama, Adhyana I.K, Samaraweera, Buddhini, Silveira, Siona, Pelosi, Emanuela, Wilson-Davies, Eleri, Williams, Rachel J, Kristiansen, Mark, Roy, Sunando, Williams, Charlotte A, Cotic, Marius, Bayzid, Nadua, Westhorpe, Adam P, Hartley, John A, Jannoo, Riaz, Lowe, Helen L, Karamani, Angeliki, Ensell, Leah, Prieto, Jacqui A, Jeremiah, Sarah, Grammatopoulos, Dimitris, Pandey, Sarojini, Berry, Lisa, Jones, Katie, Richter, Alex, Beggs, Andrew, Best, Angus, Percival, Benita, Mirza, Jeremy, Megram, Oliver, Mayhew, Megan, Crawford, Liam, Ashcroft, Fiona, Moles-Garcia, Emma, Cumley, Nicola, Smith, Colin P, Bucca, Giselda, Hesketh, Andrew R, Blane, Beth, Girgis, Sophia T, Leek, Danielle, Sridhar, Sushmita, Forrest, Sally, Cormie, Claire, Gill, Harmeet K, Dias, Joana, Higginson, Ellen E, Maes, Mailis, Young, Jamie, Kermack, Leanne M, Gupta, Ravi Kumar, Ludden, Catherine, Peacock, Sharon J, Palmer, Sophie, Churcher, Carol M, Hadjirin, Nazreen F, Carabelli, Alessandro M, Brooks, Ellena, Smith, Kim S, Galai, Katerina, McManus, Georgina M, Ruis, Chris, Davidson, Rose K, Rambaut, Andrew, Williams, Thomas, Balcazar, Carlos E, Gallagher, Michael D, O'Toole, Áine, Rooke, Stefan, Hill, Verity, Williamson, Kathleen A, Stanton, Thomas D, Michell, Stephen L, Bewshea, Claire M, Temperton, Ben, Michelsen, Michelle L, Warwick-Dugdale, Joanna, Manley, Robin, Farbos, Audrey, Harrison, James W, Sambles, Christine M, Studholme, David J, Jeffries, Aaron R, Darby, Alistair C, Hiscox, Julian A, Paterson, Steve, Iturriza-Gomara, Miren, Jackson, Kathryn A, Lucaci, Anita O, Vamos, Edith E, Hughes, Margaret, Rainbow, Lucille, Eccles, Richard, Nelson, Charlotte, Whitehead, Mark, Turtle, Lance, Haldenby, Sam T, Gregory, Richard, Gemmell, Matthew, Wierzbicki, Claudia, Webster, Hermione J, de Silva, Thushan I, Smith, Nikki, Angyal, Adrienn, Lindsey, Benjamin B, Groves, Danielle C, Green, Luke R, Wang, Dennis, Freeman, Timothy M, Parker, Matthew D, Keeley, Alexander J, Parsons, Paul J, Tucker, Rachel M, Brown, Rebecca, Wyles, Matthew, Whiteley, Max, Zhang, Peijun, Gallis, Marta, Louka, Stavroula F, Constantinidou, Chrystala, Unnikrishnan, Meera, Ott, Sascha, Cheng, Jeffrey K.J., Bridgewater, Hannah E., Frost, Lucy R., Taylor-Joyce, Grace, Stark, Richard, Baxter, Laura, Alam, Mohammad T., Brown, Paul E, Aggarwal, Dinesh, Cerda, Alberto C, Merrill, Tammy V, Wilson, Rebekah E, McClure, Patrick C, Chappell, Joseph G, Tsoleridis, Theocharis, Ball, Jonathan, Buck, David, Todd, John A, Green, Angie, Trebes, Amy, MacIntyre-Cockett, George, de Cesare, Mariateresa, Alderton, Alex, Amato, Roberto, Ariani, Cristina V, Beale, Mathew A, Beaver, Charlotte, Bellis, Katherine L, Betteridge, Emma, Bonfield, James, Danesh, John, Dorman, Matthew J, Drury, Eleanor, Farr, Ben W, Foulser, Luke, Goncalves, Sonia, Goodwin, Scott, Gourtovaia, Marina, Harrison, Ewan M, Jackson, David K, Jamrozy, Dorota, Johnston, Ian, Kane, Leanne, Kay, Sally, Keatley, Jon-Paul, Kwiatkowski, Dominic, Langford, Cordelia F, Lawniczak, Mara, Letchford, Laura, Livett, Rich, Lo, Stephanie, Martincorena, Inigo, McGuigan, Samantha, Nelson, Rachel, Palmer, Steve, Park, Naomi R, Patel, Minal, Prestwood, Liam, Puethe, Christoph, Quail, Michael A, Rajatileka, Shavanthi, Scott, Carol, Shirley, Lesley, Sillitoe, John, Spencer Chapman, Michael H, Thurston, Scott AJ, Tonkin-Hill, Gerry, Weldon, Danni, Rajan, Diana, Bronner, Iraad F, Aigrain, Louise, Redshaw, Nicholas M, Lensing, Stefanie V, Davies, Robert, Whitwham, Andrew, Liddle, Jennifier, Lewis, Kevin, Tovar-Corona, Jaime M, Leonard, Steven, Durham, Jillian, Bassett, Andrew R, McCarthy, Shane, Moll, Robin J, James, Keith, Oliver, Karen, Makunin, Alex, Barrett, Jeff, Gunson, Rory N, Hammers, Alexander, Chan, Andrew T, Wolf, Jonathan, Spector, Tim D, Steves, Claire J, Ourselin, Sebastien·2021·The Lancet Public Health
DOI 10.1016/s2468-2667(21)00055-4PMC PMC8041365
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Abstract

