%0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19043 %T The Three Steps Needed to End the COVID-19 Pandemic: Bold Public Health Leadership, Rapid Innovations, and Courageous Political Will %A Guest,Jodie L %A del Rio,Carlos %A Sanchez,Travis %+ Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 404 727 8403, Travis.Sanchez@emory.edu %K COVID-19 %K coronavirus %K SARS-CoV-2 %D 2020 %7 6.4.2020 %9 Editorial %J JMIR Public Health Surveill %G English %X The world is experiencing the expansive spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) in a global pandemic that is placing strain on health care, economic, and social systems. Commitment to implementing proven public health strategies will require bold public health leadership and courageous acts by politicians. Developing new innovative communication, mitigation, and health care approaches, particularly in the era of social media, is also clearly warranted. We believe that the best public health evidence must inform activities in three priority areas to stop this pandemic: (1) coordinated and consistent stay-at-home orders across multiple jurisdictions, including potential nationwide mandates; (2) rapid scale-up of SARS-CoV-2 testing; and (3) improved health care capacity to respond. This editorial outlines those areas, the rationale behind them, and the call for innovation and engagement of bold public health leadership to empower courageous political action to reduce the number of deaths during this pandemic. %M 32240972 %R 10.2196/19043 %U https://publichealth.jmir.org/2020/2/e19043 %U https://doi.org/10.2196/19043 %U http://www.ncbi.nlm.nih.gov/pubmed/32240972 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e15886 %T Iraq Mass Gathering Preparedness and Public Health Recommendations %A Al Nsour,Mohannad %+ Global Health Development/Eastern Mediterranean Public Health Network, Abdallah Ben Abbas St, Building No 42, Amman, 11194, Jordan, 962 77 546 3000, Executive.director@globalhealthdev.org %K mass gathering %K Iraq %D 2020 %7 8.4.2020 %9 Editorial %J JMIR Public Health Surveill %G English %X %M 32267241 %R 10.2196/15886 %U http://publichealth.jmir.org/2020/2/e15886/ %U https://doi.org/10.2196/15886 %U http://www.ncbi.nlm.nih.gov/pubmed/32267241 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e17009 %T Antimicrobial Resistance of Neisseria Gonorrhoeae in a Newly Implemented Surveillance Program in Uganda: Surveillance Report %A Workneh,Meklit %A Hamill,Matthew M %A Kakooza,Francis %A Mande,Emmanuel %A Wagner,Jessica %A Mbabazi,Olive %A Mugasha,Rodney %A Kajumbula,Henry %A Walwema,Richard %A Zenilman,Jonathan %A Musinguzi,Patrick %A Kyambadde,Peter %A Lamorde,Mohammed %A Manabe,Yukari C %+ Division of Infectious Diseases, Johns Hopkins School of Medicine, 5200 Eastern Avenue, Baltimore, MD, 21224, United States, 1 410 550 9080, mhamill6@jhu.edu %K gonorrhea %K antimicrobial resistance %K surveillance %K Uganda %K STD %K STI %K sexually transmitted %K Neisseria Gonorrhoeae %K antibiotic resistance, EGASP %D 2020 %7 10.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Neisseria gonorrhoeae (commonly known as gonorrhea) has developed resistance to all first-line therapy in Southeast Asia. East Africa has historically had absent or rudimentary gonorrhea surveillance programs and, while the existence of antimicrobial-resistant gonorrhea is recognized, the extent of its resistance is largely unknown. In 2016, the World Health Organization’s Enhanced Gonococcal Antimicrobial Surveillance Program (EGASP) was initiated in Uganda to monitor resistance trends. Objective: This study characterizes gonorrhea and antibiotic resistance in a large surveillance program of men with urethral discharge syndrome from Kampala, Uganda. Methods: Men attending sentinel clinics with urethritis provided demographic information, behavior data, and a urethral swab in line with the World Health Organization’s EGASP protocols for culture, identification, and antibiotic-sensitivity testing using 2 methods—disk diffusion (Kirby-Bauer test) and Etest (BioMérieux Inc). A subset of samples underwent detailed antimicrobial resistance testing. Results: Of 639 samples collected from September 2016 to February 2018, 400 (62.6%) were culture-positive though 414 (64.8%) had microscopic evidence of gonorrhea. The mean age of the men from whom the samples were collected was 26.9 (SD 9.6) years and 7.2% (46/639) reported having HIV. There was high-level resistance to ciprofloxacin, tetracycline, and penicillin (greater than 90%) by Kirby-Bauer disk diffusion and 2.1% (4/188) had reduced azithromycin sensitivity by Etest. Of the early isolates that underwent detailed characterization, 60.3% (70/116) were culture-positive, 94% (66/69) isolates were either ciprofloxacin-resistant or ciprofloxacin-intermediate by Etest, 96% (65/68) were azithromycin-sensitive, and 96% (66/69) were gentamicin-sensitive. Resistance profiles were comparable between methods except for ceftriaxone (disk diffusion: 68/69, 99%; Etest: 67/69, 97%) and for gentamicin (disk diffusion: 2/8, 25%; Etest: 66/69, 96%) sensitivity. Conclusions: This is the first report from a systematic gonorrhea surveillance program in Uganda. Findings demonstrated resistance or increased minimum inhibitory concentration to all key antigonococcal antibiotics. There was evidence of poor antibiotic stewardship, near-universal resistance to several antibiotics, and emerging resistance to others. Individuals in the population sampled were at exceptionally high risk of STI and HIV infection requiring intervention. Ongoing surveillance efforts to develop interventions to curtail antimicrobial-resistant gonorrhea are needed. %M 32519969 %R 10.2196/17009 %U http://publichealth.jmir.org/2020/2/e17009/ %U https://doi.org/10.2196/17009 %U http://www.ncbi.nlm.nih.gov/pubmed/32519969 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e15860 %T The Surveillance Outbreak Response Management and Analysis System (SORMAS): Digital Health Global Goods Maturity Assessment %A Tom-Aba,Daniel %A Silenou,Bernard Chawo %A Doerrbecker,Juliane %A Fourie,Carl %A Leitner,Carl %A Wahnschaffe,Martin %A Strysewske,Maté %A Arinze,Chinedu Chukwujekwu %A Krause,Gerard %+ Helmholtz Centre for Infection Research, Department of Epidemiology, Inhoffenstrasse 7, Braunschweig, 38124, Germany, 49 01739136081, daniel.tom-aba@helmholtz-hzi.de %K mHealth %K eHealth %K contact tracing %K case management %K epidemiology %K Ebola Virus Disease %K West Africa %K infectious diseases %D 2020 %7 29.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital health is a dynamic field that has been generating a large number of tools; many of these tools do not have the level of maturity required to function in a sustainable model. It is in this context that the concept of global goods maturity is gaining importance. Digital Square developed a global good maturity model (GGMM) for digital health tools, which engages the digital health community to identify areas of investment for global goods. The Surveillance Outbreak Response Management and Analysis System (SORMAS) is an open-source mobile and web application software that we developed to enable health workers to notify health departments about new cases of epidemic-prone diseases, detect outbreaks, and simultaneously manage outbreak response. Objective: The objective of this study was to evaluate the maturity of SORMAS using Digital Square’s GGMM and to describe the applicability of the GGMM on the use case of SORMAS and identify opportunities for system improvements. Methods: We evaluated SORMAS using the GGMM version 1.0 indicators to measure its development. SORMAS was scored based on all the GGMM indicator scores. We described how we used the GGMM to guide the development of SORMAS during the study period. GGMM contains 15 subindicators grouped into the following core indicators: (1) global utility, (2) community support, and (3) software maturity. Results: The assessment of SORMAS through the GGMM from November 2017 to October 2019 resulted in full completion of all subscores (10/30, (33%) in 2017; 21/30, (70%) in 2018; and 30/30, (100%) in 2019). SORMAS reached the full score of the GGMM for digital health software tools by accomplishing all 10 points for each of the 3 indicators on global utility, community support, and software maturity. Conclusions: To our knowledge, SORMAS is the first electronic health tool for disease surveillance, and also the first outbreak response management tool, that has achieved a 100% score. Although some conceptual changes would allow for further improvements to the system, the GGMM already has a robust supportive effect on developing software toward global goods maturity. %M 32347809 %R 10.2196/15860 %U https://publichealth.jmir.org/2020/2/e15860 %U https://doi.org/10.2196/15860 %U http://www.ncbi.nlm.nih.gov/pubmed/32347809 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e11512 %T Cluster Detection Mechanisms for Syndromic Surveillance Systems: Systematic Review and Framework Development %A Yeng,Prosper Kandabongee %A Woldaregay,Ashenafi Zebene %A Solvoll,Terje %A Hartvigsen,Gunnar %+ Department of Computer Science, University of Tromsø, The Arctic University of Norway, NTNU Gjøvik Teknologiveien 22, Gjøvik, 2815, Norway, 47 96992743, prosper.yeng@gmail.com %K sentinel surveillance %K space-time clustering %K aberration detection %D 2020 %7 26.5.2020 %9 Review %J JMIR Public Health Surveill %G English %X Background: The time lag in detecting disease outbreaks remains a threat to global health security. The advancement of technology has made health-related data and other indicator activities easily accessible for syndromic surveillance of various datasets. At the heart of disease surveillance lies the clustering algorithm, which groups data with similar characteristics (spatial, temporal, or both) to uncover significant disease outbreak. Despite these developments, there is a lack of updated reviews of trends and modelling options in cluster detection algorithms. Objective: Our purpose was to systematically review practically implemented disease surveillance clustering algorithms relating to temporal, spatial, and spatiotemporal clustering mechanisms for their usage and performance efficacies, and to develop an efficient cluster detection mechanism framework. Methods: We conducted a systematic review exploring Google Scholar, ScienceDirect, PubMed, IEEE Xplore, ACM Digital Library, and Scopus. Between January and March 2018, we conducted the literature search for articles published to date in English in peer-reviewed journals. The main eligibility criteria were studies that (1) examined a practically implemented syndromic surveillance system with cluster detection mechanisms, including over-the-counter medication, school and work absenteeism, and disease surveillance relating to the presymptomatic stage; and (2) focused on surveillance of infectious diseases. We identified relevant articles using the title, keywords, and abstracts as a preliminary filter with the inclusion criteria, and then conducted a full-text review of the relevant articles. We then developed a framework for cluster detection mechanisms for various syndromic surveillance systems based on the review. Results: The search identified a total of 5936 articles. Removal of duplicates resulted in 5839 articles. After an initial review of the titles, we excluded 4165 articles, with 1674 remaining. Reading of abstracts and keywords eliminated 1549 further records. An in-depth assessment of the remaining 125 articles resulted in a total of 27 articles for inclusion in the review. The result indicated that various clustering and aberration detection algorithms have been empirically implemented or assessed with real data and tested. Based on the findings of the review, we subsequently developed a framework to include data processing, clustering and aberration detection, visualization, and alerts and alarms. Conclusions: The review identified various algorithms that have been practically implemented and tested. These results might foster the development of effective and efficient cluster detection mechanisms in empirical syndromic surveillance systems relating to a broad spectrum of space, time, or space-time. %M 32357126 %R 10.2196/11512 %U http://publichealth.jmir.org/2020/2/e11512/ %U https://doi.org/10.2196/11512 %U http://www.ncbi.nlm.nih.gov/pubmed/32357126 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e16494 %T An Internet-Based, Peer-Delivered Messaging Intervention for HIV Testing and Condom Use Among Men Who Have Sex With Men in India (CHALO!): Pilot Randomized Comparative Trial %A Patel,Viraj V %A Rawat,Shruta %A Dange,Alpana %A Lelutiu-Weinberger,Corina %A Golub,Sarit A %+ Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Health System, 3300 Kossuth Ave, Bronx, NY, 10467, United States, 1 7189207102, vpatel@montefiore.org %K HIV %K internet %K mHealth %K eHealth %K men who have sex with men %K sexual minority %K LGBT %K India %K intervention %K prevention %K mobile phone %D 2020 %7 16.