Surveillance of COVID-19 in the General Population Using an Online Questionnaire: Report From 18,161 Respondents in China (Preprint)

Abstract

BACKGROUND The recent outbreak of the coronavirus disease (COVID-19) has become an international pandemic. So far, little is known about the role of an internet approach in COVID-19 surveillance. OBJECTIVE The aim of this study is to investigate whether an online survey can provide population-level information for observing prevalence trends during the early phase of an outbreak and identifying potential risk factors of COVID-19 infection. METHODS A 10-item online questionnaire was developed according to medical guidelines and relevant publications. It was distributed between January 24 and February 17, 2020. The characteristics of respondents and temporal changes of various questionnaire-derived indicators were analyzed. RESULTS A total of 18,161 questionnaires were returned, including 6.45% (n=1171) from Wuhan City. Geographical distributions of the respondents were consistent with the population per province (<i>R</i><sup>2</sup>=0.61, <i>P</i><.001). History of contact significantly decreased with time, both outside Wuhan City (<i>R</i><sup>2</sup>=0.35, <i>P</i>=.002) and outside Hubei Province (<i>R</i><sup>2</sup>=0.42, <i>P</i><.001). The percentage of respondents reporting a fever peaked around February 8 (<i>R</i><sup>2</sup>=0.57, <i>P</i><.001) and increased with a history of contact in the areas outside Wuhan City (risk ratio 1.31, 95% CI 1.13-1.52, <i>P</i><.001). Male sex, advanced age, and lung diseases were associated with a higher risk of fever in the general population with a history of contact. CONCLUSIONS This study shows the usefulness of an online questionnaire for the surveillance of outbreaks like COVID-19 by providing information about trends of the disease and aiding the identification of potential risk factors.

COVID-19 and Sex-/Gender-Specific Differences: Understanding the Discrimination

“…8 Other studies likewise consistently showed significant sex-specific differences in clinical characteristics and prognosis, with male sex as a risk factor for severe disease and mortality. 16,[19][20][21][22] Potential Causes of Sex and Gender Differences in This striking support for a male bias toward worse clinical outcomes in the COVID-19 pandemic demonstrated by the global epidemiologic data deserves investigation of the mechanisms underlying these sex-and perhaps genderbased differences. There are multiple plausible explanations, including (1) sex-specific biological differences (differences in the immune or inflammatory response, genetic profile, hormone types and levels, and differential expression of angiotensin-converting enzyme 2 [ACE2], the receptor for SARS CoV-2); (2) gender-specific behavioral or lifestyle differences; and/or (3) differences in underlying comorbid conditions.…”

“…8 Other studies likewise consistently showed significant sex-specific differences in clinical characteristics and prognosis, with male sex as a risk factor for severe disease and mortality. 16,[19][20][21][22]…”