Background The SARS-CoV-2 variant B.1.1.7 was first identified in December, 2020, in England. We aimed to investigate whether increases in the proportion of infections with this variant are associated with differences in symptoms or disease course, reinfection rates, or transmissibility. Methods We did an ecological study to examine the association between the regional proportion of infections with the SARS-CoV-2 B.1.1.7 variant and reported symptoms, disease course, rates of reinfection, and transmissibility. Data on types and duration of symptoms were obtained from longitudinal reports from users of the COVID Symptom Study app who reported a positive test for COVID-19 between Sept 28 and Dec 27, 2020 (during which the prevalence of B.1.1.7 increased most notably in parts of the UK). From this dataset, we also estimated the frequency of possible reinfection, defined as the presence of two reported positive tests separated by more than 90 days with a period of reporting no symptoms for more than 7 days before the second positive test. The proportion of SARS-CoV-2 infections with the B.1.1.7 variant across the UK was estimated with use of genomic data from the COVID-19 Genomics UK Consortium and data from Public Health England on spike-gene target failure (a non-specific indicator of the B.1.1.7 variant) in community cases in England. We used linear regression to examine the association between reported symptoms and proportion of B.1.1.7. We assessed the Spearman correlation between the proportion of B.1.1.7 cases and number of reinfections over time, and between the number of positive tests and reinfections. We estimated incidence for B.1.1.7 and previous variants, and compared the effective reproduction number, R t , for the two incidence estimates. Findings From Sept 28 to Dec 27, 2020, positive COVID-19 tests were reported by 36 920 COVID Symptom Study app users whose region was known and who reported as healthy on app sign-up. We found no changes in reported symptoms or disease duration associated with B.1.1.7. For the same period, possible reinfections were identified in 249 (0·7% [95% CI 0·6–0·8]) of 36 509 app users who reported a positive swab test before Oct 1, 2020, but there was no evidence that the frequency of reinfections was higher for the B.1.1.7 variant than for pre-existing variants. Reinfection occurrences were more positively correlated with the overall regional rise in cases (Spearman correlation 0·56–0·69 for South East, London, and East of England) than with the regional increase in the proportion of infections with the B.1.1.7 variant (Spearman correlation 0·38–0·56 in the same regions), suggesting B.1.1.7 does not substantially alter the risk of reinfection. We found a multiplicative increase in the R t of B.1.1.7 by a factor of 1·35 (95% CI 1·02–1·69) relative to pre-existing variants. However, R t fell below 1 during regional and national lockdowns, even in regions with high proportions of infections with the B.1.1.7 variant. Interpretation The lack of change in symptoms identified in this study indicates that existing testing and surveillance infrastructure do not need to change specifically for the B.1.1.7 variant. In addition, given that there was no apparent increase in the reinfection rate, vaccines are likely to remain effective against the B.1.1.7 variant. Funding Zoe Global, Department of Health (UK), Wellcome Trust, Engineering and Physical Sciences Research Council (UK), National Institute for Health Research (UK), Medical Research Council (UK), Alzheimer's Society.

