Digital COVID-19 'Symptom Checkers' Lack Treatment Priority

Highlights:

Digital COVID-19 'symptom checkers' use is on the rise as they are currently being used at a national level to pick up COVID-19 infection
Lack of the questionnaires’ potential to discriminate between degrees of severity of COVID-19 puts the patient at risk of improper triaging during the pandemic
Reduction of physical contacts may allow symptom checkers to potentially save valuable resources and reduce viral spread

COVID-19 online 'symptom checkers' may stop some patients getting prompt treatment for serious illness, as per an international case simulation study published in the online journal BMJ Health & Care Informatics.

Digital symptom checkers consist of a series of set questions and pre-determined responses that can predict the most appropriate course of action for a person. The patients utilize the assessment services for seeking guidance about health problems. But the identification of the severe COVID-19 symptoms like bacterial pneumonia, and sepsis, failed to render appropriate advice, asking most of the cases to stay at home, as revealed by symptom checkers both in the US and UK.

Most of the COVID-19 infections mimic common clinical conditions (with no specific clinical signs or symptoms that predict the severity of the disease) that rarely require medical attention. This makes it challenging to identify the right patient for a specific group of treatment.

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‘With the increasing trend of Digital COVID-19 'symptom checkers' use to pick up COVID-19 infection, the lack of potential to discriminate between degrees of COVID-19 severityby the digital platform puts the patient at risk with improper triaging during the pandemic.’
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Use of Digital Symptom Checkers during COVID-19 Pandemic

The study reports a lack of evidence on the effectiveness or safety of symptom checkers to prioritize the treatment (triaging) during a pandemic. Thus, the ability of national government-sponsored digital symptom checkers to correctly triage people in need of a medical assessment and/or treatment was examined in Singapore, Japan, the US, and the UK.

The Singapore COVID-19 Symptom Checker; Stop COVID-19 Symptom Checker (Japan); CDC Coronavirus Symptom Checker (US); and 111 COVID-19 Symptom Checker (UK) were among the list.

Since the death rates from COVID-19, in Singapore and Japan, are comparatively low than in the US and the UK (high), the study team explored the capacity of the symptom checkers in differentiating mild & severe COVID-19 and picking up COVID-19 'mimickers' like bacterial pneumonia and sepsis in 52 standardized case scenarios.

Simulation of common COVID-19 related signs/symptoms of varying severity and risk factors and respect to the patient's age were done. These include cough and fever, shortness of breath, a co-existing condition (high blood pressure), and suppressed immunity due to drug treatment.

It was found that the symptom checkers in Singapore and Japan were capable of triaging twice as many cases for direct clinical assessment and overall referral rate at 88% when compared to those in the US (38% referral rate) and the UK.

Coronavirus
Coronaviruses infect animals, humans, and birds. Human coronaviruses, such as SARS, MERS, and 2019-nCoV cause respiratory distress and even death. The S protein is the infectious agent of the virus.

Lack of Questionnaires in Digital Symptom Checkers

Most of the simulated cases with possible severe COVID-19, bacterial pneumonia, and sepsis were triaged to either stay home or seek medical attention within 24 hours for possible neutropenic (low white cell count after chemotherapy) sepsis, as per UK's and US symptom checker respectively. Thus, the questionnaires lack the potential to discriminate between degrees of severity.

"Both symptom checkers maintain a high threshold for referring onward to clinical contact, triaging the majority of patients to stay home with no clinical contact." "whilst 'symptom checkers' may be of use to the healthcare COVID-19 response, there is the potential for such patient-led assessment tools to worsen outcomes by delaying appropriate clinical assessment. Our results support the recommendation that symptom checkers should be subjected to the same level of evidenced-based quality assurance as other diagnostic tests before implementation", concludes the study. The team acknowledges the fact that reduction of physical contacts may allow symptom checkers to potentially save valuable resources and reduce viral spread, as only fewer resources are required by them when compared to phone and telemedicine triaging services.

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Key Ways to Slow COVID-19 Spread

While many countries are experiencing the effects of a second wave of Coronavirus, safety practices like wearing a mask, cleaning your hands, and coughing into a bent elbow or tissue along with physical distancing (6 feet about 2 arm’s length) may help evade the severity of COVID-19 infection
Get a COVID-19 vaccine
Seek medical advice at the earliest if any symptoms suspected of COVID-19
Avoid crowd and poorly ventilated spaces

Reference:

Performance of national COVID-19 ‘symptom checkers’: a comparative case simulation study: Fatma Mansab et al: BMJ Health & Care Informatics 2021: http://dx.doi.org/10.1136/bmjhci-2020-100187,/li>

Source-Medindia

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