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Leveraging internet-based communication tools (eg, messaging apps, SMS text messaging, and email) may be an effective avenue for delivery of HIV prevention messages to men who have sex with men (MSM) in India, but there are limited models for such internet-based interventions. Objective: The CHALO! pilot was an online educational and behavioral intervention aimed to determine the feasibility, acceptability, and preliminary impact of a peer-delivered, internet-based messaging intervention for HIV testing and consistent condom use for MSM in India. The messages addressed barriers to HIV testing and condom use and were theoretically based on the information-motivation-behavioral skills model. Methods: Between February and March 2015, we recruited, enrolled, and randomized 244 participants via online advertisements on mobile dating apps and Facebook. Eligible men (18 years or older, sexually active with other men, and self-reported HIV-negative or unknown status) were randomized to receive educational and motivational messages framed as either approach (ie, a desirable outcome to be achieved) or avoidance (an undesirable outcome to be avoided) over 12 weeks via internet-based messaging platforms. Participants completed online surveys at baseline and immediately postintervention. Results: Participants were similar across arms with respect to sociodemographic and behavioral characteristics. Over 82.0% (200/244) of participants were retained (ie, viewed final messages), and 52.3% (130/244) of them completed the follow-up survey. Of those completing the follow-up survey, 82.3% (107/130) liked or strongly liked participating in CHALO!. The results showed a significant increase in self-reported HIV testing in the past 6 months from baseline to follow-up (41/130, 31.5% to 57/130, 43.8%; P=.04). When including those who reported intentions to test, this percentage increased from 44.6% (58/130) at baseline to 65.4% (85/130) at follow-up (P<.01). When examining intentions to test among those without prior HIV testing, intentions increased from 32% (16/50) of the sample at baseline to 56% (28/50) of the sample at follow-up (P=.02). Condom use during anal sex did not significantly change from baseline to follow-up. HIV testing and condom use did not significantly differ between approach and avoidance conditions at follow-up. Conclusions: As one of the first studies of an online HIV prevention intervention for Indian MSM, CHALO! was feasible to implement by a community-based organization, was acceptable to participants, and demonstrated potential to improve HIV testing rates. %M 32297875 %R 10.2196/16494 %U http://publichealth.jmir.org/2020/2/e16494/ %U https://doi.org/10.2196/16494 %U http://www.ncbi.nlm.nih.gov/pubmed/32297875 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e14952 %T Classification of Health-Related Social Media Posts: Evaluation of Post Content–Classifier Models and Analysis of User Demographics %A Rivas,Ryan %A Sadah,Shouq A %A Guo,Yuhang %A Hristidis,Vagelis %+ Department of Computer Science and Engineering, University of California, Riverside, 363 Winston Chung Hall, 900 University Ave, Riverside, CA, 92521, United States, 1 951 827 2838, rriva002@ucr.edu %K social media %K demographics %K classification %D 2020 %7 1.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The increasing volume of health-related social media activity, where users connect, collaborate, and engage, has increased the significance of analyzing how people use health-related social media. Objective: The aim of this study was to classify the content (eg, posts that share experiences and seek support) of users who write health-related social media posts and study the effect of user demographics on post content. Methods: We analyzed two different types of health-related social media: (1) health-related online forums—WebMD and DailyStrength—and (2) general online social networks—Twitter and Google+. We identified several categories of post content and built classifiers to automatically detect these categories. These classifiers were used to study the distribution of categories for various demographic groups. Results: We achieved an accuracy of at least 84% and a balanced accuracy of at least 0.81 for half of the post content categories in our experiments. In addition, 70.04% (4741/6769) of posts by male WebMD users asked for advice, and male users’ WebMD posts were more likely to ask for medical advice than female users’ posts. The majority of posts on DailyStrength shared experiences, regardless of the gender, age group, or location of their authors. Furthermore, health-related posts on Twitter and Google+ were used to share experiences less frequently than posts on WebMD and DailyStrength. Conclusions: We studied and analyzed the content of health-related social media posts. Our results can guide health advocates and researchers to better target patient populations based on the application type. Given a research question or an outreach goal, our results can be used to choose the best online forums to answer the question or disseminate a message. %M 32234706 %R 10.2196/14952 %U https://publichealth.jmir.org/2020/2/e14952 %U https://doi.org/10.2196/14952 %U http://www.ncbi.nlm.nih.gov/pubmed/32234706 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e10919 %T Google Searches and Suicide Rates in Spain, 2004-2013: Correlation Study %A Jimenez,Alberto %A Santed-Germán,Miguel-Angel %A Ramos,Victoria %+ The National Distance Education University (UNED), UNED - Facultad de Psicología, Calle de Juan del Rosal, 10, Madrid, 28040, Spain, 34 646517577, msanted@psi.uned.es %K suicide %K big data %K infodemiology %K infoveillance %K incidence %K help-seeking behaviors %K searching behavior %K early diagnosis %D 2020 %7 13.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Different studies have suggested that web search data are useful in forecasting several phenomena from the field of economics to epidemiology or health issues. Objective: This study aimed to (1) evaluate the correlation between suicide rates released by the Spanish National Statistics Institute (INE) and internet search trends in Spain reported by Google Trends (GT) for 57 suicide-related terms representing major known risks of suicide and an analysis of these results using a linear regression model and (2) study the differential association between male and female suicide rates published by the INE and internet searches of these 57 terms. Methods: The study period was from 2004 to 2013. In this study, suicide data were collected from (1) Spain’s INE and (2) local internet search data from GT, both from January 2004 to December 2013. We investigated and validated 57 suicide-related terms already tested in scientific studies before 2015 that would be the best predictors of new suicide cases. We then evaluated the nowcasting effects of a GT search through a cross-correlation analysis and by linear regression of the suicide incidence data with the GT data. Results: Suicide rates in Spain in the study period were positively associated (r<-0.2) for the general population with the search volume for 7 terms and negatively for 1 from the 57 terms used in previous studies. Suicide rates for men were found to be significantly different than those of women. The search term, “allergy,” demonstrated a lead effect for new suicide cases (r=0.513; P=.001). The next significant correlating terms for those 57 studied were “antidepressant,” “alcohol abstinence,” “relationship breakup” (r=0.295, P=.001; r=0.295, P=.001; and r=0.268, P=.002, respectively). Significantly different results were obtained for men and women. Search terms that correlate with suicide rates of women are consistent with previous studies, showing that the incidence of depression is higher in women than in men, and showing different gender searching patterns. Conclusions: A better understanding of internet search behavior of both men and women in relation to suicide and related topics may help design effective suicide prevention programs based on information provided by search robots and other big data sources. %M 32281540 %R 10.2196/10919 %U https://publichealth.jmir.org/2020/2/e10919 %U https://doi.org/10.2196/10919 %U http://www.ncbi.nlm.nih.gov/pubmed/32281540 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e14986 %T Comparison of Social Media, Syndromic Surveillance, and Microbiologic Acute Respiratory Infection Data: Observational Study %A Daughton,Ashlynn R %A Chunara,Rumi %A Paul,Michael J %+ Analytics, Intelligence and Technology, Los Alamos National Laboratory, Mail Stop F608, Los Alamos, NM, 87545, United States, 1 505 667 7000, adaughton@lanl.gov %K social media %K infodemiology %K influenza, human %K selection bias %K bias %K logistic models %D 2020 %7 24.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Internet data can be used to improve infectious disease models. However, the representativeness and individual-level validity of internet-derived measures are largely unexplored as this requires ground truth data for study. Objective: This study sought to identify relationships between Web-based behaviors and/or conversation topics and health status using a ground truth, survey-based dataset. Methods: This study leveraged a unique dataset of self-reported surveys, microbiological laboratory tests, and social media data from the same individuals toward understanding the validity of individual-level constructs pertaining to influenza-like illness in social media data. Logistic regression models were used to identify illness in Twitter posts using user posting behaviors and topic model features extracted from users’ tweets. Results: Of 396 original study participants, only 81 met the inclusion criteria for this study. Of these participants’ tweets, we identified only two instances that were related to health and occurred within 2 weeks (before or after) of a survey indicating symptoms. It was not possible to predict when participants reported symptoms using features derived from topic models (area under the curve [AUC]=0.51; P=.38), though it was possible using behavior features, albeit with a very small effect size (AUC=0.53; P≤.001). Individual symptoms were also generally not predictable either. The study sample and a random sample from Twitter are predictably different on held-out data (AUC=0.67; P≤.001), meaning that the content posted by people who participated in this study was predictably different from that posted by random Twitter users. Individuals in the random sample and the GoViral sample used Twitter with similar frequencies (similar @ mentions, number of tweets, and number of retweets; AUC=0.50; P=.19). Conclusions: To our knowledge, this is the first instance of an attempt to use a ground truth dataset to validate infectious disease observations in social media data. The lack of signal, the lack of predictability among behaviors or topics, and the demonstrated volunteer bias in the study population are important findings for the large and growing body of disease surveillance using internet-sourced data. %M 32329741 %R 10.2196/14986 %U http://publichealth.jmir.org/2020/2/e14986/ %U https://doi.org/10.2196/14986 %U http://www.ncbi.nlm.nih.gov/pubmed/32329741 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e16061 %T Comparison of Clinical Outcomes of Persons Living With HIV by Enrollment Status in Washington, DC: Evaluation of a Large Longitudinal HIV Cohort Study %A Opoku,Jenevieve %A Doshi,Rupali K %A Castel,Amanda D %A Sorensen,Ian %A Horberg,Michael %A Allston,Adam %A Kharfen,Michael %A Greenberg,Alan E %+ HIV/AIDS, Hepatitis, STD, and TB Administration, DC Health, 899 North Capitol St NE, Washington, DC, United States, 1 202 671 4911, jenevieve.opoku@dc.gov %K HIV %K DC Cohort %K cohort studies %K HIV clinical outcomes %D 2020 %7 15.