Background: The pandemic of novel coronavirus disease (COVID-19) is worsening, with the widespread disease spread in most countries. Due to varied clinical characteristics of the disease and lack of access to testing, the true burden of disease may be unknown. Epidemiological data and early signals of COVID-19 infection are crucial for disease investigation. Aim: To assess early signals of COVID-19 in India before official reporting of cases in the country and to compare epidemiological characteristics using different surveillance sources. Methods: We used open-source data from November 2019 to April 2020 from the rapid intelligence surveillance tool Epiwatch to determine trends in " pneumonia of unknown causes" in India. COVID-19 line list was extracted from the crowdsourced database to determine the demographic characteristics of cases. Descriptive analysis was performed to assess the trend of pneumonia of unknown cause in India. Results: Reporting of pneumonia of unknown cause increased in India from 24th January 2020. Before the first notification on 30th January 2020, four cases of pneumonia of unknown cause were identified in news reports. Conclusion: The study findings suggest that COVID-19 may have been present in India before the first notified case. Rapid surveillance tools like Epiwatch can be a useful adjunct to traditional, validated surveillance in estimating the trends and burden of infectious diseases.

Background Residential aged-care facilities in Australia emerged as the high-risk setting during the COVID-19 outbreaks due to community transmission. The vulnerable aged-care residents of these facilities suffered due to low hospital transfers and high mortality and morbidity rates. This study aimed to assess the burden of COVID-19 in residential aged-care facilities across Australia and the impact of hospital transfer policies on resident hospitalisation during the first year of the pandemic.Methods We conducted a retrospective cohort study by collecting data from weekly aged-care outbreak reports published by open-sources and official government sources between 1st March and 20th November 2020.A comprehensive line list of outbreaks was created using open-source data. Statistical analyses were performed on the data obtained.Results 126 aged-care COVID-19 outbreaks were identified in Australia during the study period. The incidence rate of COVID-19 infections among aged-care residents in Australia was (1118.5 per 100,000 resident population) which is 10 times higher than the general population (107.6 per 100,000 population). The hospitalisation rate for aged-care residents in Australia was 0.93 per 100,000 population. The hospitalisation rate of aged-care residents in Victoria was merely 3.14 per 100,000 population despite having the highest COVID-19 cases in the state. Excluding South Australia, all states followed case-by-case hospital transfer policies for aged-care residents.Conclusion This study documented a higher risk of COVID-19 infection for aged-care residents and workers but found low hospitalisation rates among residents across Australia. The hospitalisation rates in Victoria were higher than the national average but low when considering the COVID-19 infection rates in the state. The hospitalisation rates could have been impacted due to the state hospital transfer policies at that time. We recommend immediate hospital transfer of infected residents to hospitals as healthcare settings follow necessary infection control measures and ensure staff are trained in personal protective equipment use.