Checked 2026-10-06 · 1 reference not checked yet

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TL;DR

In this ecological study, increasing regional prevalence of SARS-CoV-2 variant B.1.1.7 was not associated with changes in self-reported symptoms or disease duration, nor with higher reinfection frequency. B.1.1.7 was associated with increased transmissibility, with a mean multiplicative increase in Rt of 1·35, but Rt fell below 1 during regional and national lockdowns even in areas with high B.1.1.7 prevalence.

Key findings

  • Among 36 920 COVID Symptom Study app users reporting positive COVID-19 tests between Sept 28 and Dec 27, 2020, there was no evidence of an association between the regional proportion of B.1.1.7 infections and reported symptoms, number of symptoms, asymptomatic infection, self-reported hospital visits, or long symptom duration after adjustment and false-discovery-rate control.
  • Possible reinfection was identified in 249 (0·7% [95% CI 0·6–0·8]) of 36 509 app users who reported a positive swab before Oct 1, 2020; reinfection frequency was not higher with B.1.1.7. Reinfection occurrences correlated more with overall regional rises in cases (Spearman correlation 0·56–0·69 for South East, London, and East of England) than with regional increases in B.1.1.7 proportion (0·38–0·56 in the same regions).
  • B.1.1.7 was associated with a mean multiplicative increase in Rt of 1·35 (95% CI 1·02–1·69) and a mean additive increase of 0·34 (95% CI 0·02–0·66) relative to pre-existing variants. After the second lockdown, the mean multiplicative increase was 1·28 (95% CI 1·02–1·61); using SGTF data after Dec 1, 2020, it was 1·25 (95% CI 1·17–1·34).
  • Rt fell to around 0·8 in London, the South East, and East of England during the national lockdown beginning Jan 5, 2021, where at least 80% of infections were likely due to B.1.1.7.

Methods

  • Ecological study combining longitudinal self-reported symptom and test data from the COVID Symptom Study app (1 767 914 UK users active Sept 28–Dec 27, 2020; symptom analyses focused on 36 920 positive-test users with known region and healthy at sign-up) with COG-UK genomic surveillance and Public Health England spike-gene target failure (SGTF) data.
  • Linear regression examined associations between regional B.1.1.7 proportion and reported symptoms, adjusted for age, sex, regional temperature, and humidity, with false discovery rate control. Possible reinfection was defined as two reported positive tests separated by more than 90 days with more than 7 symptom-free days before the second positive test; Spearman correlations and Mann-Whitney U tests compared reinfection correlations.
  • Incidence was decomposed into B.1.1.7 and pre-existing variant time-series using COG-UK proportions; Rt was estimated separately for each using a Poisson process and Markov Chain Monte-Carlo methods, assuming a gamma-distributed serial interval with α=6·0 and β=1·5, and compared when regional B.1.1.7 proportion exceeded 3%.

Limitations

  • The paper states that the ecological design cannot support causal interpretation, assumes all non-B.1.1.7 variants had the same symptoms, immune response, and transmissibility, and notes that undetected variants with different characteristics cannot be ruled out.
  • The paper states that participatory app data have demographic biases, possible ascertainment or collider bias, and self-report errors; asymptomatic and hospital-admission assessments are limited because most users test only when symptomatic and severe hospitalised cases may not self-report, and mortality could not be assessed.
  • The paper states that reinfection was inferred from test timing rather than sequencing, prolonged PCR positivity cannot be ruled out, and seasonal effects may not have been fully accounted for despite adjustment for temperature and humidity.

