Participatory COVID-19 Surveillance Tool in Rural Appalachia : Real-Time Disease Monitoring and Regional Response

Abstract

Introduction: Few US studies have examined the usefulness of participatory surveillance during the coronavirus disease 2019 (COVID-19) pandemic for enhancing local health response efforts, particularly in rural settings. We report on the development and implementation of an internet-based COVID-19 participatory surveillance tool in rural Appalachia.

Methods: A regional collaboration among public health partners culminated in the design and implementation of the COVID-19 Self-Checker, a local online symptom tracker. The tool collected data on participant demographic characteristics and health history. County residents were then invited to take part in an automated daily electronic follow-up to monitor symptom progression, assess barriers to care and testing, and collect data on COVID-19 test results and symptom resolution.

Results: Nearly 6500 county residents visited and 1755 residents completed the COVID-19 Self-Checker from April 30 through June 9, 2020. Of the 579 residents who reported severe or mild COVID-19 symptoms, COVID-19 symptoms were primarily reported among women (n = 408, 70.5%), adults with preexisting health conditions (n = 246, 70.5%), adults aged 18-44 (n = 301, 52.0%), and users who reported not having a health care provider (n = 131, 22.6%). Initial findings showed underrepresentation of some racial/ethnic and non-English-speaking groups.

Practical implications: This low-cost internet-based platform provided a flexible means to collect participatory surveillance data on local changes in COVID-19 symptoms and adapt to guidance. Data from this tool can be used to monitor the efficacy of public health response measures at the local level in rural Appalachia.

Keywords: COVID-19; digital epidemiology; internet data collection; longitudinal assessment; online data entry; participatory surveillance; symptom checker.

Figure 1

Zip code–level map of residents who completed the COVID-19 Self-Checker tool, by proportion of residents self-reporting (A) mild symptoms, (B) severe symptoms, and (C) mild and severe symptoms and (D) the total number of Self-Checker users, Buncombe County, North Carolina, April 30–June 9, 2020. The Self-Checker is an internet-based participatory surveillance system that comprises an initial COVID-19 symptom checker and includes an option for individual follow-up with county public health staff members. Abbreviation: COVID-19, coronavirus disease 2019.

Figure 2

The cumulative distribution plots of the number of visits before a person undergoing follow-up for self-reported (A) severe or (B) mild COVID-19 symptoms connected with a health care provider, COVID-19 Self-Checker tool, Buncombe County, North Carolina, April 30–June 9, 2020. The COVID-19 Self-Checker tool is an internet-based participatory surveillance system that comprises an initial COVID-19 symptom checker and includes an option for individual follow-up with county public health staff members. Abbreviation: COVID-19, coronavirus disease 2019.