JMIR Publications

ABSTRACT

Background:

In 2020, at the onset of the COVID-19 pandemic, the United States experienced surges in healthcare needs which challenged capacity throughout the healthcare system. Stay-at-home orders in many jurisdictions, cancellation of elective procedures, and closures of outpatient medical offices disrupted patient access to care. To inform symptomatic persons about when to seek care and potentially help alleviate the burden on the healthcare system, the Centers for Disease Control and Prevention (CDC) and partners developed the CDC Coronavirus Self-Checker (“Self-Checker”), an interactive clinical assessment tool that assists individuals seeking health information about COVID-19 to determine the appropriate level of care based on responses to demographic, clinical, and non-clinical questions during an online “conversation.”

Objective:

This paper describes user characteristics and recommendations delivered by the Self-Checker between March 23, 2020 and April 19,2021, for pursuing appropriate levels of medical care, depending on the severity of user symptoms.

Methods:

User characteristics and trends in completed conversations that resulted in a care message were analyzed. Care messages delivered by the Self-Checker were classified into three categories : 1) seek care immediately; 2) take no action, or stay home and self-monitor; and 3) conversation redirected. Trends in 7-day averages of conversations and COVID-19 cases were examined with development and marketing milestones that potentially impacted Self-Checker user engagement.

Results:

United States users initiated 16,718,667 completed conversations with the Self-Checker during the study period. Among these, the Self-Checker delivered recommendations for 70% of conversations to “take no action, or stay home and self- monitor,” 29% of conversations to “seek care immediately,” and less than 2% of conversations were redirected to other resources without providing clinical care advice. Among 8.8 million conversations initiated for self-reported sick individuals, 46% resulted in the Self-Checker providing a recommendation to “take no action, or stay home and self-monitor.” These conversations were for sick individuals who did not experience life-threatening symptoms but did report either one COVID-19 symptom or non-COVID related symptoms. The remaining 54% of sick individuals were recommended to “seek care immediately” if they had at least one comorbidity that put them at higher risk of getting severely sick with COVID-19, had life-threatening symptoms, or had two or more symptoms related to COVID-19. Nearly 100% of individuals who were not sick were advised to “take no action, or stay home and self-monitor.”

Conclusions:

The Self-Checker aimed to provide appropriate care advice for over 16 million conversations; for 70% of conversations, the Self-Checker advised individuals to take no action, or stay home and self-monitor. This guidance may have reduced patient volume on the medical system, but future studies evaluating patients’ course of action, intention to follow care advice received, and care modality pursued could clarify the impact of the Self-Checker and similar tools during future public health emergencies.