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Crossref · 10.1016/s2468-2667(21)00055-4

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Figures

Figure 1 Presence of the B.1.1.7 variant by region in the UK from Sept 27 to Dec 31, 2020, measured using COG-UK genomic surveillance data and SGTF data Grey bars indicate the daily number of samples of positive cases available in the COG-UK data. SGTF data were not available for Scotland or Wales. COG-UK=COVID-19 Genomics UK Consortium. SGTF=spike-gene target failure.
Figure 1 Presence of the B.1.1.7 variant by region in the UK from Sept 27 to Dec 31, 2020, measured using COG-UK genomic surveillance data and SGTF data Grey bars indicate the daily number of samples of positive cases available in the COG-UK data. SGTF data were not available for Scotland or Wales. COG-UK=COVID-19 Genomics UK Consortium. SGTF=spike-gene target failure.CC BY · PubMed Central
Figure 2 Regional plots of the frequency of reporting of each symptom in users reporting positive test results over time from Sept 28 to Dec 27, 2020 Symptom occurrence per 1-week window is shown smoothed over three timepoints as a function of time. The drop in reporting of fever in early November was caused by a change in the wording of the question; this wording was subsequently reverted a week later.
Figure 2 Regional plots of the frequency of reporting of each symptom in users reporting positive test results over time from Sept 28 to Dec 27, 2020 Symptom occurrence per 1-week window is shown smoothed over three timepoints as a function of time. The drop in reporting of fever in early November was caused by a change in the wording of the question; this wording was subsequently reverted a week later.CC BY · PubMed Central
Figure 3 Number of reports of possible reinfection by region from Sept 28 to Dec 27, 2020 Bars indicate the number of reports of possible reinfection each week, plotted by the date of the second infection. Lines show the total number of positive tests reported through the COVID Symptom Study app and the proportion of infections with the B.1.1.7 variant for the same period.
Figure 3 Number of reports of possible reinfection by region from Sept 28 to Dec 27, 2020 Bars indicate the number of reports of possible reinfection each week, plotted by the date of the second infection. Lines show the total number of positive tests reported through the COVID Symptom Study app and the proportion of infections with the B.1.1.7 variant for the same period.CC BY · PubMed Central
Figure 4 Total case numbers and Rt for pre-existing variants and B.1.1.7, and ratio between these Rt values, from Sept 28 to Dec 27, 2020 Data are shown for the three regions in England with the highest proportion of infections with the B.1.1.7 variant. Rt=effective reproduction number.
Figure 4 Total case numbers and Rt for pre-existing variants and B.1.1.7, and ratio between these Rt values, from Sept 28 to Dec 27, 2020 Data are shown for the three regions in England with the highest proportion of infections with the B.1.1.7 variant. Rt=effective reproduction number.CC BY · PubMed Central
Figure 5 Total case numbers and Rt from Oct 15, 2020, to Jan 16, 2021, capturing the third national lockdown beginning Jan 5, 2021 Data are shown for the three regions in England with the highest proportion of infections with the B.1.1.7 variant in December, 2020. Rt=effective reproduction number.
Figure 5 Total case numbers and Rt from Oct 15, 2020, to Jan 16, 2021, capturing the third national lockdown beginning Jan 5, 2021 Data are shown for the three regions in England with the highest proportion of infections with the B.1.1.7 variant in December, 2020. Rt=effective reproduction number.CC BY · PubMed Central

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  • It may state two separate claims as one. 12
  • Probably not a substantial claim. 15
24 of 24

  • The paper relies on this without support.

    The COVID Symptom Study app users are representative of the UK population for assessing symptoms and reinfection rates.

    “We used data from the COVID Symptom Study,7 a longitudinal dataset providing symptom reports and test results from a population of more than 4 million adults living in the UK”
    “We included users living in the UK who had logged responses through the app at least once in the period between Sept 28 and Dec 27, 2020.”