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: HIV cohort studies have been used to assess health outcomes and inform the care and treatment of people living with HIV disease. However, there may be similarities and differences between cohort participants and the general population from which they are drawn. Objective: The objective of this analysis was to compare people living with HIV who have and have not been enrolled in the DC Cohort study and assess whether participants are a representative citywide sample of people living with HIV in the District of Columbia (DC). Methods: Data from the DC Health (DCDOH) HIV surveillance system and the DC Cohort study were matched to identify people living with HIV who were DC residents and had consented for the study by the end of 2016. Analysis was performed to identify differences between DC Cohort and noncohort participants by demographics and comorbid conditions. HIV disease stage, receipt of care, and viral suppression were evaluated. Adjusted logistic regression assessed correlates of health outcomes between the two groups. Results: There were 12,964 known people living with HIV in DC at the end of 2016, of which 40.1% were DC Cohort participants. Compared with nonparticipants, participants were less likely to be male (68.0% vs 74.9%, P<.001) but more likely to be black (82.3% vs 69.5%, P<.001) and have a heterosexual contact HIV transmission risk (30.3% vs 25.9%, P<.001). DC Cohort participants were also more likely to have ever been diagnosed with stage 3 HIV disease (59.6% vs 47.0%, P<.001), have a CD4 <200 cells/µL in 2017 (6.2% vs 4.6%, P<.001), be retained in any HIV care in 2017 (72.9% vs 59.4%, P<.001), and be virally suppressed in 2017. After adjusting for demographics, DC Cohort participants were significantly more likely to have received care in 2017 (adjusted odds ratio 1.8, 95% CI 1.70-2.00) and to have ever been virally suppressed (adjusted odds ratio 1.3, 95% CI 1.20-1.40). Conclusions: These data have important implications when assessing the representativeness of patients enrolled in clinic-based cohorts compared with the DC-area general HIV population. As participants continue to enroll in the DC Cohort study, ongoing assessment of representativeness will be required. %M 32293567 %R 10.2196/16061 %U https://publichealth.jmir.org/2020/2/e16061 %U https://doi.org/10.2196/16061 %U http://www.ncbi.nlm.nih.gov/pubmed/32293567 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e17733 %T Effectiveness of a Web-Based Intervention to Support Medication Adherence Among People Living With HIV: Web-Based Randomized Controlled Trial %A Côté,José %A Rouleau,Geneviève %A Ramirez-Garcia,Maria Pilar %A Auger,Patricia %A Thomas,Réjean %A Leblanc,Judith %+ Research Centre of the Centre Hospitalier de l’Université de Montréal, 850 Rue Saint-Denis, Montreal, QC, H2X 0A9, Canada, 1 514 890 8000, jose.cote@umontreal.ca %K medication adherence %K people living with HIV %K antiretroviral therapy %K self-management %K nursing %K web-based intervention %K web-based randomized controlled trial %D 2020 %7 20.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Taking antiretroviral therapy (ART) is part of the daily life of people living with HIV. Different electronic health (eHealth) initiatives adjunctive to usual care have been proposed to support optimal medication adherence. A web-based intervention called HIV Treatment, Virtual Nursing Assistance, and Education or VIH-TAVIE (from its French version Virus de l’immunodéficience humaine-Traitement assistance virtuelle infirmière et enseignement) was developed to empower people living with HIV to manage their ART and symptoms optimally. Objective: We aimed to evaluate the effectiveness of VIH-TAVIE in a web-based randomized controlled trial (RCT). Methods: This RCT was entirely web-based, including recruitment, consent granting, questionnaire completion, and intervention exposure (consultation with VIH-TAVIE [experimental group] or websites [control group]). To be eligible for the study, people living with HIV had to be 18 years or older, be on ART for at least 6 months, have internet access, and have internet literacy. Participants were randomly assigned to either the experimental group (n=45) or control group (n=43). The primary outcome was ART adherence. The secondary outcomes included self-efficacy regarding medication intake, symptom-related discomfort, skills and strategies, and social support. All outcomes were measured with a self-administered web-based questionnaire at the following three time points: baseline and 3 and 6 months later. A generalized linear mixed model was built to assess the evolution of ART adherence over time in both groups. Results: The sample included 88 participants, and of these, 73 (83%) were men. The median age of the participants was 42 years. Participants had been diagnosed with HIV a median of 7 years earlier (IQR 3-17) and had been on ART for a median of 5 years (IQR 2-12). The proportion of treatment-adherent participants at baseline was high in both groups (34/41, 83% in the experimental group and 30/39, 77% in the control group). Participants also reported high treatment adherence, high self-efficacy, and high skills; perceived good social support; and experienced low discomfort from symptoms. Analyses revealed no intergroup difference regarding ART adherence (OR 1.9, 95% CI 0.6-6.4). Conclusions: This study highlights the challenges and lessons learned from conducting an entirely web-based RCT among people living with HIV. The challenges were related to the engagement of people living with HIV on the following three levels: starting the web-based study (recruitment), completing the web-based intervention (engagement), and continuing the study (retention). The results contribute to the existing body of knowledge regarding how to conduct web-based evaluation studies of eHealth interventions aimed at developing and strengthening personal skills and abilities. Trial Registration: ClinicalTrials.gov NCT01510340; https://clinicaltrials.gov/ct2/show/NCT01510340 %M 32310145 %R 10.2196/17733 %U http://publichealth.jmir.org/2020/2/e17733/ %U https://doi.org/10.2196/17733 %U http://www.ncbi.nlm.nih.gov/pubmed/32310145 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e15079 %T Recommendations From a Descriptive Evaluation to Improve Screening Procedures for Web-Based Studies With Couples: Cross-Sectional Study %A Mitchell,Jason W %A Chavanduka,Tanaka M D %A Sullivan,Stephen %A Stephenson,Rob %+ Office of Public Health Studies, Myron B Thompson School of Social Work, University of Hawai’i at Mānoa, 1960 East-West Road, Biomed T110, Honolulu, HI, 96822, United States, 1 808 956 3342, jasonmit@hawaii.edu %K couples %K methods %K internet %D 2020 %7 12.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although there are a number of advantages to using the internet to recruit and enroll participants into Web-based research studies, these advantages hinge on data validity. In response to this concern, researchers have provided recommendations for how best to screen for fraudulent survey entries and to handle potentially invalid responses. Yet, the majority of this previous work focuses on screening (ie, verification that individual met the inclusion criteria) and validating data from 1 individual, and not from 2 people who are in a dyadic relationship with one another (eg, same-sex male couple; mother and daughter). Although many of the same data validation and screening recommendations for Web-based studies with individual participants can be used with dyads, there are differences and challenges that need to be considered. Objective: This paper aimed to describe the methods used to verify and validate couples’ relationships and data from a Web-based research study, as well as the associated lessons learned for application toward future Web-based studies involving the screening and enrollment of couples with dyadic data collection. Methods: We conducted a descriptive evaluation of the procedures and associated benchmarks (ie, decision rules) used to verify couples’ relationships and validate whether data uniquely came from each partner of the couple. Data came from a large convenience sample of same-sex male couples in the United States, who were recruited through social media venues for a Web-based, mixed methods HIV prevention research study. Results: Among the 3815 individuals who initiated eligibility screening, 1536 paired individuals (ie, data from both partners of a dyad) were assessed for relationship verification; all passed this benchmark. For data validation, 450 paired individuals (225 dyads) were identified as fraudulent and failed this benchmark, resulting in a total sample size of 1086 paired participants representing 543 same-sex male couples who were enrolled. The lessons learned from the procedures used to screen couples for this Web-based research study have led us to identify and describe four areas that warrant careful attention: (1) creation of new and replacement of certain relationship verification items, (2) identification of resources needed relative to using a manual or electronic approach for screening, (3) examination of approaches to link and identify both partners of the couple, and (4) handling of bots. Conclusions: The screening items and associated rules used to verify and validate couples’ relationships and data worked yet required extensive resources to implement. New or updating some items to verify a couple’s relationship may be beneficial for future studies. The procedures used to link and identify whether both partners were coupled also worked, yet they call into question whether new approaches are possible to help increase linkage, suggesting the need for further inquiry. %M 32396133 %R 10.2196/15079 %U http://publichealth.jmir.org/2020/2/e15079/ %U https://doi.org/10.2196/15079 %U http://www.ncbi.nlm.nih.gov/pubmed/32396133 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e17217 %T Time From HIV Diagnosis to Viral Suppression: Survival Analysis of Statewide Surveillance Data in Alabama, 2012 to 2014 %A Batey,D Scott %A Dong,Xueyuan %A Rogers,Richard P %A Merriweather,Anthony %A Elopre,Latesha %A Rana,Aadia I %A Hall,H Irene %A Mugavero,Michael J %+ Department of Social Work, University of Alabama at Birmingham, University Hall 3154, Birmingham, AL, United States, 1 (205) 996 7984, dsbatey@uab.edu %K HIV %K public health surveillance %K sustained viral suppression %D 2020 %7 22.