Digital acoustic surveillance for early detection of respiratory disease outbreaks in Spain: a protocol for an observational study

Abstract

Introduction: Cough is a common symptom of COVID-19 and other respiratory illnesses. However, objectively measuring its frequency and evolution is hindered by the lack of reliable and scalable monitoring systems. This can be overcome by newly developed artificial intelligence models that exploit the portability of smartphones. In the context of the ongoing COVID-19 pandemic, cough detection for respiratory disease syndromic surveillance represents a simple means for early outbreak detection and disease surveillance. In this protocol, we evaluate the ability of population-based digital cough surveillance to predict the incidence of respiratory diseases at population level in Navarra, Spain, while assessing individual determinants of uptake of these platforms.

Methods and analysis: Participants in the Cendea de Cizur, Zizur Mayor or attending the local University of Navarra (Pamplona) will be invited to monitor their night-time cough using the smartphone app Hyfe Cough Tracker. Detected coughs will be aggregated in time and space. Incidence of COVID-19 and other diagnosed respiratory diseases within the participants cohort, and the study area and population will be collected from local health facilities and used to carry out an autoregressive moving average analysis on those independent time series. In a mixed-methods design, we will explore barriers and facilitators of continuous digital cough monitoring by evaluating participation patterns and sociodemographic characteristics. Participants will fill an acceptability questionnaire and a subgroup will participate in focus group discussions.

Ethics and dissemination: Ethics approval was obtained from the ethics committee of the Centre Hospitalier de l'Université de Montréal, Canada and the Medical Research Ethics Committee of Navarre, Spain. Preliminary findings will be shared with civil and health authorities and reported to individual participants. Results will be submitted for publication in peer-reviewed scientific journals and international conferences.

Trial registration number: NCT04762693.

Keywords: COVID-19; epidemiology; respiratory infections.

Conflict of interest statement

Competing interests: JB is the CEO of Hyfe.

© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Study design, timeline and monitoring plan for the study’s primary objective.

Figure 2

Receiver operating characteristic analysis showing an area under the curve (AUC) of 0.995 for the classification of cough in participants recruited between November and December 2020.

Figure 3

Coughs per person-hour registered in participants recruited between November 2020 and January 2021.

Figure 4

Heat map of registered cough episodes in the municipalities of Zizur Mayor, Cendea de Cizur, and Pamplona between November 2020 and March 2021 (Cendea de Cizur is an incontiguous municipality).