RESUMO
BackgroundLimitations in laboratory diagnostic capacity and reporting delays have hampered efforts to mitigate and control the ongoing COVID-19 pandemic globally. Syndromic surveillance of COVID-19 is an important public health tool that can help detect outbreaks, mobilize a rapid response, and thereby reduce morbidity and mortality. The primary objective of this study was to determine whether syndromic surveillance through self-reported COVID-19 symptoms could be a timely proxy for laboratory-confirmed case trends in the Canadian province of Ontario. MethodsWe retrospectively analyzed self-reported symptoms data collected using an online tool - Outbreaks Near Me (ONM) - from April 20th to Oct 11th, 2020 in Ontario, Canada. We estimated the correlation coefficient between the weekly proportion of respondents reporting a COVID-like illness (CLI) to both the weekly number of PCR-confirmed COVID-19 cases and the percent positivity in the same period for the same week and with a one-week lag. ResultsThere were 314,686 responses from 188,783 unique respondents to the ONM symptom survey. Respondents were more likely to be female and be in the 40-59 age demographic compared to the Ontario general population. There was a strong positive correlation between the weekly number of reported cases in Ontario and the percent of respondents reporting CLI each week (r = 0.89, p <0.01) and with a one-week lag (r = 0.89, p <0.01). InterpretationWe demonstrate a strong positive and significant correlation (r = 0.89, p <0.01) between percent of self-reported COVID-like illness and the subsequent weeks COVID-19 cases reported, highlighting that a rise in CLI may precede official statistics by at least 1 week. This demonstrates the utility of syndromic surveillance in predicting near-future disease activity. Digital surveillance systems are low-cost tools that may help measure the burden of COVID-19 in a community if there is under-detection of cases through conventional laboratory diagnostic testing. This additional information can be used to guide a healthcare response and policy decisions.
RESUMO
BackgroundSyndromic surveillance systems for COVID-19 are being increasingly used to track and predict outbreaks of confirmed cases. Seasonal circulating respiratory viruses share syndromic overlap with COVID-19, and it is unknown how they will impact the performance of syndromic surveillance tools. Here we investigated the role of non-SARS-CoV-2 respiratory virus test positivity on COVID-19 two independent syndromic surveillance systems in Ontario, Canada. MethodsWe compared the weekly number of reported COVID-19 cases reported in the province of Ontario against two syndromic surveillance metrics: 1) the proportion of respondents with a self-reported COVID-like illness (CLI) from COVID Near You (CNY) and 2) the proportion of emergency department visits for upper respiratory conditions from the Acute Care Enhanced Surveillance (ACES) system. Separately, we plotted the percent positivity for other seasonal respiratory viruses over the same time period and reported Pearsons correlation coefficients before and after the uncoupling of syndromic tools to COVID-19 cases. ResultsThere were strong positive correlations of both CLI and ED visits for upper respiratory causes with COVID-19 cases up to and including a rise in entero/rhinovirus (r = 0.86 and 0.87, respectively). There was a strong negative correlation of both CLI and ED visits for upper respiratory causes with COVID-19 cases (r = -0.85 and -0.91, respectively) during a fall in entero/rhinovirus. InterpretationTwo methods of syndromic surveillance showed strong positive correlations with COVID-19 confirmed case counts before and during a rise in circulating entero/rhinovirus. However, as positivity for enterovirus/rhinovirus fell in late September 2020, syndromic signals became uncoupled from COVID-19 cases and instead tracked the fall in entero/rhinovirus. This finding provides proof-of-principle that regional transmission of seasonal respiratory viruses may complicate the interpretation of COVID-19 surveillance data. It is imperative that surveillance systems incorporate other respiratory virus testing data in order to more accurately track and forecast COVID-19 disease activity.
RESUMO
IntroductionCloth face coverings and surgical masks have become commonplace across the United States in response to the SARS-CoV-2 epidemic. While evidence suggests masks help curb the spread of respiratory pathogens, research is limited. Face masks have quickly become a topic of public debate as government mandates have started requiring their use. Here we investigate the association between self-reported mask wearing, social distancing and community SARS-CoV-2 transmission in the United States, as well as the effect of statewide mandates on mask uptake. MethodsSerial cross-sectional surveys were administered June 3 through July 27, 2020 via web platform. Surveys queried individuals likelihood to wear a face mask to the grocery store or with family and friends. Responses (N=378,207) were aggregated by week and state and combined with measures of the instantaneous reproductive number (Rt), social distancing proxies, respondent demographics and other potential sources of confounding. We fit multivariate logistic regression models to estimate the association between mask wearing and community transmission control (Rt <1) for each state and week. Multiple sensitivity analyses were considered to corroborate findings across mask wearing definitions, Rt estimators and data sources. Additionally, mask wearing in 12 states was evaluated two weeks before and after statewide mandates. ResultsWe find an upward trend in mask usage across the U.S., although uptake varies by geography and demographic groups. A multivariate logistic model controlling for social distancing and other variables found a 10% increase in mask wearing was associated with a 3.53 (95% CI: 2.03, 6.43) odds of transmission control (Rt <1). We also find that communities with high mask wearing and social distancing have the highest predicted probability of a controlled epidemic. These positive associations were maintained across sensitivity analyses. Segmented regression analysis of mask wearing found no statistical change following mandates, however the positive trend of increased mask wearing over time was preserved. ConclusionWidespread utilization of face masks combined with social distancing increases the odds of SARS-CoV-2 transmission control. Mask wearing rose separately from government mask mandates, suggesting supplemental public health interventions are needed to maximize mask adoption and disrupt the spread of SARS-CoV-2, especially as social distancing measures are relaxed.
RESUMO
BackgroundSyndromic surveillance through web or phone-based polling has been used to track the course of infectious diseases worldwide. Our study objective was to describe the characteristics, symptoms, and self-reported testing rates of respondents in three different COVID-19 symptom surveys in Canada. MethodsData sources consisted of two distinct Canada-wide web-based surveys, and phone polling in Ontario. All three sources contained self-reported information on COVID-19 symptoms and testing. In addition to describing respondent characteristics, we examined symptom frequency and the testing rate among the symptomatic, as well as rates of symptoms and testing across respondent groups. ResultsWe found that 1.6% of respondents experienced a symptom on the day of their survey, 15% of Ontario households had a symptom in the previous week, and 44% of Canada-wide respondents had a symptom in the previous month over March-April 2020. Across the three surveys, SARS-CoV-2-testing was reported in 2-9% of symptomatic responses. Women, younger and middle-aged adults (versus older adults) and Indigenous/First nations/Inuit/Metis were more likely to report at least one symptom, and visible minorities were more likely to report the combination of fever with cough or shortness of breath. InterpretationThe low rate of testing among those reporting symptoms suggests significant opportunity to expand testing among community-dwelling residents of Canada. Syndromic surveillance data can supplement public health reports and provide much-needed context to gauge the adequacy of current SARS-CoV-2 testing rates.