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Evaluation of the time from HIV diagnosis to viral suppression (VS) captures the collective effectiveness of HIV prevention and treatment activities in a given locale and provides a more global estimate of how effectively the larger HIV care system is working in a given geographic area or jurisdiction. Objective: This study aimed to evaluate temporal and geographic variability in VS among persons with newly diagnosed HIV infection in Alabama between 2012 and 2014. Methods: With data from the National HIV Surveillance System, we evaluated median time from HIV diagnosis to VS (<200 c/mL) overall and stratified by Alabama public health area (PHA) among persons with HIV diagnosed during 2012 to 2014 using the Kaplan-Meier approach. Results: Among 1979 newly diagnosed persons, 1181 (59.67%) achieved VS within 12 months of diagnosis; 52.6% (353/671) in 2012, 59.5% (377/634) in 2013, and 66.9% (451/674) in 2014. Median time from HIV diagnosis to VS was 8 months: 10 months in 2012, 8 months in 2013, and 6 months in 2014. Across 11 PHAs in Alabama, 12-month VS ranged from 45.8% (130/284) to 84% (26/31), and median time from diagnosis to VS ranged from 5 to 13 months. Conclusions: Temporal improvement in persons achieving VS following HIV diagnosis statewide in Alabama is encouraging. However, considerable geographic variability warrants further evaluation to inform public health action. Time from HIV diagnosis to VS represents a meaningful indicator that can be incorporated into public health surveillance and programming. %M 32045344 %R 10.2196/17217 %U https://publichealth.jmir.org/2020/2/e17217 %U https://doi.org/10.2196/17217 %U http://www.ncbi.nlm.nih.gov/pubmed/32045344 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e17107 %T Rates and Correlates of HIV Incidence in Namibia’s Zambezi Region From 2014 to 2016: Sentinel, Community-Based Cohort Study %A Maher,Andrew D %A Nakanyala,Tuli %A Mutenda,Nicholus %A Banda,Karen M %A Prybylski,Dimitri %A Wolkon,Adam %A Jonas,Anna %A Sawadogo,Souleymane %A Ntema,Charity %A Chipadze,Melody Regina %A Sinvula,Grace %A Tizora,Annastasia %A Mwandemele,Asen %A Chaturvedi,Shaan %A Agovi,Afiba Manza-A %A Agolory,Simon %A Hamunime,Ndapewa %A Lowrance,David W %A Mcfarland,Willi %A Patel,Sadhna V %+ Institute for Global Health Sciences, University of California San Francisco, Mission Hall, 3rd Floor, 550 16th Street, San Francisco, CA, 94158, United States, 1 2033137847, andrew.maher@ucsf.edu %K HIV %K incidence %K risk factors %K sentinel surveillance %K longitudinal studies %K cohort studies %D 2020 %7 24.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Direct measures of HIV incidence are needed to assess the population-level impact of prevention programs but are scarcely available in the subnational epidemic hotspots of sub-Saharan Africa. We created a sentinel HIV incidence cohort within a community-based program that provided home-based HIV testing to all residents of Namibia’s Zambezi region, where approximately 24% of the adult population was estimated to be living with HIV. Objective: The aim of this study was to estimate HIV incidence, detect correlates of HIV acquisition, and assess the feasibility of the sentinel, community-based approach to HIV incidence surveillance in a subnational epidemic hotspot. Methods: Following the program’s initial home-based testing (December 2014-July 2015), we purposefully selected 10 clusters of 60 to 70 households each and invited residents who were HIV negative and aged ≥15 years to participate in the cohort. Consenting participants completed behavioral interviews and a second HIV test approximately 1 year later (March-September 2016). We used Poisson models to calculate HIV incidence rates between baseline and follow-up and multivariable Cox proportional hazard models to assess the correlates of seroconversion. Results: Among 1742 HIV-negative participants, 1624 (93.23%) completed follow-up. We observed 26 seroconversions in 1954 person-years (PY) of follow-up, equating to an overall incidence rate of 1.33 per 100 PY (95% CI 0.91-1.95). Among women, the incidence was 1.55 per 100 PY (95% CI 1.12-2.17) and significantly higher among those aged 15 to 24 years and residing in rural areas (adjusted hazard ratio [aHR] 4.26, 95% CI 1.39-13.13; P=.01), residing in the Ngweze suburb of Katima Mulilo city (aHR 2.34, 95% CI 1.25-4.40; P=.01), who had no prior HIV testing in the year before cohort enrollment (aHR 3.38, 95% CI 1.04-10.95; P=.05), and who had engaged in transactional sex (aHR 17.64, 95% CI 2.88-108.14; P=.02). Among men, HIV incidence was 1.05 per 100 PY (95% CI 0.54-2.31) and significantly higher among those aged 40 to 44 years (aHR 13.04, 95% CI 5.98-28.41; P<.001) and had sought HIV testing outside the study between baseline and follow-up (aHR 8.28, 95% CI 1.39-49.38; P=.02). No seroconversions occurred among persons with HIV-positive partners on antiretroviral treatment. Conclusions: Nearly three decades into Namibia’s generalized HIV epidemic, these are the first estimates of HIV incidence for its highest prevalence region. By creating a sentinel incidence cohort from the infrastructure of an existing community-based testing program, we were able to characterize current transmission patterns, corroborate known risk factors for HIV acquisition, and provide insight into the efficacy of prevention interventions in a subnational epidemic hotspot. This study demonstrates an efficient and scalable framework for longitudinal HIV incidence surveillance that can be implemented in diverse sentinel sites and populations. %M 32348290 %R 10.2196/17107 %U http://publichealth.jmir.org/2020/2/e17107/ %U https://doi.org/10.2196/17107 %U http://www.ncbi.nlm.nih.gov/pubmed/32348290 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e16119 %T Participatory Surveillance Based on Crowdsourcing During the Rio 2016 Olympic Games Using the Guardians of Health Platform: Descriptive Study %A Leal Neto,Onicio %A Cruz,Oswaldo %A Albuquerque,Jones %A Nacarato de Sousa,Mariana %A Smolinski,Mark %A Pessoa Cesse,Eduarda Ângela %A Libel,Marlo %A Vieira de Souza,Wayner %+ University of Zurich, Schönberggasse 1, Room SOF-H10, Zurich, , Switzerland, 41 44 634 55 50, onicio@gmail.com %K participatory surveillance %K epidemiology %K infectious diseases %K pandemics %K health innovation %K digital disease detection %K disease surveillance %K mobile phone %D 2020 %7 7.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With the evolution of digital media, areas such as public health are adding new platforms to complement traditional systems of epidemiological surveillance. Participatory surveillance and digital epidemiology have become innovative tools for the construction of epidemiological landscapes with citizens’ participation, improving traditional sources of information. Strategies such as these promote the timely detection of warning signs for outbreaks and epidemics in the region. Objective: This study aims to describe the participatory surveillance platform Guardians of Health, which was used in a project conducted during the 2016 Olympic and Paralympic Games in Rio de Janeiro, Brazil, and officially used by the Brazilian Ministry of Health for the monitoring of outbreaks and epidemics. Methods: This is a descriptive study carried out using secondary data from Guardians of Health available in a public digital repository. Based on syndromic signals, the information subsidy for decision making by policy makers and health managers becomes more dynamic and assertive. This type of information source can be used as an early route to understand the epidemiological scenario. Results: The main result of this research was demonstrating the use of the participatory surveillance platform as an additional source of information for the epidemiological surveillance performed in Brazil during a mass gathering. The platform Guardians of Health had 7848 users who generated 12,746 reports about their health status. Among these reports, the following were identified: 161 users with diarrheal syndrome, 68 users with respiratory syndrome, and 145 users with rash syndrome. Conclusions: It is hoped that epidemiological surveillance professionals, researchers, managers, and workers become aware of, and allow themselves to use, new tools that improve information management for decision making and knowledge production. This way, we may follow the path for a more intelligent, efficient, and pragmatic disease control system. %M 32254042 %R 10.2196/16119 %U https://publichealth.jmir.org/2020/2/e16119 %U https://doi.org/10.2196/16119 %U http://www.ncbi.nlm.nih.gov/pubmed/32254042 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e16303 %T Ambiguity in Communicating Intensity of Physical Activity: Survey Study %A Kim,Hyeoneui %A Kim,Jaemin %A Taira,Ricky %+ School of Nursing, Duke University, 307 Trent Drive, Durham, NC, 27710, United States, 1 919 684 7534, hyeoneui.kim@duke.edu %K exercise %K health communication %K exercise intensity %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Communicating physical activity information with sufficient details, such as activity type, frequency, duration, and intensity, is vital to accurately delineate the attributes of physical activity that bring positive health impact. Unlike frequency and duration, intensity is a subjective concept that can be interpreted differently by people depending on demographics, health status, physical fitness, and exercise habits. However, activity intensity is often communicated using general degree modifiers, degree of physical exertion, and physical activity examples, which are the expressions that people may interpret differently. Lack of clarity in communicating the intensity level of physical activity is a potential barrier to an accurate assessment of exercise effect and effective imparting of exercise recommendations. Objective: This study aimed to assess the variations in people’s perceptions and interpretations of commonly used intensity descriptions of physical activities and to identify factors that may contribute to these variations. Methods: A Web-based survey with a 25-item questionnaire was conducted using Amazon Mechanical Turk, targeting adults residing in the United States. The questionnaire included questions on participants’ demographics, exercise habits, overall perceived health status, and perceived intensity of 10 physical activity examples. The survey responses were analyzed using the R statistical package. Results: The analyses included 498 responses. The majority of respondents were females (276/498, 55.4%) and whites (399/498, 79.9%). Numeric ratings of physical exertion after exercise were relatively well associated with the 3 general degree descriptors of exercise intensity: light, moderate, and vigorous. However, there was no clear association between the intensity expressed with those degree descriptors and the degree of physical exertion the participants reported to have experienced after exercise. Intensity ratings of various examples of physical activity differed significantly according to respondents’ characteristics. Regression analyses showed that those who reported good health or considered regular exercise was important for their health tended to rate the intensity levels of the activity examples significantly higher than their counterparts. The respondents’ age and race (white vs nonwhite) were not significant predictors of the intensity rating. Conclusions: This survey showed significant variations in how people perceive and interpret the intensity levels of physical activities described with general severity modifiers, degrees of physical exertion, and physical activity examples. Considering that these are among the most widely used methods of communicating physical activity intensity in current practice, a possible miscommunication in assessing and promoting physical activity seems to be a real concern. We need to adopt a method that represents activity intensity in a quantifiable manner to avoid unintended miscommunication. %M 32348256 %R 10.2196/16303 %U http://publichealth.jmir.org/2020/2/e16303/ %U https://doi.org/10.2196/16303 %U http://www.ncbi.nlm.nih.gov/pubmed/32348256 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e16847 %T The Annual American Men’s Internet Survey of Behaviors of Men Who Have Sex With Men in the United States: 2017 Key Indicators Report %A Zlotorzynska,Maria %A Cantu,Cera %A Rai,Ramona %A Sullivan,Patrick %A Sanchez,Travis %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Rd NE, Atlanta, GA, 30317, United States, 1 404 727 8799, mzlotor@emory.edu %K HIV %K internet %K men who have sex with men %K sexually transmitted infections: surveillance %K survey %D 2020 %7 13.4.2020 %9 Rapid Surveillance Report %J JMIR Public Health Surveill %G English %X The American Men’s Internet Survey (AMIS) is an annual Web-based behavioral survey of men who have sex with men (MSM) who live in the United States. This Rapid Surveillance Report describes the fifth cycle of data collection (July 2017 to November 2017: AMIS 2017). The key indicators are the same as those previously reported for past AMIS cycles (December 2013 to May 2014: AMIS 2013; November 2014 to April 2015: AMIS 2014; September 2015 to April 2016: AMIS 2015; and