Intelligent applications for self-reporting of clinical information

The global COVID-19 pandemic has placed unprecedented health, economic and social pressures on nations around the world. After the initial Wuhan-Hu-1 variant, various SARS-CoV-2 genetic lineages emerged and circulated around the world, including the five successive variants of concern, alpha (B.1.1.7), beta (B.1.351) , gamma (P.1), delta (B.1.617.2) and omicron (B.1.1.529).
1
WHO
SARS-CoV-2 variant tracking.

,

2
Centers for Disaster Control and Prevention
Classifications and definitions of SARS-CoV-2 variants.

Understanding both the characteristics of COVID-19 and the dynamics of its causative variants is a crucial step in preventing transmission and reducing infections, hospitalizations and deaths. Large-scale monitoring tools using simple and accessible devices and allowing rapid and widespread analyzes are highly desirable.

In May 2020, Cristina Menni and her colleagues
3
  • Menni C
  • Valdes AM
  • Freidin MB
  • et al.
Real-time tracking of self-reported symptoms to predict potential COVID-19.

reported the use of a free smartphone app to capture various self-reported symptoms, hospital admissions, RT-PCR or lateral flow antigen test results, demographic information, and pre-existing medical conditions, in order to to identify the most predictive symptoms of COVID-19. This app, named ZOE, provided insight into the usefulness of tracking COVID-19 symptoms.

3
  • Menni C
  • Valdes AM
  • Freidin MB
  • et al.
Real-time tracking of self-reported symptoms to predict potential COVID-19.

Indeed, the combination of only four symptoms (anosmia, fatigue, persistent cough and loss of appetite) made it possible to identify individuals infected during previous waves.

3
  • Menni C
  • Valdes AM
  • Freidin MB
  • et al.
Real-time tracking of self-reported symptoms to predict potential COVID-19.

In The Lancet,
4
  • Menni C
  • Valdes AM
  • Polidori L
  • et al.
A comparison of the prevalence, duration, and risk of hospitalization of SARS-CoV-2 symptoms among vaccinees from the ZOE COVID study during omicron-dominant versus delta-variant periods.

the same team reports its use of the ZOE app to quantify the prevalence and duration of each of 32 COVID-19-related symptoms and the risk of hospitalization in people who had received two or three doses of any vaccine against SARS-CoV-2 and who were infected during periods of prevalence of the omicron or delta variant in the UK. Patients were matched 1:1 for age, sex and vaccination dose. Compared with other studies,

5
  • Espenhain L
  • Funk T
  • Overvad M
  • et al.
Epidemiological characterization of the first 785 cases of SARS-CoV-2 omicron variant in Denmark, December 2021.

,

6
  • Houhamdi L.
  • Gautret P.
  • Hoang VT
  • Fournier PE
  • Colson P.
  • Raoult D
Characteristics of the first 1119 cases of the SARS-CoV-2 Omicron variant, in Marseille, France, November-December 2021.

,

7
  • Wolter N.
  • Jassat W
  • Walaza S
  • et al.
Early assessment of clinical severity of SARS-CoV-2 omicron variant in South Africa: a data linkage study.

Menni and colleagues report that omicron infections were associated with less anosmia and lower airway involvement, and a shorter duration of the acute phase, whereas delta-infected patients had less hoarseness. and sore throat.

4
  • Menni C
  • Valdes AM
  • Polidori L
  • et al.
A comparison of the prevalence, duration, and risk of hospitalization of SARS-CoV-2 symptoms among vaccinees from the ZOE COVID study during omicron-dominant versus delta-variant periods.

Additionally, patients who received a booster vaccine had a greater reduction in symptoms and were twice as likely to recover within a week of the onset of omicron symptoms than those who received two doses, or those infected with delta who had received two or three doses.

4
  • Menni C
  • Valdes AM
  • Polidori L
  • et al.
A comparison of the prevalence, duration, and risk of hospitalization of SARS-CoV-2 symptoms among vaccinees from the ZOE COVID study during omicron-dominant versus delta-variant periods.

This study has many strengths. First, it is a prospective survey with a 1:1 matching design and uses an emerging concept, i.e., real-time recording of multiple clinical symptoms based on self-reported information by patients. participants themselves. Second, the cohort of fully vaccinated or boosted individuals subsequently infected with omicron or delta variants was large. And last, but not least, this was the first study to detail every symptom and duration of acute illness in every infected vaccinee.