  • The paper relies on this without support.

    The regional proportion of B.1.1.7 infections is a valid proxy for the variant infecting individual app users in that region.

    “We did ecological studies to assess the symptoms, disease course, rates of reinfection, and transmissibility associated with increasing proportions of infections with the B.1.1.7 variant in the UK population.”

  • The paper relies on this without support.

    Vaccine-induced immunity and immunity from natural infection are similar enough that lack of increased reinfection implies vaccines remain effective against B.1.1.7.

    “given that there was no apparent increase in the reinfection rate, vaccines are likely to remain effective against the B.1.1.7 variant.”

  • The paper relies on this without support.

    Self-reported positive tests and symptom logs in the app are accurate enough to measure infection and symptoms.

    “Users are asked to record each day whether they feel physically normal and, if not, to log any symptoms. After a user reports any symptoms, they are asked “Where are you right now?”, with the options “At home”, “At hospital with suspected COVID-19 symptoms”, or “Back from hospital”. Users are also asked to maintain a record of any COVID-19 tests and their date, type, and result in the app.”

  • The paper relies on this without support.

    The COG-UK sequencing sample is representative of all SARS-CoV-2 cases in the regions.

    “These data were produced by sequencing a sample of PCR tests done in the community.”

  • The authors state this as an assumption.

    The proportion of infections with the B.1.1.7 variant in London, the South East, and the East of England had not decreased from the end of December 2020 to January 2021.

    “assuming the proportion had not decreased from the end of December.”

  • The authors state this as an assumption.

    All non-B.1.1.7 variants in circulation at the time of study give rise to the same range of symptoms and immune response, and have the same transmissibility.

    “Our work assumes that all non-B.1.1.7 variants in circulation at the time of study give rise to the same range of symptoms and immune response, and have the same transmissibility.”

  • The authors state this as an assumption.

    Testing positive for SARS-CoV-2 infection after an interval of 90 days with at least a 7-day period with an absence of symptoms is consistent with reinfection.