September 2016 to February 2017: AMIS 2016). The AMIS methodology has not substantively changed since AMIS 2016. The MSM were recruited from a variety of websites using banner advertisements and email blasts. Additionally, participants from AMIS 2016 who agreed to be recontacted for future research were emailed a link to AMIS 2017. Men were eligible to participate if they were aged ≥15 years, resided in the United States, provided a valid US zone improvement plan code, and reported ever having sex with a man or identified as gay or bisexual. The analysis was limited to those who reported having oral or anal sex with a male partner in the past 12 months. We examined demographic and recruitment characteristics using multivariable regression modeling (P<.05) stratified by the participants’ self-reported HIV status. The AMIS 2017 round of data collection resulted in 10,049 completed surveys from MSM representing every US state, Puerto Rico, and Guam. Participants were mainly non-Hispanic white, over the age of 40 years, living in the Southern United States and urban areas, and recruited from geospatial social networking websites. The plurality (4485/10,049, 44.6%) of participants was in the 40 years and older age group, followed by the youngest age group, 15 to 24 years (2726/10,049, 27.1%). Self-reported HIV prevalence was 9.6% (964/10,049). Compared with HIV-negative or unknown-status participants, HIV-positive participants were more likely to have had anal sex without a condom with a male partner in the past 12 months (adjusted odds ratio [aOR] 2.21, 95% CI 1.86-2.63) and more likely to have had anal sex without a condom with a serodiscordant or an unknown-status partner (aOR 3.13, 95% CI 2.71-3.62). The reported use of marijuana in the past 12 months was higher among HIV-positive participants than HIV-negative or unknown status participants (aOR 1.29, 95% CI 1.09-1.51). The reported use of methamphetamines and other illicit substances in the past 12 months was higher among HIV-positive participants than HIV-negative or unknown status participants (aOR 5.57, 95% CI 4.38-7.09 and aOR 1.93, 95% CI 1.65-2.27, respectively). Most HIV-negative or unknown status participants (7330/9085, 80.7%) reported ever taking an HIV test previously, and 60.6% (5504/9085) reported undergoing HIV testing in the past 12 months. HIV-positive participants were more likely to report testing and diagnosis of sexually transmitted infections than HIV-negative or unknown status participants (aOR 2.85, 95% CI 2.46-3.31 and aOR 2.73, 95% CI 2.29-3.26, respectively). %M 32281937 %R 10.2196/16847 %U http://publichealth.jmir.org/2020/2/e16847/ %U https://doi.org/10.2196/16847 %U http://www.ncbi.nlm.nih.gov/pubmed/32281937 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19369 %T Collateral Crises of Gun Preparation and the COVID-19 Pandemic: Infodemiology Study %A Caputi,Theodore L %A Ayers,John W %A Dredze,Mark %A Suplina,Nicholas %A Burd-Sharps,Sarah %+ Department of Health Sciences, University of York, Seebohm Rowntree Building, University of York, York, YO10 5DD, United Kingdom, 44 7307968882, tcaputi@gmail.com %K COVID-19 %K gun %K firearm %K surveillance %K injury %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In the past, national emergencies in the United States have resulted in increased gun preparation (ie, purchasing new guns or removing guns from storage); in turn, these gun actions have effected increases in firearm injuries and deaths. Objective: The aim of this paper was to assess the extent to which interest in gun preparation has increased amid the coronavirus disease (COVID-19) pandemic using data from Google searches related to purchasing and cleaning guns. Methods: We fit an Autoregressive Integrated Moving Average (ARIMA) model over Google search data from January 2004 up to the week that US President Donald Trump declared COVID-19 a national emergency. We used this model to forecast Google search volumes, creating a counterfactual of the number of gun preparation searches we would expect if the COVID-19 pandemic had not occurred, and reported observed deviations from this counterfactual. Results: Google searches related to preparing guns have surged to unprecedented levels, approximately 40% higher than previously reported spikes following the Sandy Hook, CT and Parkland, FL shootings and 158% (95% CI 73-270) greater than would be expected if the COVID-19 pandemic had not occurred. In absolute terms, approximately 2.1 million searches related to gun preparation were performed over just 34 days. States severely affected by COVID-19 appear to have some of the greatest increases in the number of searches. Conclusions: Our results corroborate media reports that gun purchases are increasing amid the COVID-19 pandemic and provide more precise geographic and temporal trends. Policy makers should invest in disseminating evidence-based educational tools about gun risks and safety procedures to avert a collateral public health crisis. %M 32437329 %R 10.2196/19369 %U http://publichealth.jmir.org/2020/2/e19369/ %U https://doi.org/10.2196/19369 %U http://www.ncbi.nlm.nih.gov/pubmed/32437329 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e15044 %T Assessing Bias in Population Size Estimates Among Hidden Populations When Using the Service Multiplier Method Combined With Respondent-Driven Sampling Surveys: Survey Study %A Chabata,Sungai T %A Fearon,Elizabeth %A Webb,Emily L %A Weiss,Helen A %A Hargreaves,James R %A Cowan,Frances M %+ Centre for Sexual Health and HIV/AIDS Research, 4 Bath Road, Belgravia, Harare, Zimbabwe, 263 773577686, sungaichabata@gmail.com %K service multiplier method %K respondent-driven sampling %K population size estimation %K female sex workers %K key populations %K HIV %K Zimbabwe %D 2020 %7 15.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Population size estimates (PSEs) for hidden populations at increased risk of HIV, including female sex workers (FSWs), are important to inform public health policy and resource allocation. The service multiplier method (SMM) is commonly used to estimate the sizes of hidden populations. We used this method to obtain PSEs for FSWs at 9 sites in Zimbabwe and explored methods for assessing potential biases that could arise in using this approach. Objective: This study aimed to guide the assessment of biases that arise when estimating the population sizes of hidden populations using the SMM combined with respondent-driven sampling (RDS) surveys. Methods: We conducted RDS surveys at 9 sites in late 2013, where the Sisters with a Voice program (the program), which collects program visit data of FSWs, was also present. Using the SMM, we obtained PSEs for FSWs at each site by dividing the number of FSWs who attended the program, based on program records, by the RDS-II weighted proportion of FSWs who reported attending this program in the previous 6 months in the RDS surveys. Both the RDS weighting and SMM make a number of assumptions, potentially leading to biases if the assumptions are not met. To test these assumptions, we used convergence and bottleneck plots to assess seed dependence of RDS-II proportion estimates, chi-square tests to assess if there was an association between the characteristics of FSWs and their knowledge of program existence, and logistic regression to compare the characteristics of FSWs attending the program with those recruited to RDS surveys. Results: The PSEs ranged from 194 (95% CI 62-325) to 805 (95% CI 456-1142) across 9 sites from May to November 2013. The 95% CIs for the majority of sites were wide. In some sites, the RDS-II proportion of women who reported program use in the RDS surveys may have been influenced by the characteristics of selected seeds, and we also observed bottlenecks in some sites. There was no evidence of association between characteristics of FSWs and knowledge of program existence, and in the majority of sites, there was no evidence that the characteristics of the populations differed between RDS and program data. Conclusions: We used a series of rigorous methods to explore potential biases in our PSEs. We were able to identify the biases and their potential direction, but we could not determine the ultimate direction of these biases in our PSEs. We have evidence that the PSEs in most sites may be biased and a suggestion that the bias is toward underestimation, and this should be considered if the PSEs are to be used. These tests for bias should be included when undertaking population size estimation using the SMM combined with RDS surveys. %M 32459645 %R 10.2196/15044 %U http://publichealth.jmir.org/2020/2/e15044/ %U https://doi.org/10.2196/15044 %U http://www.ncbi.nlm.nih.gov/pubmed/32459645 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19601 %T Correction: Preventive Behaviors Conveyed on YouTube to Mitigate Transmission of COVID-19: Cross-Sectional Study %A Basch,Corey H %A Hillyer,Grace C %A Meleo-Erwin,Zoe C %A Jaime,Christie %A Mohlman,Jan %A Basch,Charles E %+ William Paterson University, University Hall, Wayne, NJ, 07470, United States, 1 9737202603, baschc@wpunj.edu %D 2020 %7 6.5.2020 %9 Corrigenda and Addenda %J JMIR Public Health Surveill %G English %X %M 32374718 %R 10.2196/19601 %U http://publichealth.jmir.org/2020/2/e19601/ %U https://doi.org/10.2196/19601 %U http://www.ncbi.nlm.nih.gov/pubmed/32374718 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19893 %T Correction: Estimating the Size of Key Populations in Kampala, Uganda: 3-Source Capture-Recapture Study %A Doshi,Reena H %A Apodaca,Kevin %A Ogwal,Moses %A Bain,Rommel %A Amene,Ermias %A Kiyingi,Herbert %A Aluzimbi,George %A Musinguzi,Geofrey %A Serwadda,David %A McIntyre,Anne F %A Hladik,Wolfgang %+ Centers for Disease Control and Prevention, Center for Global Health, Division of Global HIV and TB, 1600 Clifton Road, Atlanta, GA, 30329, United States, 1 470 298 5583, rdoshi@cdc.gov %D 2020 %7 12.5.2020 %9 Corrigenda and Addenda %J JMIR Public Health Surveill %G English %X %M 32396517 %R 10.2196/19893 %U http://publichealth.jmir.org/2020/2/e19893/ %U https://doi.org/10.2196/19893 %U http://www.ncbi.nlm.nih.gov/pubmed/32396517 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e15917 %T Comparing Methods for Record Linkage for Public Health Action: Matching Algorithm Validation Study %A Avoundjian,Tigran %A Dombrowski,Julia C %A Golden,Matthew R %A Hughes,James P %A Guthrie,Brandon L %A Baseman,Janet %A Sadinle,Mauricio %+ Department of Epidemiology, School of Public Health, University of Washington, 1959 NE Pacific Street, Seattle, WA, 98195, United States, 1 5431065, tavoun@uw.edu %K medical record linkage %K public health surveillance %K public health practice %K data management %D 2020 %7 30.