A Self-Assessment Web-Based App to Assess Trends of the COVID-19 Pandemic in France: Observational Study

Fabrice Denis, Arnaud Fontanet, Yann-Mael Le Douarin, Florian Le Goff, Stephan Jeanneau, François-Xavier Lescure, Fabrice Denis, Arnaud Fontanet, Yann-Mael Le Douarin, Florian Le Goff, Stephan Jeanneau, François-Xavier Lescure

Abstract

Background: We developed a self-assessment and participatory web-based triage app to assess the trends of the COVID-19 pandemic in France in March 2020.

Objective: We compared daily large-scale RT-PCR test results to monitor recent reports of anosmia through a web-based app to assess the dynamics of emergency department visits, hospitalizations, and intensive care unit (ICU) admissions among individuals with COVID-19 in France.

Methods: Between March 21 and November 18, 2020, users of the maladiecoronavirus.fr self-triage app were asked questions about COVID-19 symptoms. Data on daily hospitalizations, large-scale positive results on RT-PCR tests, emergency department visits, and ICU admission of individuals with COVID-19 were compared to data on daily reports of anosmia on the app.

Results: As of November 18, 2020, recent anosmia was reported 575,214 times from among approximately 13,000,000 responses. Daily anosmia reports during peak engagement with the app on September 16, 2020, were spatially correlated with the peak in daily COVID-19-related hospitalizations in November 2020 (Spearman rank correlation coefficient [ρ]=0.77; P<.001). This peak in daily anosmia reports was observed primarily among young adults (age range 18-40 years), being observed 49 days before the peak of hospitalizations that corresponded to the first wave of infections among the young population, followed by a peak in hospitalizations among older individuals (aged ≥50 years) in November 2020. The reduction in the daily reports of anosmia associated with the peaks in the number of cases preceded the reduction in daily hospitalizations by 10 and 9 days during the first and the second waves of infection, respectively, although the reduction in the positivity rates on RT-PCR tests preceded the reduction in daily hospitalizations by only 2 days during the second wave of infections.

Conclusions: Data on daily reports of anosmia collected through a nationwide, web-based self-assessment app can be a relevant tool to anticipate surges in outbreaks, hospitalizations, and ICU admission during the COVID-19 pandemic.

Trial registration: ClinicalTrials.gov NCT04331171; https://ichgcp.net/clinical-trials-registry/NCT04331171.

Keywords: COVID-19; France; app; big data; diagnosis; diagnostic test; digital health; mobile phone; observational; participatory app; self-assessment; surveillance; trend; web-based app.

Conflict of interest statement

Conflicts of Interest: FD reports receiving a personal fee from AstraZeneca, Ipsen, Sivan Innovation, Kelindi, Pfizer, Chugai, and Roche. FD and FLG are the cofounders of Kelindi. SJ is the founder of Adobis Group. Outside of this work, AF receives fees from Gilead and MSD for educational seminars. FXL does not report any conflict of interest.

©Fabrice Denis, Arnaud Fontanet, Yann-Mael Le Douarin, Florian Le Goff, Stephan Jeanneau, François-Xavier Lescure. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 12.03.2021.

Figures

Figure 1
Figure 1
Comparisons between the daily number of hospitalizations and the daily reports of anosmia on the web-based self-triage app maladiecoronavirus.fr during the first and second peaks of the pandemic in France between March 21, 2020, and November 18, 2020. The first peak of hospitalizations occurred on January 4, 2020, and the second one occurred on April 11, 2020. In total, 4 peaks of daily reports of anosmia were recorded from the web-based app: March 23, 2020 (+), July 22, 2020 (++), September 16, 2020 (+++), and October 26, 2020 (++++). *Peak of hospitalizations during the first wave of the COVID-19 pandemic. **Peak of hospitalizations during the second wave of the COVID-19 pandemic. The graph shows a reduction in the number of connections 10 days before the reduction in daily hospitalizations during the first wave of the pandemic and 9 days before the reduction in daily hospitalizations during the second wave (semilog scale). Red transparent windows show the reduction in daily reports of anosmia, and blue transparent windows show the reduction in the number of daily hospitalizations during the first and second waves of the pandemic.
Figure 2
Figure 2
Age of users reporting anosmia on the web-based self-triage app maladiecoronavirus.fr during the COVID-19 outbreak in France. (2A) Median age of the users of the app. *Peak of hospitalizations during the first wave of the pandemic. **Peak of hospitalizations during the second wave of the pandemic. Four peaks of daily reports of anosmia were recorded from the web-based app: the first peak of reports of anosmia (+; median age=40 years), second peak of reports of anosmia (++; median age=32 years), third peak of reports of anosmia (+++; median age=30 years), and fourth peak of reports of anosmia (++++; median age=37 years). (2B) Histograms of the number of reports of anosmia based on the age of the users during third and fourth peaks of connections. Users of aged >45 years were more numerous in the October 2020 outbreak than in the September 2020 outbreak peak of during the second wave of hospitalizations (n=190/2088, 9.1% vs n=402/1668, 24.1% respectively).
Figure 3
Figure 3
Trends of the COVID-19 pandemic during the second wave of infections in France from August 10 to November 18, 2020: (3A) comparison between the number of daily reports of anosmia and positive outcomes on daily RT–PCR tests; (3B) comparison between the number of daily reports of anosmia and the number of emergency department visits; (3C) comparison between the number of daily reports of anosmia and the number of daily hospitalizations; and (3D) comparison between the number of daily reports of anosmia and the number of daily admissions to the intensive care unit.
Figure 4
Figure 4
Maps displaying the correlation between daily reports of anosmia with COVID-19–related hospitalizations during the second wave of the pandemic in France. The cumulative number of (4A) daily reports of anosmia during September 15-17, 2020; (4B) positive outcomes on large-scale RT–PCR tests on September 16, 2020; and (4C) daily hospitalizations of individuals with COVID-19 in France during November 3-5, 2020.

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