Abstract
BackgroundWe developed a self-assessment and participatory surveillance web application for coronavirus disease (COVID-19), which was launched in France in March 2020.ObjectiveOur objective was to determine if self-reported symptoms could help monitor the dynamics of the COVID-19 outbreak in France.MethodsUsers were asked questions about underlying conditions, sociodemographic status, zip code, and COVID-19 symptoms. Depending on the symptoms reported and the presence of coexisting disorders, users were told to either stay at home, contact a general practitioner (GP), or call an emergency phone number. Data regarding COVID-19–related hospitalizations were retrieved from the Ministry of Health.ResultsAs of March 29, 2020, the application was opened 4,126,789 times; 3,799,535 electronic questionnaires were filled out; and 2,477,174 users had at least one symptom. In total, 34.8% (n=1,322,361) reported no symptoms. The remaining users were directed to self-monitoring (n=858,878, 22.6%), GP visit or teleconsultation (n=1,033,922, 27.2%), or an emergency phone call (n=584,374, 15.4%). Emergency warning signs were reported by 39.1% of participants with anosmia, a loss of the sense of smell (n=127,586) versus 22.7% of participants without anosmia (n=1,597,289). Anosmia and fever and/or cough were correlated with hospitalizations for COVID-19 (Spearman correlation coefficients=0.87 and 0.82, respectively; P<.001 for both).ConclusionsThis study suggests that anosmia may be strongly associated with COVID-19 and its severity. Despite a lack of medical assessment and virological confirmation, self-checking application data could be a relevant tool to monitor outbreak trends.Trial RegistrationClinicalTrials.gov NCT04331171; https://clinicaltrials.gov/ct2/show/NCT04331171
Highlights
Web-based self-reporting of symptoms is a growing field and has been used to improve survival in oncology [1,2]; it can be used as a participatory surveillance tool for coronavirus disease (COVID-19) or other influenza-like illnesses as well [3,4]
This study suggests that anosmia may be strongly associated with COVID-19 and its severity
Respondents provided information on sociodemographic data, zip code, and coexisting disorders anonymously. They were asked about nine symptoms associated with possible COVID-19 infection—fever, unusual cough, shortness of breath, sore throat, muscle aches, diarrhea, anorexia, and asthenia
Summary
Users were recruited via national media campaigns in France, including social media, radio, and magazine campaigns, between March 17-29, 2020. Respondents provided information on sociodemographic data, zip code, and coexisting disorders anonymously. They were asked about nine symptoms associated with possible COVID-19 infection—fever (body temperature >37.7°C), unusual cough, shortness of breath, sore throat, muscle aches, diarrhea, anorexia, and asthenia. A notification was sent, recommending the user either to stay at home and use the website again in case of evolving symptomatology (self-monitoring), or to contact a general practitioner (GP), or to call an emergency number if they reported dyspnea or anorexia. We compared the distribution of web-based, self-reported symptoms to that of hospitalized COVID-19 patients according to Ministry of Health reports.
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