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Many public health departments use record linkage between surveillance data and external data sources to inform public health interventions. However, little guidance is available to inform these activities, and many health departments rely on deterministic algorithms that may miss many true matches. In the context of public health action, these missed matches lead to missed opportunities to deliver interventions and may exacerbate existing health inequities. Objective: This study aimed to compare the performance of record linkage algorithms commonly used in public health practice. Methods: We compared five deterministic (exact, Stenger, Ocampo 1, Ocampo 2, and Bosh) and two probabilistic record linkage algorithms (fastLink and beta record linkage [BRL]) using simulations and a real-world scenario. We simulated pairs of datasets with varying numbers of errors per record and the number of matching records between the two datasets (ie, overlap). We matched the datasets using each algorithm and calculated their recall (ie, sensitivity, the proportion of true matches identified by the algorithm) and precision (ie, positive predictive value, the proportion of matches identified by the algorithm that were true matches). We estimated the average computation time by performing a match with each algorithm 20 times while varying the size of the datasets being matched. In a real-world scenario, HIV and sexually transmitted disease surveillance data from King County, Washington, were matched to identify people living with HIV who had a syphilis diagnosis in 2017. We calculated the recall and precision of each algorithm compared with a composite standard based on the agreement in matching decisions across all the algorithms and manual review. Results: In simulations, BRL and fastLink maintained a high recall at nearly all data quality levels, while being comparable with deterministic algorithms in terms of precision. Deterministic algorithms typically failed to identify matches in scenarios with low data quality. All the deterministic algorithms had a shorter average computation time than the probabilistic algorithms. BRL had the slowest overall computation time (14 min when both datasets contained 2000 records). In the real-world scenario, BRL had the lowest trade-off between recall (309/309, 100.0%) and precision (309/312, 99.0%). Conclusions: Probabilistic record linkage algorithms maximize the number of true matches identified, reducing gaps in the coverage of interventions and maximizing the reach of public health action. %M 32352389 %R 10.2196/15917 %U http://publichealth.jmir.org/2020/2/e15917/ %U https://doi.org/10.2196/15917 %U http://www.ncbi.nlm.nih.gov/pubmed/32352389 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19115 %T Prediction of the COVID-19 Pandemic for the Top 15 Affected Countries: Advanced Autoregressive Integrated Moving Average (ARIMA) Model %A Singh,Ram Kumar %A Rani,Meenu %A Bhagavathula,Akshaya Srikanth %A Sah,Ranjit %A Rodriguez-Morales,Alfonso J %A Kalita,Himangshu %A Nanda,Chintan %A Sharma,Shashi %A Sharma,Yagya Datt %A Rabaan,Ali A %A Rahmani,Jamal %A Kumar,Pavan %+ College of Horticulture and Forestry, Rani Lakshmi Bai Central Agricultural University, NH-75, Near Pahuj Dam, Gwalior Road, Jhansi, 284003, India, 91 9785879797, pawan2607@gmail.com %K SARS-COV2 %K COVID-19 %K coronavirus %K forecast %K prediction %K ARIMA models %D 2020 %7 13.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic has affected more than 200 countries and has infected more than 2,800,000 people as of April 24, 2020. It was first identified in Wuhan City in China in December 2019. Objective: The aim of this study is to identify the top 15 countries with spatial mapping of the confirmed cases. A comparison was done between the identified top 15 countries for confirmed cases, deaths, and recoveries, and an advanced autoregressive integrated moving average (ARIMA) model was used for predicting the COVID-19 disease spread trajectories for the next 2 months. Methods: The comparison of recent cumulative and predicted cases was done for the top 15 countries with confirmed cases, deaths, and recoveries from COVID-19. The spatial map is useful to identify the intensity of COVID-19 infections in the top 15 countries and the continents. The recent reported data for confirmed cases, deaths, and recoveries for the last 3 months was represented and compared between the top 15 infected countries. The advanced ARIMA model was used for predicting future data based on time series data. The ARIMA model provides a weight to past values and error values to correct the model prediction, so it is better than other basic regression and exponential methods. The comparison of recent cumulative and predicted cases was done for the top 15 countries with confirmed cases, deaths, and recoveries from COVID-19. Results: The top 15 countries with a high number of confirmed cases were stratified to include the data in a mathematical model. The identified top 15 countries with cumulative cases, deaths, and recoveries from COVID-19 were compared. The United States, the United Kingdom, Turkey, China, and Russia saw a relatively fast spread of the disease. There was a fast recovery ratio in China, Switzerland, Germany, Iran, and Brazil, and a slow recovery ratio in the United States, the United Kingdom, the Netherlands, Russia, and Italy. There was a high death rate ratio in Italy and the United Kingdom and a lower death rate ratio in Russia, Turkey, China, and the United States. The ARIMA model was used to predict estimated confirmed cases, deaths, and recoveries for the top 15 countries from April 24 to July 7, 2020. Its value is represented with 95%, 80%, and 70% confidence interval values. The validation of the ARIMA model was done using the Akaike information criterion value; its values were about 20, 14, and 16 for cumulative confirmed cases, deaths, and recoveries of COVID-19, respectively, which represents acceptable results. Conclusions: The observed predicted values showed that the confirmed cases, deaths, and recoveries will double in all the observed countries except China, Switzerland, and Germany. It was also observed that the death and recovery rates were rose faster when compared to confirmed cases over the next 2 months. The associated mortality rate will be much higher in the United States, Spain, and Italy followed by France, Germany, and the United Kingdom. The forecast analysis of the COVID-19 dynamics showed a different angle for the whole world, and it looks scarier than imagined, but recovery numbers start looking promising by July 7, 2020. %M 32391801 %R 10.2196/19115 %U http://publichealth.jmir.org/2020/2/e19115/ %U https://doi.org/10.2196/19115 %U http://www.ncbi.nlm.nih.gov/pubmed/32391801 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e10877 %T Injuries Reported by Selected Health Facilities During the Arbaeenia Mass Gathering at Babel Governorate, Iraq, 2014: Retrospective Records Analysis %A Chitheer,Abdulaal %A Lami,Faris %A Radhi,Ahmed %A Arbaji,Ali %+ Department of Community and Family Medicine, College of Medicine, University of Baghdad, Baghdad College of Medicine, Baghdad, 00964, Iraq, 964 7901402692, farislami@gmail.com %K mass gathering %K Injury %K Karbala, Iraq %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Arbaeenia is the largest religious mass gathering in Iraq. The conditions associated with mass gatherings result in high rates of injury. There have been no prior studies on injuries during the Arbaeenia mass gathering. Objective: This study describes the injuries observed during the Arbaeenia mass gathering in Babel Governorate in Iraq between November 24 and December 14, 2014. Methods: The study was conducted in Babel Governorate at the emergency departments of six public hospitals and two major temporary medical units that were located along the three roads connecting the Middle and Southern Iraqi governorates. We used the Iraq Injury Surveillance System modified form to collect information on injured patients treated in the selected facilities. Data on fatal injuries was obtained from the coroner’s office. The following data were collected from the patients: demographics, outcome of injury, place and time of occurrence, mode of evacuation and medical care before arriving at the hospital, duration of travel from place of occurrence to hospital, disposition of non-fatal injury, cause and mode of injury, and whether the injury occurred in connection with the Arbaeenia mass gathering. Results: Information was collected on 1564 injury cases, of which 73 were fatal. About half of the reported nonfatal injuries, 687/1404 (48.9%), and a quarter of fatalities, 18/73 (25%) were related to the Arbaeenia mass gathering (P<.001). Most of the reported injuries were unintentional, 1341/1404 (95.51%), occurred on the street, 864/1323 (65.6%), occurred during the daytime 1103/1174 (93.95 %). Most of those injured were evacuated by means other than ambulance 1107/1206 (91.79%) and did not receive pre-hospital medical care 788/1163 (67.7%). Minor injuries 400/1546 (25.9%) and traffic accidents 394/1546 (25.5%) were the most common types of injuries, followed by falls 270/1546 (17.5%). Among fatal injuries, traffic accidents 38/73 (52%) and violence 18/73 (25%) were the leading causes of death. Mass gathering injuries were more likely to occur among individuals aged 21-40 years (odds ratio [OR] 3.5; 95% CI 2.7-4.5) and >41 years (OR 7.6; 95% CI 5.4-10.6) versus those <21 years; more likely to be unintentional than assault (OR 5.3; 95% CI 1.8-15.5); more likely to happen on the street versus at home (OR 37.7; 95% CI 22.4-63.6); less likely to happen at night than during the day (OR 0.2; 95% CI 0.1-0.4); and less likely to result in hospital admission (OR 0.5; 95% CI 0.3-0.7). Conclusions: The study shows that most injuries were minor, unintentional, and nonfatal, and most people with injuries had limited access to ambulance transportation and did not require hospitalization. %M 32463371 %R 10.2196/10877 %U http://publichealth.jmir.org/2020/2/e10877/ %U https://doi.org/10.2196/10877 %U http://www.ncbi.nlm.nih.gov/pubmed/32463371 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e15477 %T Assessing the Emergent Public Health Concern of All-Terrain Vehicle Injuries in Rural and Agricultural Environments: Initial Review of Available National Datasets in the United States %A Weichelt,Bryan %A Gorucu,Serap %A Jennissen,Charles %A Denning,Gerene %A Oesch,Stephen %+ National Farm Medicine Center, Marshfield Clinic Research Institute, Marshfield Clinic Health System, 1000 N Oak Ave, Marshfield, WI, 54449, United States, 1 2217276, weichelt.bryan@marshfieldresearch.org %K agriculture %K all-terrain vehicle %K fatality %K injury %K off-road vehicle %K rural %D 2020 %7 29.5.2020 %9 Review %J JMIR Public Health Surveill %G English %X Background: Injuries related to the operation of off-road vehicles (ORVs), including all-terrain vehicles (ATVs), continue to be a significant public health concern, especially in rural and agricultural environments. In the United States alone, ATVs have played a role in thousands of fatalities and millions of injuries in the recent decades. However, no known centralized federal surveillance system consistently captures these data. Traditional injury data sources include surveys, police reports, trauma registries, emergency department data, newspaper and online media reports, and state and federal agency databases. Objective: The objectives of this study paper were to (1) identify published articles on ORV-related injuries and deaths that used large databases and determine the types of datasets that were used, (2) examine and describe several national US-based surveillance systems that capture ORV-related injuries and fatalities, and (3) promote and provide support for the establishment of a federally-funded agricultural injury surveillance system. Methods: In this study, we examined several national United States–based injury datasets, including the web-based AgInjuryNews, the Fatality Analysis Reporting System, databases compiled by the US Consumer Product Safety Commission, and the National Fatality Review Case Reporting System. Results: Our review found that these data sources cannot provide a complete picture of the incidents or the circumstantial details needed to effectively inform ORV injury prevention efforts. This is particularly true with regard to ORV-related injuries in agricultural production. Conclusions: We encourage the establishment of a federally funded national agricultural injury surveillance system. However, in lieu of this, use of multiple data sources will be necessary to provide a more complete picture of ORV- and other agriculture-related injuries and fatalities. %M 32469319 %R 10.2196/15477 %U http://publichealth.jmir.org/2020/2/e15477/ %U https://doi.org/10.2196/15477 %U http://www.ncbi.nlm.nih.gov/pubmed/32469319 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e14359 %T Survival Rate of Gastric Cancer Patients in Jordan: Secondary Data Analysis %A Aqel,Ashraf %A Khader,Yousef %A Arqoub,Kamal %A Nimri,Omar %+ Department of Community Medicine, Public Health and Family Medicine, Faculty of Medicine, Jordan University of Science and Technology, Alramtha-Amman Street, Irbid, Jordan, 1 962796802040, yskhader@just.edu.jo %K gastric cancer %K survival rate %K Jordanian cancer cases %D 2020 %7 4.