    “Another limitation was that we assumed that testing positive for SARS-CoV-2 infection after an interval of 90 days with at least a 7-day period with an absence of symptoms is consistent with reinfection.”
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Authors
Graham, M. S., Sudre, C. H., May, A., Antonelli, M., Murray, B., Varsavsky, T., Kläser, K., Canas, L. S., Molteni, E., Modat, M., Drew, D. A., Nguyen, L. H., Polidori, L., Selvachandran, S., Hu, C., Capdevila, J., Koshy, C., Ash, A., Wise, E., Moore, N., Mori, M., Cortes, N., Lynch, J., Kidd, S., Fairley, D. J., Curran, T., McKenna, J. P., Adams, H., Fraser, C., Golubchik, T., Bonsall, D., Hassan-Ibrahim, M. O., Malone, C. S., Cogger, B. J., Wantoch, M., Reynolds, N., Warne, B., Maksimovic, J., Spellman, K., McCluggage, K., John, M., Beer, R., Afifi, S., Morgan, S., Marchbank, A., Price, A., Kitchen, C., Gulliver, H., Merrick, I., Southgate, J., Guest, M., Munn, R., Workman, T., Connor, T. R., Fuller, W., Bresner, C., Snell, L. B., Patel, A., Charalampous, T., Nebbia, G., Batra, R., Edgeworth, J., Robson, S. C., Beckett, A. H., Aanensen, D. M., Underwood, A. P., Yeats, C. A., Abudahab, K., Taylor, B. E., Menegazzo, M., Clark, G., Smith, W., Khakh, M., Fleming, V. M., Lister, M. M., Howson-Wells, H. C., Berry, L., Boswell, T., Joseph, A., Willingham, I., Jones, C., Holmes, C., Bird, P., Helmer, T., Fallon, K., Tang, J., Raviprakash, V., Campbell, S., Sheriff, N., Blakey, V., Williams, L.-A., Loose, M. W., Holmes, N., Moore, C., Carlile, M., Wright, V., Sang, F., Debebe, J., Coll, F., Signell, A. W., Betancor, G., Wilson, H. D., Eldirdiri, S., Kenyon, A., Davis, T., Pybus, O. G., du Plessis, L., Zarebski, A. E., Raghwani, J., Kraemer, M. U., Francois, S., Attwood, S. W., Vasylyeva, T. I., Escalera Zamudio, M., Gutierrez, B., Torok, M. E., Hamilton, W. L., Goodfellow, I. G., Hall, G., Jahun, A. S., Chaudhry, Y., Hosmillo, M., Pinckert, M. L., Georgana, I., Moses, S., Lowe, H., Bedford, L., Moore, J., Stonehouse, S., Fisher, C. L., Awan, A. R., BoYes, J., Breuer, J., Harris, K. A., Brown, J. R., Shah, D., Atkinson, L., Lee, J. C., Storey, N., Flaviani, F., Alcolea-Medina, A., Williams, R., Vernet, G., Chapman, M. R., Levett, L. J., Heaney, J., Chatterton, W., Pusok, M., Xu-McCrae, L., Smith, D. L., Bashton, M., Young, G. R., Holmes, A., Randell, P. A., Cox, A., Madona, P., Bolt, F., Price, J., Mookerjee, S., Ragonnet-Cronin, M., Nascimento, F. F., Jorgensen, D., Siveroni, I., Johnson, R., Boyd, O., Geidelberg, L., Volz, E. M., Rowan, A., Taylor, G. P., Smollett, K. L., Loman, N. J., Quick, J., McMurray, C., Stockton, J., Nicholls, S., Rowe, W., Poplawski, R., McNally, A., Martinez Nunez, R. T., Mason, J., Robinson, T. I., O'Toole, E., Watts, J., Breen, C., Cowell, A., Sluga, G., Machin, N. W., Ahmad, S. S. Y., George, R. P., Halstead, F., Sivaprakasam, V., Hogsden, W., Illingworth, C. J., Jackson, C., Thomson, E. C., Shepherd, J. G., Asamaphan, P., Niebel, M. O., Li, K. K., Shah, R. N., Jesudason, N. G., Tong, L., Broos, A., Mair, D., Nichols, J., Carmichael, S. N., Nomikou, K., Aranday-Cortes, E., Johnson, N., Starinskij, I., da Silva