UKHSA - Formal request for an urgent review of public health advice on COVID-19 and respiratory infections
Last week we wrote to Professor Hopkins, Chief Executive Officer at the UK Health Security Agency (UKHSA), with a formal request for an urgent review of public health advice. Read our urgent message to UKHSA below.
We are writing on behalf of Long Covid SOS, a charity advocating for people living with Long Covid, to request an urgent review and strengthening of current public health advice on respiratory infections, including COVID-19.
Your blog post of 8 October 2026, Should we be worried about the current COVID-19 variants?, directs readers to existing advice on what to do if they have symptoms and how to live safely with respiratory infections.
The two principal public advice pages, People with symptoms of a respiratory infection, including COVID-19 and Living safely with respiratory infections, including COVID-19, were last updated in 2022. They do not go far enough in explaining how COVID-19 spreads, how transmission can be reduced in shared indoor spaces, or the potentially life-changing consequences of Long Covid.
This guidance now requires a thorough review so that people can make informed decisions, reduce the risk of infection and better protect those at increased risk of harm. Public health messaging should reflect current understanding of transmission and the lived experience of people affected by Long Covid, while recognising the practical constraints that can prevent individuals from following advice.
1. Symptoms, staying at home and testing
Current advice encourages people to try to stay at home if they have a high temperature or feel too unwell to carry out normal activities. However, COVID-19 can spread before symptoms develop, and some people experience only mild symptoms or none at all.
Feeling well enough to work or continue normal activities does not necessarily mean that
someone is not infectious. Public health messaging should explain this clearly and set out practical steps people can take to reduce transmission when they may have an infection.
We also recognise that many people cannot afford to stay at home when ill because of insecure employment, inadequate sick pay or caring responsibilities. Advice should acknowledge these barriers and be accompanied by practical support. Responsibility for preventing transmission cannot be placed entirely on individuals when the social and economic conditions needed to follow the advice are absent.
People should be encouraged to test when they have symptoms, while being clearly informed that a single negative result does not rule out COVID-19. Where possible, they should also be advised to keep a record of a positive result, as this may be useful if they later develop Long Covid.
However, assessment, diagnosis and care for Long Covid must not depend on a positive test. Many people cannot afford tests, while others were unable to access them at the time of infection. The World Health Organization’s clinical case definition of post-COVID-19 condition recognises a history of probable or confirmed infection. Long Covid can affect anyone, regardless of age or the severity of their initial illness.
The absence of a positive test result must not become a barrier to recognition, assessment or care.
2. Airborne transmission, clean air and respiratory protection
The UKHSA advice on ventilation acknowledges that infectious particles can accumulate in enclosed or poorly ventilated spaces. It also explains the importance of fresh air and the potential role of HEPA air filtration where adequate ventilation is difficult.
These messages nevertheless need to be more prominent, clearer and easier to put into practice. Opening windows is not always practical or sufficient, particularly in schools, workplaces, hospitals, care homes and on public transport. Advice should explain more clearly how infectious particles can build up in shared indoor air and why effective ventilation and filtration benefit everyone.
Responsibility for safer indoor air should not be left to individuals to negotiate or arrange for themselves. Organisations and those responsible for shared spaces should be expected to take reasonable steps to reduce airborne transmission.
Masking is a public health measure, not a political stance. This distinction should be made clear throughout public discussions of face coverings and respiratory protection. Well-fitting respirators, such as FFP2 or FFP3 masks, can offer greater protection against inhaling infectious particles than loose-fitting face coverings, although fit and correct use are important. Surgical masks do not form a close seal against the face and are not designed to provide the same level of respiratory protection.
The UK Health and Safety Executive (HSE) guidance on respiratory protective equipment explains the importance of fit and effective respiratory protection, while CDC/NIOSH guidance on respirators versus surgical masks outlines the differences between them.
The public needs clear, accessible information about these differences so that people can make informed choices without stigma or politicisation. Handwashing and covering coughs and sneezes remain sensible measures, but they do not address the risks from shared indoor air on their own.
Clean air should be a public health priority, not something individuals have to campaign for or arrange themselves. Everyone deserves the benefits of clean air in shared indoor spaces. There is no downside to clean air.
3. Protecting people at increased risk
People living with Long Covid, people who are immunocompromised and others at increased risk cannot simply withdraw from everyday life. They still need to access healthcare, work, education, public transport and essential services, often in settings where they have little control over the risk of infection.
Many vulnerabilities are not visible. People should not have to disclose private health information, repeatedly explain their circumstances or ask others to take precautions in order to feel safer. Nor should anyone be ridiculed or stigmatised for requesting reasonable protections.
