JMIR Publications

ABSTRACT

Background:

The emergence of SARS-CoV-2 and the resulting COVID-19 pandemic has led to tremendous strain on institutions/agencies working to prevent viral transmission.1,2 Up to a fifth of individuals with COVID-19 infection require hospitalization, but those with milder symptoms convalesce isolated at home.3 Furthermore, individuals exposed to COVID-19 cases may be monitored on home quarantine for up to fourteen days.4,5 Current symptom monitoring systems are resource intensive, using telephone, tele-video or text-messaging. Monitoring a multitude of individuals can quickly exceed institutional capacity. Our multidisciplinary team implemented privacy-assured systems using the Georgetown University’s AvesTerra framework for privacy-assured technology for HIV surveillance,6 to design a user-friendly system to efficiently track symptoms associated with COVID-19 infection.

Objective:

We conducted a beta-test of the system to test the functionality of the system and reporter functions that aim to provide institutions and agencies to identify individuals with changing health status who may be able to come off isolation or quarantine.

Methods:

The Georgetown University COVID-19 Symptom Tracker (www.covidgu.org) captures key risk factors and symptoms for remote self-monitoring of COVID-19 patients and exposed individuals on home isolation or quarantine. Self-reported temperature, cough, sore throat, shortness of breath or other symptoms commonly associated with COVID-19 are entered via a simple web interface using a unique identification number without personal identifiers. We beta-tested the COVID-19 Symptom Tracker under a protocol deemed exempt by the Georgetown University Institutional Review Board (IRB). Georgetown University medical students were invited to participate by email, with a link to a Qualtrics survey used to describe the project, provide instructions, and document consent. A random unique identifier (ID) number was directly generated in Qualtrics for consenting individuals. Participants were asked to enter data twice daily for three days. An aggregate summary report was downloaded by the research team. No personal identifiers were available to the study team.

Results:

Results A total of forty-eight users participated in beta-testing conducted between March 31 and April 5, 2020 (Table 1). One individual reported active COVID-19 infection, and forty-seven individuals were not infected. On the last day of monitoring, the individual with COVID-19 infection was asymptomatic. None of the forty-seven other participants reported symptoms concerning for COVID-19 infection. By the April 5, thirty-eight of the forty-seven individuals had completed three days of reporting and were no longer submitting reports.

Conclusions:

We designed and deployed a user-friendly and scalable rapid response system to efficiently monitor individuals with or exposed to COVID-19 while maintaining privacy. The system is designed to accommodate data from millions of unique individuals. Reports can be automatically generated by agencies/institutions that include only their own institution-specific data. Our beta-test demonstrates feasibility and functionality of the Symptom Tracker and Reporter. Actionable information such as the ID number alert for the person whose symptoms have resolved or an individual with new symptoms would provide data to inform individual and institutional decision making. Information on the individuals who have not submitted data for the past twenty four hours is also generated, and allows institutions to identify subgroups of individuals who may need to be contacted. Possible explanations for this including non-compliance with requests for entering symptoms, completion of the recommended quarantine/isolation period that would thus be an alert to remove the isolation/quarantine order, or possibly due to worsening symptoms that have led to hospitalization. We designed the system with a streamlined onboarding process and without inclusion of personal identifiers to facilitate widespread use. Standard procedures to execute data use agreements as is required when identifiers are included are arduous and impractical during this public health emergency. Further, there may be reluctance by the individual to use a system that captures personal identifiers. In Figure 1, we describe the process for institutions/agencies to gain access to the Symptom Tracker by agreeing to the terms of use outlined in Table 2. Participating institutions/agencies are provided with a Reporter executable file and unique authorization code to access data linked to their own entity. Institutions/agencies maintain access to the unique identifiers assigned to individuals they ask to enter data into the system, thereby maintaining privacy and confidentiality from our development team and other system users. The Symptom Tracker is now freely-available to support COVID-19 contact tracing and monitoring. A safety feature alerts individuals who report new or worsening symptoms to contact their healthcare providers. The system also allows prospective monitoring of research cohorts to identify incidence and duration of COVID-19 infection while maintaining confidentiality. Additional modifications have since been implemented including a Spanish language version of the website. There are no geographic limitations to the use of this system, and hence could be implemented in any environment where is internet access is available. Clinical Trial: N/A