Filipe, A., Robertson, D. L., Orton, R. J., Hughes, J., Vattipally, S., Singer, J. B., Nickbakhsh, S., Hale, A. D., Macfarlane-Smith, L. R., Harper, K. L., Carden, H., Taha, Y., Payne, B. A., Burton-Fanning, S., Waugh, S., Collins, J., Eltringham, G., Rushton, S., O'Brien, S., Bradley, A., Maclean, A., Mollett, G., Blacow, R., Templeton, K. E., McHugh, M. P., Dewar, R., Wastenge, E., Dervisevic, S., Stanley, R., Meader, E. J., Coupland, L., Smith, L., Graham, C., Barton, E., Padgett, D., Scott, G., Swindells, E., Greenaway, J., Nelson, A., McCann, C. M., Yew, W. C., Andersson, M., Peto, T., Justice, A., Eyre, D., Crook, D., Sloan, T. J., Duckworth, N., Walsh, S., Chauhan, A. J., Glaysher, S., Bicknell, K., Wyllie, S., Elliott, S., Lloyd, A., Impey, R., Levene, N., Monaghan, L., Bradley, D. T., Wyatt, T., Allara, E., Pearson, C., Osman, H., Bosworth, A., Robinson, E., Muir, P., Vipond, I. B., Hopes, R., Pymont, H. M., Hutchings, S., Curran, M. D., Parmar, S., Lackenby, A., Mbisa, T., Platt, S., Miah, S., Bibby, D., Manso, C., Hubb, J., Chand, M., Dabrera, G., Ramsay, M., Bradshaw, D., Thornton, A., Myers, R., Schaefer, U., Groves, N., Gallagher, E., Lee, D., Williams, D., Ellaby, N., Harrison, I., Hartman, H., Manesis, N., Patel, V., Bishop, C., Chalker, V., Ledesma, J., Twohig, K. A., Holden, M. T. G., Shaaban, S., Birchley, A., Adams, A., Davies, A., Gaskin, A., Plimmer, A., Gatica-Wilcox, B., McKerr, C., Moore, C., Williams, C., Heyburn, D., De Lacy, E., Hilvers, E., Downing, F., Shankar, G., Jones, H., Asad, H., Coombes, J., Watkins, J., Evans, J. M., Fina, L., Gifford, L., Gilbert, L., Graham, L., Perry, M., Morgan, M., Bull, M., Cronin, M., Pacchiarini, N., Craine, N., Jones, R., Howe, R., Corden, S., Rey, S., Kumziene-SummerhaYes, S., Taylor, S., Cottrell, S., Jones, S., Edwards, S., O'Grady, J., Page, A. J., Mather, A. E., Baker, D. J., Rudder, S., Aydin, A., Kay, G. L., Trotter, A. J., Alikhan, N.-F., de Oliveira Martins, L., Le-Viet, T., Meadows, L., Casey, A., Ratcliffe, L., Simpson, D. A., Molnar, Z., Thompson, T., Acheson, E., Masoli, J. A., Knight, B. A., Ellard, S., Auckland, C., Jones, C. R., Mahungu, T. W., Irish-Tavares, D., Haque, T., Hart, J., Witele, E., Fenton, M. L., Dadrah, A., Symmonds, A., Saluja, T., Bourgeois, Y., Scarlett, G. P., Loveson, K. F., Goudarzi, S., Fearn, C., Cook, K., Dent, H., Paul, H., Partridge, D. G., Raza, M., Evans, C., Johnson, K., Liggett, S., Baker, P., Bonner, S., Essex, S., Lyons, R. A., Saeed, K., Mahanama, A. I. K., Samaraweera, B., Silveira, S., Pelosi, E., Wilson-Davies, E., Williams, R. J., Kristiansen, M., Roy, S., Williams, C. A., Cotic, M., Bayzid, N., Westhorpe, A. P., Hartley, J. A., Jannoo, R., Lowe, H. L., Karamani, A., Ensell, L., Prieto, J. A., Jeremiah, S., Grammatopoulos, D., Pandey, S., Berry, L., Jones, K., Richter, A., Beggs, A., Best, A., Percival, B., Mirza, J., Megram, O., Mayhew, M., Crawford, L., Ashcroft, F., Moles-Garcia, E., Cumley, N., Smith, C. P., Bucca, G., Hesketh, A. R., Blane, B., Girgis, S. T., Leek, D., Sridhar, S., Forrest, S., Cormie, C., Gill, H. K., Dias, J., Higginson, E. E., Maes, M., Young, J., Kermack, L. M., Gupta, R. K., Ludden, C., Peacock, S. J., Palmer, S., Churcher, C. M., Hadjirin, N. F., Carabelli, A. M., Brooks, E., Smith, K. S., Galai, K., McManus, G. M., Ruis, C., Davidson, R. K., Rambaut, A., Williams, T., Balcazar, C. E., Gallagher, M. D., O'Toole, Á., Rooke, S., Hill, V., Williamson, K. A., Stanton, T. D., Michell, S. L., Bewshea, C. M., Temperton, B., Michelsen, M. L., Warwick-Dugdale, J., Manley, R., Farbos, A., Harrison, J. W., Sambles, C. M., Studholme, D. J., Jeffries, A. R., Darby, A. C., Hiscox, J. A., Paterson, S., Iturriza-Gomara, M., Jackson, K. A., Lucaci, A. O., Vamos, E. E., Hughes, M., Rainbow, L., Eccles, R., Nelson, C., Whitehead, M., Turtle, L., Haldenby, S. T., Gregory, R., Gemmell, M., Wierzbicki, C., Webster, H. J., de