Syndromic surveillance apps may be key in providing solutions to limitations on current COVID-19 case projection data collection efforts.
Coronavirus disease 2019 (COVID-19) has unleashed many unprecedented challenges for the United States. Among work-from-home measures, business restrictions, and mandated mask-wearing, the United States has also grappled with implementing the most effective ways to amass accurate COVID-19 infection projections.1
Currently, approximately 460,000 Americans are being tested each day, a mere 1.5% of the population. Experts have urged that between 900,000 and 30 million individuals need to be tested daily in order to effectively articulate the extent of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the United States.2
Without a definitive and clear national strategy, state officials are left to decide how to test their residents for COVID-19 and make case projections, resulting in a “patchwork” of widely varied tactics, testing types, and extent of success.1,2
According to a commentary published in The New England Journal of Medicine, the majority of US COVID-19 case projections have relied on incidence calculated from current COVID-19 testing, hospitalizations, and deaths.2 The authors asserted that these limited estimates do little to accurately depict the extent of COVID-19 in the United States for a number of reasons:2
1. Lack of uniformly collected data on a national scale
2. Substantial delays in reporting and aggregating data
3. Limited availability of testing for COVID-19
4. Data based on hospitalizations and death rates only capturing severe COVID-19 cases
5. Dearth of information on reliability, accuracy, and availability of antibody-based testing
The commentary pointed to the opportunity to use technology-based solutions to address these limitations. With social distancing measures in place, the COVID-19 pandemic has carried telemedicine to the forefront of health care.
The authors brought attention to the launching of their Covid Symptom Study app, which has been used by nearly 3.5 million people in the United States, the United Kingdom, and Sweden. A cost-efficient participatory syndromic-surveillance tool, the app not only finds individuals who may have more moderate manifestations of COVID-19 infection, but is able to collect data on other potential risk factors for and outcomes of COVID-19, which can be offered to real-time epidemiologic studies, including current population-based cohort studies.2
The authors additionally collaborated with Boston Children’s Hospital to adapt a web- and text message-based syndromic surveillance tool, called FluNearYou. Although the original platform allowed users to view influenza patterns, CovidNearYou has captured upwards of 1 million individual reports, possessing the potential for identifying syndromic data and key demographic risk factors.2
These telemedicine tools have the key potential to advise officials and government on decisions concerning reopening economies and relaxing stay-at-home orders across the United States. The national COVID-19 response is based on data from emergency department utilizations, which neglects the surge in telemedicine visits. The authors stressed the importance of using syndromic surveillance data to screen and detect COVID-19 infection earlier in the process, not only to slow the viral spread, but also to take action on COVID-19 symptoms before they become more severe.2
Julie Ann Justo, PharmD, infectious disease clinical pharmacist and associate professor at the University of South Carolina College of Pharmacy, also underlined the importance of early detection of COVID-19 symptoms.
“Time is of the essence. If patients feel that they have any symptoms and may be at risk for having COVID-19, I strongly encourage them to seek medical attention as soon as possible, and not wait until they’re very severely ill,” she told Drug Topics® in a video interview.
However, the commentary did express some limitations in utilizing mobile apps, including that users will not completely reflect the broader populations. In addition, certain demographics lack access to high-speed broadband internet; the 2018 Broadband Deployment report found that only 69.3% of rural areas and 64.6% of tribal areas had access to high-speed broadband that met the minimum benchmark set by the Federal Communications Commission (FCC).3
But the authors working on the Covid Symptom Study app have sought out increased representation from racial and ethnic groups that are more vulnerable to being infected with COVID-19 through various initiatives, such as a Spanish-language app.2
“We believe that digital syndromic surveillance as a method of ‘contactless tracing’ holds substantial appeal for the future, beyond the immediate priority of reopening our society,” the commentary authors wrote. “Although caseloads are decreasing, without a universal vaccine or highly effective treatment, we will continue to need to collect data on COVID-19 symptoms for the foreseeable future, particularly given concerns about a resurgence of cases after the summer. These tools will also be valuable for other efforts, including recruiting volunteers for clinical trials, estimating risk of reinfection, and assessing vaccine efficacy on a population scale. Thus, such mobile technology will remain an important weapon in our efforts to defeat COVID-19 and to better position ourselves to respond to the next pandemic.”2
1. Weiner R, Helderman RS. States are wrestling on their own with how to expand testing, with little guidance from the Trump administration. The Washington Post. June 10, 2020. Accessed June 10, 2020.https://www.washingtonpost.com/politics/states-are-wrestling-on-their-own-with-how-to-expand-testing-with-little-guidance-from-the-trump-administration/2020/06/09/d02672f4-9bab-11ea-ad09-8da7ec214672_story.html.
2. Chan AT, Brownstein JS. Putting the Public Back in Public Health – Surveying Symptoms of COVID-19. The New England Journal of Medicine. 2020; doi: 10.1056/NEJMp2016259.
3. Helseth, C. Barriers to Telehealth in Rural Areas. Rural Health Information Hub. Updated 2020 Accessed June 10, 2020. https://www.ruralhealthinfo.org/toolkits/telehealth/1/barriers.