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Gastric cancer accounts for 2.7% of all newly diagnosed cancer cases in Jordan. Objective: The aim of this study was to calculate the survival rate and its determinants among Jordanian patients who were diagnosed with gastric cancer between 2010 and 2014. Methods: A descriptive study was conducted based on secondary analysis of data from the Jordan Cancer Registry during the period of 2010-2014. Only cancer-related deaths were recorded as “death” in the survival analysis. Results: A total of 1388 new cases of gastric cancer were recorded between 2010 and 2014. Of these, 872 (62.8%) were Jordanians and 60.5% were males. The mean age at diagnosis was 58.9 years and the median follow-up time was 1.6 years. The 5-year survival rate decreased significantly from 89% in patients with well-differentiated cancer to 32% in patients with poorly differentiated cancer (P=.005). The overall 5-year survival rate was 37.7% and the median survival was 1.48 years (95% CI 1.179-1.783). The 5-year survival rate decreased significantly with increasing age and with advanced stage of the disease: the 5-year survival rate was 75% for localized-stage, 48% for regional-stage, and 22.7% for distant-metastasis disease (P=.005). Conclusions: This study showed that the overall 5-year survival rate among patients with gastric cancer in Jordan between 2010 and 2014 was 37.7%, which is higher than the reported rates from different countries in the Eastern Mediterranean region such as Egypt. %M 32364509 %R 10.2196/14359 %U https://publichealth.jmir.org/2020/2/e14359 %U https://doi.org/10.2196/14359 %U http://www.ncbi.nlm.nih.gov/pubmed/32364509 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e17574 %T Using Twitter to Surveil the Opioid Epidemic in North Carolina: An Exploratory Study %A Anwar,Mohd %A Khoury,Dalia %A Aldridge,Arnie P %A Parker,Stephanie J %A Conway,Kevin P %+ North Carolina A&T State University, 1601 East Market St, Greensboro, NC, 27401, United States, 1 (336) 334 7500, manwar@ncat.edu %K opioids %K surveillance %K social media %D 2020 %7 24.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Over the last two decades, deaths associated with opioids have escalated in number and geographic spread, impacting more and more individuals, families, and communities. Reflecting on the shifting nature of the opioid overdose crisis, Dasgupta, Beletsky, and Ciccarone offer a triphasic framework to explain that opioid overdose deaths (OODs) shifted from prescription opioids for pain (beginning in 2000), to heroin (2010 to 2015), and then to synthetic opioids (beginning in 2013). Given the rapidly shifting nature of OODs, timelier surveillance data are critical to inform strategies that combat the opioid crisis. Using easily accessible and near real-time social media data to improve public health surveillance efforts related to the opioid crisis is a promising area of research. Objective: This study explored the potential of using Twitter data to monitor the opioid epidemic. Specifically, this study investigated the extent to which the content of opioid-related tweets corresponds with the triphasic nature of the opioid crisis and correlates with OODs in North Carolina between 2009 and 2017. Methods: Opioid-related Twitter posts were obtained using Crimson Hexagon, and were classified as relating to prescription opioids, heroin, and synthetic opioids using natural language processing. This process resulted in a corpus of 100,777 posts consisting of tweets, retweets, mentions, and replies. Using a random sample of 10,000 posts from the corpus, we identified opioid-related terms by analyzing word frequency for each year. OODs were obtained from the Multiple Cause of Death database from the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research (CDC WONDER). Least squares regression and Granger tests compared patterns of opioid-related posts with OODs. Results: The pattern of tweets related to prescription opioids, heroin, and synthetic opioids resembled the triphasic nature of OODs. For prescription opioids, tweet counts and OODs were statistically unrelated. Tweets mentioning heroin and synthetic opioids were significantly associated with heroin OODs and synthetic OODs in the same year (P=.01 and P<.001, respectively), as well as in the following year (P=.03 and P=.01, respectively). Moreover, heroin tweets in a given year predicted heroin deaths better than lagged heroin OODs alone (P=.03). Conclusions: Findings support using Twitter data as a timely indicator of opioid overdose mortality, especially for heroin. %M 32469322 %R 10.2196/17574 %U http://publichealth.jmir.org/2020/2/e17574/ %U https://doi.org/10.2196/17574 %U http://www.ncbi.nlm.nih.gov/pubmed/32469322 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e17073 %T Online Conversation Monitoring to Understand the Opioid Epidemic: Epidemiological Surveillance Study %A Black,Joshua C %A Margolin,Zachary R %A Olson,Richard A %A Dart,Richard C %+ Rocky Mountain Poison and Drug Safety, 1391 N Speer Blvd #600, M/C 0180, Denver, CO, 80204, United States, 1 303 389 1652, joshua.black@rmpds.org %K epidemiological surveillance %K infoveillance %K infodemiology %K opioids %K social media %K misuse %K abuse %K addiction %K overdose %K death %D 2020 %7 29.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Between 2016 and 2017, the national mortality rate involving opioids continued its escalation; opioid deaths rose from 42,249 to 47,600, bringing the public health crisis to a new height. Considering that 69% of adults in the United States use online social media sites, a resource that builds a more complete understanding of prescription drug misuse and abuse could supplement traditional surveillance instruments. The Food and Drug Administration has identified 5 key risks and consequences of opioid drugs—misuse, abuse, addiction, overdose, and death. Identifying posts that discuss these key risks could lead to novel information that is not typically captured by traditional surveillance systems. Objective: The goal of this study was to describe the trends of online posts (frequency over time) involving abuse, misuse, addiction, overdose, and death in the United States and to describe the types of websites that host these discussions. Internet posts that mentioned fentanyl, hydrocodone, oxycodone, or oxymorphone were examined. Methods: Posts that did not refer to personal experiences were removed, after which 3.1 million posts remained. A stratified sample of 61,000 was selected. Unstructured data were classified into 5 key risks by manually coding for key outcomes of misuse, abuse, addiction, overdose, and death. Sampling probabilities of the coded posts were used to estimate the total post volume for each key risk. Results: Addiction and misuse were the two most commonly discussed key risks for hydrocodone, oxycodone, and oxymorphone. For fentanyl, overdose and death were the most discussed key risks. Fentanyl had the highest estimated number of misuse-, overdose-, and death-related mentions (41,808, 42,659, and 94,169, respectively). Oxycodone had the highest estimated number of abuse- and addiction-related mentions (3548 and 12,679, respectively). The estimated volume of online posts for fentanyl increased by more than 10-fold in late 2017 and 2018. The odds of discussing fentanyl overdose (odds ratios [OR] 4.32, 95% CI 2.43-7.66) and death (OR 5.05, 95% CI 3.10-8.21) were higher for social media, while the odds of discussing fentanyl abuse (OR 0.10, 95% CI 0.04-0.22) and addiction (OR 0.24, 95% CI 0.15-0.38) were higher for blogs and forums. Conclusions: Of the 5 FDA-defined key risks, fentanyl overdose and death has dominated discussion in recent years, while discussion of oxycodone, hydrocodone, and oxymorphone has decreased. As drug-related deaths continue to increase, an understanding of the motivations, circumstances, and consequences of drug abuse would assist in developing policy responses. Furthermore, content was notably different based on media origin, and studies that exclusively use either social media sites (such as Twitter) or blogs and forums could miss important content. This study sets out sustainable, ongoing methodology for surveilling internet postings regarding these drugs. %M 32597786 %R 10.2196/17073 %U http://publichealth.jmir.org/2020/2/e17073/ %U https://doi.org/10.2196/17073 %U http://www.ncbi.nlm.nih.gov/pubmed/32597786 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19160 %T Knowledge and Perceptions of COVID-19 Among Health Care Workers: Cross-Sectional Study %A Bhagavathula,Akshaya Srikanth %A Aldhaleei,Wafa Ali %A Rahmani,Jamal %A Mahabadi,Mohammadjavad Ashrafi %A Bandari,Deepak Kumar %+ Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, 17666, United Arab Emirates, 971 543226187, akshaypharmd@gmail.com %K coronavirus %K outbreak %K COVID-19 %K knowledge %K perception %K health care %K questionnaire %K health care worker %D 2020 %7 30.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the first week of March, the coronavirus disease 2019 (COVID-19) outbreak reached more than 100 countries with over 100,000 cases. Health care authorities have already initiated awareness and preparedness activities worldwide. A poor understanding of the disease among health care workers (HCWs) may result in delayed treatment and result in the rapid spread of the infection. Objective: This study aimed to investigate the knowledge and perceptions of HCWs about COVID-19. Methods: A cross-sectional, web-based study was conducted among HCWs about COVID-19 during the first week of March 2020. A 23-item survey instrument was developed and distributed randomly to HCWs using social media; it required 5 minutes to complete. A chi-square test was used to investigate the level of association among variables, with significance set to P<.05. Results: Of 529 participants, a total of 453 HCWs completed the survey (response rate: 85.6%); 51.6% (n=234) were male, 32.1% (n=147) were aged 25-34 years, and most were doctors (n=137, 30.2%) and medical students (n=134, 29.6%). Most participants (n=276, 61.0%) used social media to obtain information on COVID-19. A significant proportion of HCWs had poor knowledge of its transmission (n=276, 61.0%) and symptom onset (n=288, 63.6%) and showed positive perceptions of COVID-19. Factors such as age and profession were associated with inadequate knowledge and a poor perception of COVID-19. Conclusions: As the global threat of COVID-19 continues to emerge, it is critical to improve the knowledge and perceptions of HCWs. Educational interventions are urgently needed to reach HCWs worldwide, and further studies are warranted. %M 32320381 %R 10.2196/19160 %U http://publichealth.jmir.org/2020/2/e19160/ %U https://doi.org/10.2196/19160 %U http://www.ncbi.nlm.nih.gov/pubmed/32320381 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18717 %T Assessment of Health Information About COVID-19 Prevention on the Internet: Infodemiological Study %A Hernández-García,Ignacio %A Giménez-Júlvez,Teresa %+ Department of Preventive Medicine, Lozano Blesa University Clinical Hospital of Zaragoza, Avda San Juan Bosco 15, Zaragoza, 50009, Spain, 34 976 76 57 00 ext 162414, ignaciohernandez79@yahoo.es %K COVID-19 %K coronavirus %K prevention %K internet %K information %K evaluation %K authorship %K World Health Organization %K official public health organizations %K digital media %K infodemic %K infodemiology %D 2020 %7 1.