Public advice should make clear that reducing transmission is a shared responsibility. Employers, healthcare providers, educational settings, transport operators and those responsible for other shared spaces all have an important role to play in making them safer. People at increased risk should not be left to manage the situation alone.
It is also important to recognise that Long Covid can affect anyone, including people who were previously fit and healthy and whose initial infection was mild. Public health messaging should not imply that only those already considered medically vulnerable need to take the risk of Long Covid seriously.
4. Rest during acute illness
The current advice includes a recommendation to take exercise outdoors if someone needs to leave home while unwell. While being outdoors can reduce the risk of transmitting infection to others, this should not be confused with advice about whether someone who is ill should exercise.
The importance of rest during acute infection needs to be stated more clearly. Research into whether inadequate rest may increase the risk of Long Covid is ongoing, and the evidence is not conclusive. However, people should not be encouraged to push through illness or feel that they should continue exercising when unwell.
For people who develop Long Covid, post-exertional symptom exacerbation (PESE), also known as post-exertional malaise (PEM), can cause symptoms to worsen after physical or cognitive activity. Public advice should take this into account and avoid messaging that could lead people to disregard their symptoms or overexert themselves.
People should be encouraged to rest when ill and to respond to their symptoms. At the same time, many people have no choice but to attend work, education or healthcare appointments when unwell. Making shared indoor spaces safer is therefore an essential part of reducing transmission and protecting those who cannot avoid exposure.
5. Long Covid and the consequences of reinfection
Long Covid can follow an infection that was initially mild and can cause persistent, sometimes disabling symptoms affecting multiple body systems. It can have a profound impact on health, independence, education, employment and family life.
For some people already living with Long Covid, reinfection can worsen existing symptoms and lead to a lasting reduction in their health and ability to function. This risk deserves greater recognition in public health communications.
Preventing infection is not only about reducing hospital admissions or severe illness during the acute phase. It is also about reducing the risk of long-term illness and disability. Public advice should reflect this broader understanding of harm rather than focusing primarily on the likelihood of severe acute disease.
We recommend that the advice include clear information about Long Covid, the possibility of developing it after a mild infection and the potential consequences of reinfection. The NHS information on Long Covid and the NICE guideline on the long-term effects of COVID-19 provides background information.
6. Relevant findings from the UK Covid-19 Inquiry
The UK Covid-19 Inquiry’s Module 2 full report includes recommendations on considering people at increased risk and making government communications accessible.
Recommendation 8 calls for a framework to identify those most at risk of infection and death, as well as those likely to be negatively affected by measures taken in response, and to identify steps to mitigate those risks. Recommendation 14 calls for action plans to make government communications more accessible.
Although these recommendations do not specifically instruct UKHSA to revise its current public advice, their principles are directly relevant. We ask UKHSA to consider how they should inform communications about respiratory infections, including communications addressing the needs of people living with Long Covid and others who face increased risks from infection. The UK Government’s response to the Module 2 report is also relevant to this consideration.
7. What we are asking UKHSA to do
Long Covid SOS is a patient-led charity established in 2020. Our work is grounded in the experiences of people living with Long Covid and our commitment to Recognition, Research and Rights.
We ask UKHSA to review the current public advice pages and address the gaps outlined in this letter, including:
The risk of transmission before symptoms develop and from people with mild or no symptoms, together with the limitations of testing.
The importance of ventilation, filtration and effective respiratory protection in reducing transmission.
The practical barriers that prevent people from staying at home when ill, and the need for advice to reflect these realities.
The importance of rest during acute illness and the need to avoid encouraging people to exercise when unwell.
The lasting effects of Long Covid and the potential for reinfection to worsen existing illness.
The shared responsibility of employers, organisations and those managing public spaces to reduce transmission and protect people at increased risk.
The need for accessible, evidence-based information that enables people to make informed decisions without stigma or blame.
We would welcome a written response confirming whether UKHSA will undertake this review and, if so, within what timeframe. We would also appreciate clarification of:
The evidence informing the current advice.
How the needs of people living with Long Covid and others at increased risk are considered.
How current understanding of airborne transmission, ventilation and respiratory protection is reflected.
How the relevant findings of the Covid-19 Inquiry will be taken into account. Whether people living with Long Covid and other affected communities will be involved in reviewing or revising the advice.
If UKHSA does not intend to review and strengthen the advice, we ask that you explain why.
Public health advice should not simply tell people how to live with the risk of infection; it must go much further in seeking to prevent it. Preventing transmission must be a shared public health responsibility, supported by clear, evidence-based advice and safer shared environments. It must not be a burden placed on individuals, particularly those at increased risk of harm and those whose health has already been compromised by infection or who are living with Long Covid.
We look forward to your response.
Yours sincerely,
Long Covid SOS