Silva, T. I., Smith, N., Angyal, A., Lindsey, B. B., Groves, D. C., Green, L. R., Wang, D., Freeman, T. M., Parker, M. D., Keeley, A. J., Parsons, P. J., Tucker, R. M., Brown, R., Wyles, M., Whiteley, M., Zhang, P., Gallis, M., Louka, S. F., Constantinidou, C., Unnikrishnan, M., Ott, S., Cheng, J. K. J., Bridgewater, H. E., Frost, L. R., Taylor-Joyce, G., Stark, R., Baxter, L., Alam, M. T., Brown, P. E., Aggarwal, D., Cerda, A. C., Merrill, T. V., Wilson, R. E., McClure, P. C., Chappell, J. G., Tsoleridis, T., Ball, J., Buck, D., Todd, J. A., Green, A., Trebes, A., MacIntyre-Cockett, G., de Cesare, M., Alderton, A., Amato, R., Ariani, C. V., Beale, M. A., Beaver, C., Bellis, K. L., Betteridge, E., Bonfield, J., Danesh, J., Dorman, M. J., Drury, E., Farr, B. W., Foulser, L., Goncalves, S., Goodwin, S., Gourtovaia, M., Harrison, E. M., Jackson, D. K., Jamrozy, D., Johnston, I., Kane, L., Kay, S., Keatley, J.-P., Kwiatkowski, D., Langford, C. F., Lawniczak, M., Letchford, L., Livett, R., Lo, S., Martincorena, I., McGuigan, S., Nelson, R., Palmer, S., Park, N. R., Patel, M., Prestwood, L., Puethe, C., Quail, M. A., Rajatileka, S., Scott, C., Shirley, L., Sillitoe, J., Spencer Chapman, M. H., Thurston, S. A., Tonkin-Hill, G., Weldon, D., Rajan, D., Bronner, I. F., Aigrain, L., Redshaw, N. M., Lensing, S. V., Davies, R., Whitwham, A., Liddle, J., Lewis, K., Tovar-Corona, J. M., Leonard, S., Durham, J., Bassett, A. R., McCarthy, S., Moll, R. J., James, K., Oliver, K., Makunin, A., Barrett, J., Gunson, R. N., Hammers, A., Chan, A. T., Wolf, J., Spector, T. D., Steves, C. J., & Ourselin, S.
Affiliations
  • King's College London (GB)
  • ZOE (United Kingdom) (GB)
  • Harvard University (US)
Corresponding author
Graham, Mark S
ORCID
Venue
The Lancet Public Health
Publisher
Elsevier BV
Published
2021-05
Volume
6
Issue
5
Pages
e335-e345
ISSN
2468-2667 (ISSN-L)
DOI
10.1016/s2468-2667(21)00055-4
PMC
PMC8041365
OpenAlex
W3155952134
Semantic Scholar
15e9050536b354de7a7b4118467db8026e190ed4
Cited by
304
References
25
Citations by year
2026: 7 · 2025: 11 · 2024: 28 · 2023: 37 · 2022: 115 · 2021: 106
FWCI
22.65
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Public Health (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • ePrints Soton (University of Southampton) (acceptedVersion)
  • UEA Digital Repository (University of East Anglia) (acceptedVersion)
  • Cronfa (Swansea University) (acceptedVersion)
  • ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • Acceda (Universidad de Las Palmas de Gran Canaria) (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
  • IRIS eCampus Telematic University (Università degli Studi eCampus) (submittedVersion)
  • Research Portal (King's College London) (submittedVersion, cc-by)
  • University of Birmingham Research Portal (University of Birmingham) (submittedVersion, cc-by)
  • Spiral (Imperial College London) (submittedVersion, other-oa)
Funders
  • MRC
  • Wellcome Trust
Topics
  • Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
  • Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
  • Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
Keywords
COVID-19 pandemic, symptomatology, reinfection, transmissibility, effective reproduction number, clinical course, COVID-19 incidence, United Kingdom
MeSH terms
Reinfection, COVID-19, SARS-CoV-2, Adolescent, Adult, Aged, Female, United Kingdom, Humans, Male, Middle Aged, Young Adult

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

A language model drew the claims from the paper on 2026-10-06, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).

A second model labelled each claim on 2026-10-06 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

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