Mobile apps for disease monitoring are very valuable
8
  • Mugenyi L
  • Namugabwe Nsubuga R
  • Wanyana I
  • Muttamba F
  • Mbona Tumwesigye N
  • Hannington Nsubuga S
Feasibility of using a mobile app to monitor and report COVID-19 related symptoms and movement of people in Uganda.

and can easily be implemented worldwide and in different languages. However, this strategy has several limitations, as recognized by Menni and his colleagues.

4
  • Menni C
  • Valdes AM
  • Polidori L
  • et al.
A comparison of the prevalence, duration, and risk of hospitalization of SARS-CoV-2 symptoms among vaccinees from the ZOE COVID study during omicron-dominant versus delta-variant periods.

First, the relevance of each item did not seem to be explained to participants in order to increase their involvement and attendance, and the use of error reminders at each stage of filling out the online form is important. Second, participants under the age of 16 and those with a body mass index above 55 kg/m2 were excluded.

4
  • Menni C
  • Valdes AM
  • Polidori L
  • et al.
A comparison of the prevalence, duration, and risk of hospitalization of SARS-CoV-2 symptoms among vaccinees from the ZOE COVID study during omicron-dominant versus delta-variant periods.

However, patients in these categories should not be overlooked when working with COVID-19. Indeed, cases of omicron have been reported in patients under the age of 16,

6
  • Houhamdi L.
  • Gautret P.
  • Hoang VT
  • Fournier PE
  • Colson P.
  • Raoult D
Characteristics of the first 1119 cases of the SARS-CoV-2 Omicron variant, in Marseille, France, November-December 2021.

and obesity is an indisputable comorbidity factor in the severity of COVID-19. Third, patients who reported symptoms within 7 days of vaccination were excluded because symptoms during this period could reflect reactions to the vaccine and not be due to COVID-19.

4
  • Menni C
  • Valdes AM
  • Polidori L
  • et al.
A comparison of the prevalence, duration, and risk of hospitalization of SARS-CoV-2 symptoms among vaccinees from the ZOE COVID study during omicron-dominant versus delta-variant periods.

This assumption may underestimate early post-vaccination infections.

Finally, adding information not currently explored should be possible, such as the history of a previous episode of COVID-19; possible co-infection with another respiratory pathogen; confirmation of variants by genotyping screening or genomic sequencing; creation of a unique and lifetime identifier per individual; and specialized consultations for better participant management.

As of February 21, 2022, COVID-19 has caused 424,718,523 confirmed cases and 5,889,150 deaths worldwide.
9
Johns Hopkins University CSSEOur world in data
COVID-19: daily dashboard.

The severity of this disease and the unprecedented ability of SARS-CoV-2 to modify its genome and spread in successive waves underscore the usefulness of easy-to-use mobile applications such as ZOE to quickly assess the characteristics of a new variant and implement management measures.

We declare no competing interests.

The references

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    SARS-CoV-2 variant tracking.

  2. 2.
    • Centers for Disaster Control and Prevention

    Classifications and definitions of SARS-CoV-2 variants.

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    • Menni C
    • Valdes AM
    • Freidin MB
    • et al.

    Real-time tracking of self-reported symptoms to predict potential COVID-19.

    NatMed. 2020; 26: 1037-1040

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    • Menni C
    • Valdes AM
    • Polidori L
    • et al.

    A comparison of the prevalence, duration, and risk of hospitalization of SARS-CoV-2 symptoms among vaccinees from the ZOE COVID study during omicron-dominant versus delta-variant periods.

    Lancet. 2022; ()

  5. 5.
    • Espenhain L
    • Funk T
    • Overvad M
    • et al.

    Epidemiological characterization of the first 785 cases of SARS-CoV-2 omicron variant in Denmark, December 2021.

    Euro Surveillance. 2021; 262101146

  6. 6.
    • Houhamdi L.
    • Gautret P.
    • Hoang VT
    • Fournier PE
    • Colson P.
    • Raoult D

    Characteristics of the first 1119 cases of the SARS-CoV-2 Omicron variant, in Marseille, France, November-December 2021.

    J Med Virol. 2022; 94: 2290-2295

  7. 7.
    • Wolter N.
    • Jassat W
    • Walaza S
    • et al.

    Early assessment of clinical severity of SARS-CoV-2 omicron variant in South Africa: a data linkage study.

    Lancet. 2022; 399: 437-446

  8. 8.
    • Mugenyi L
    • Namugabwe Nsubuga R
    • Wanyana I
    • Muttamba F
    • Mbona Tumwesigye N
    • Hannington Nsubuga S

    Feasibility of using a mobile app to monitor and report COVID-19 related symptoms and movement of people in Uganda.

    PLoS One. 2021; 16e0260269

  9. 9.
    • Johns Hopkins University CSSE
    • Our world in data

    COVID-19: daily dashboard.

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