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The internet is a large source of health information and has the capacity to influence its users. However, the information found on the internet often lacks scientific rigor, as anyone may upload content. This factor is a cause of great concern to scientific societies, governments, and users. Objective: The objective of our study was to investigate the information about the prevention of coronavirus disease 2019 (COVID-19) on the internet. Methods: On February 29, 2020, we performed a Google search with the terms “Prevention coronavirus,” “Prevention COVID-19,” “Prevención coronavirus,” and “Prevención COVID-19”. A univariate analysis was performed to study the association between the type of authorship, country of publication, and recommendations to avoid COVID-19 according to the World Health Organization (WHO). Results: In total, 80 weblinks were reviewed. Most of them were produced in the United States and Spain (n=58, 73%) by digital media sources and official public health organizations (n=60, 75%). The most mentioned WHO preventive measure was “wash your hands frequently” (n=65, 81%). A less frequent recommendation was to “stay home if you feel unwell” (n=26, 33%). The analysis by type of author (official public health organizations versus digital media) revealed significant differences regarding the recommendation to wear a mask when you are healthy only if caring for a person with suspected COVID-19 (odds ratio [OR] 4.39). According to the country of publication (Spain versus the United States), significant differences were detected regarding some recommendations such as “wash your hands frequently” (OR 9.82), “cover your mouth and nose with your bent elbow or tissue when you cough or sneeze” (OR 4.59), or “stay home if you feel unwell” (OR 0.31). Conclusions: It is necessary to urge and promote the use of the websites of official public health organizations when seeking information on COVID-19 preventive measures on the internet. In this way, users will be able to obtain high-quality information more frequently, and such websites may improve their accessibility and positioning, given that search engines justify the positioning of links obtained in a search based on the frequency of access to them. %M 32217507 %R 10.2196/18717 %U https://publichealth.jmir.org/2020/2/e18717 %U https://doi.org/10.2196/18717 %U http://www.ncbi.nlm.nih.gov/pubmed/32217507 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18810 %T Global Telemedicine Implementation and Integration Within Health Systems to Fight the COVID-19 Pandemic: A Call to Action %A Ohannessian,Robin %A Duong,Tu Anh %A Odone,Anna %+ Télémédecine 360, TLM360, 55 Avenue Marceau, Paris, 75116, France, 33 647814410, robin.ohannessian@telemedecine-360.com %K telemedicine %K telehealth %K digital health %K digital medicine %K COVID-19 %K coronavirus %K SARS-CoV-2 %K public health %K surveillance %K outbreak %K pandemic %D 2020 %7 2.4.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) outbreak as a pandemic, with over 720,000 cases reported in more than 203 countries as of 31 March. The response strategy included early diagnosis, patient isolation, symptomatic monitoring of contacts as well as suspected and confirmed cases, and public health quarantine. In this context, telemedicine, particularly video consultations, has been promoted and scaled up to reduce the risk of transmission, especially in the United Kingdom and the United States of America. Based on a literature review, the first conceptual framework for telemedicine implementation during outbreaks was published in 2015. An updated framework for telemedicine in the COVID-19 pandemic has been defined. This framework could be applied at a large scale to improve the national public health response. Most countries, however, lack a regulatory framework to authorize, integrate, and reimburse telemedicine services, including in emergency and outbreak situations. In this context, Italy does not include telemedicine in the essential levels of care granted to all citizens within the National Health Service, while France authorized, reimbursed, and actively promoted the use of telemedicine. Several challenges remain for the global use and integration of telemedicine into the public health response to COVID-19 and future outbreaks. All stakeholders are encouraged to address the challenges and collaborate to promote the safe and evidence-based use of telemedicine during the current pandemic and future outbreaks. For countries without integrated telemedicine in their national health care system, the COVID-19 pandemic is a call to adopt the necessary regulatory frameworks for supporting wide adoption of telemedicine. %M 32238336 %R 10.2196/18810 %U https://publichealth.jmir.org/2020/2/e18810 %U https://doi.org/10.2196/18810 %U http://www.ncbi.nlm.nih.gov/pubmed/32238336 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18606 %T Emergence of a Novel Coronavirus (COVID-19): Protocol for Extending Surveillance Used by the Royal College of General Practitioners Research and Surveillance Centre and Public Health England %A de Lusignan,Simon %A Lopez Bernal,Jamie %A Zambon,Maria %A Akinyemi,Oluwafunmi %A Amirthalingam,Gayatri %A Andrews,Nick %A Borrow,Ray %A Byford,Rachel %A Charlett,André %A Dabrera,Gavin %A Ellis,Joanna %A Elliot,Alex J %A Feher,Michael %A Ferreira,Filipa %A Krajenbrink,Else %A Leach,Jonathan %A Linley,Ezra %A Liyanage,Harshana %A Okusi,Cecilia %A Ramsay,Mary %A Smith,Gillian %A Sherlock,Julian %A Thomas,Nicholas %A Tripathy,Manasa %A Williams,John %A Howsam,Gary %A Joy,Mark %A Hobbs,Richard %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House,Walton Well Road, Oxford, OX2 6ED, United Kingdom, 44 01865289344, simon.delusignan@phc.ox.ac.uk %K general practice %K medical record systems %K computerized %K sentinel surveillance %K coronavirus %K COVID-19 %K SARS-CoV-2 %K surveillance %K infections %K pandemic %K records as topic %K serology %D 2020 %7 2.4.2020 %9 Protocol %J JMIR Public Health Surveill %G English %X Background: The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) have successfully worked together on the surveillance of influenza and other infectious diseases for over 50 years, including three previous pandemics. With the emergence of the international outbreak of the coronavirus infection (COVID-19), a UK national approach to containment has been established to test people suspected of exposure to COVID-19. At the same time and separately, the RCGP RSC’s surveillance has been extended to monitor the temporal and geographical distribution of COVID-19 infection in the community as well as assess the effectiveness of the containment strategy. Objectives: The aims of this study are to surveil COVID-19 in both asymptomatic populations and ambulatory cases with respiratory infections, ascertain both the rate and pattern of COVID-19 spread, and assess the effectiveness of the containment policy. Methods: The RCGP RSC, a network of over 500 general practices in England, extract pseudonymized data weekly. This extended surveillance comprises of five components: (1) Recording in medical records of anyone suspected to have or who has been exposed to COVID-19. Computerized medical records suppliers have within a week of request created new codes to support this. (2) Extension of current virological surveillance and testing people with influenza-like illness or lower respiratory tract infections (LRTI)—with the caveat that people suspected to have or who have been exposed to COVID-19 should be referred to the national containment pathway and not seen in primary care. (3) Serology sample collection across all age groups. This will be an extra blood sample taken from people who are attending their general practice for a scheduled blood test. The 100 general practices currently undertaking annual influenza virology surveillance will be involved in the extended virological and serological surveillance. (4) Collecting convalescent serum samples. (5) Data curation. We have the opportunity to escalate the data extraction to twice weekly if needed. Swabs and sera will be analyzed in PHE reference laboratories. Results: General practice clinical system providers have introduced an emergency new set of clinical codes to support COVID-19 surveillance. Additionally, practices participating in current virology surveillance are now taking samples for COVID-19 surveillance from low-risk patients presenting with LRTIs. Within the first 2 weeks of setup of this surveillance, we have identified 3 cases: 1 through the new coding system, the other 2 through the extended virology sampling. Conclusions: We have rapidly converted the established national RCGP RSC influenza surveillance system into one that can test the effectiveness of the COVID-19 containment policy. The extended surveillance has already seen the use of new codes with 3 cases reported. Rapid sharing of this protocol should enable scientific critique and shared learning. International Registered Report Identifier (IRRID): DERR1-10.2196/18606 %M 32240095 %R 10.2196/18606 %U https://publichealth.jmir.org/2020/2/e18606 %U https://doi.org/10.2196/18606 %U http://www.ncbi.nlm.nih.gov/pubmed/32240095 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18807 %T Preventive Behaviors Conveyed on YouTube to Mitigate Transmission of COVID-19: Cross-Sectional Study %A Basch,Corey H %A Hillyer,Grace C %A Meleo-Erwin,Zoe C %A Jaime,Christie %A Mohlman,Jan %A Basch,Charles E %+ William Paterson University, University Hall, Wayne, NJ, 07470, United States, 1 9737202603, baschc@wpunj.edu %K YouTube %K COVID-19 %K social media %K pandemic %K outbreak %K infectious disease %K public health %K prevention %D 2020 %7 2.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Accurate information and guidance about personal behaviors that can reduce exposure to severe acute respiratory syndrome coronavirus 2 are among the most important elements in mitigating the spread of coronavirus disease 2019 (COVID-19). With over 2 billion users, YouTube is a media channel that millions turn to when seeking information. Objective: At the time of this study, there were no published studies investigating the content of YouTube videos related to COVID-19. This study aims to address this gap in the current knowledge. Methods: The 100 most widely viewed YouTube videos uploaded throughout the month of January 2020 were reviewed and the content covered was described. Collectively, these videos were viewed over 125 million times. Results: Fewer than one-third of the videos covered any of the seven key prevention behaviors listed on the US Centers for Disease Control and Prevention website. Conclusions: These results represent an important missed opportunity for disease prevention. %M 32240096 %R 10.2196/18807 %U http://publichealth.jmir.org/2020/2/e18807/ %U https://doi.org/10.2196/18807 %U http://www.ncbi.nlm.nih.gov/pubmed/32240096 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18887 %T Conducting Clinical Research During the COVID-19 Pandemic: Investigator and Participant Perspectives %A Padala,Prasad R %A Jendro,Ashlyn M %A Padala,Kalpana P %+ Geriatric Research Education and Clinical Center, Eugene J Towbin Healthcare Center, Central Arkansas Veterans Healthcare System, 2200 Fort Roots Drive, North Little Rock, AR, 72114-1706, United States, 1 501 257 2537, prasad.padala@va.gov %K clinical research %K COVID-19 %K pandemic %K outbreak %K infectious disease %K public health %K ethics %D 2020 %7 6.4.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X As the medical landscape changes daily with the coronavirus disease (COVID-19) pandemic, clinical researchers are caught off-guard and are forced to make decisions on research visits in their ongoing clinical trials. Although there is some guidance from local and national organizations, the principal investigator (PI) is ultimately responsible for determining the risk-benefit ratio of conducting, rescheduling, or cancelling each research visit. The PI should take into consideration the ethical principles of research, local/national guidance, the community risk of the pandemic in their locale, staffing strain, and the risk involved to each participant, to ultimately decide on the course of action. While balancing the rights and protection of the human subject, we seldom examine patients’ views and opinions about their scheduled research visit(s). This article discusses the ethical principles of beneficence and autonomy in helping the decision-making process. We discuss ways to weigh-in local and national guidance, staffing strain, and institutional support into the decision-making process and outline potential changes needed for regulatory bodies depending on the decision. Further, we discuss the need to weigh-in the individual risk-benefit ratio for each participant and present a decision tree to navigate this complex process. Finally, we examine participant and caregiver perspectives on their fears, sense of preparedness, and factors that they consider before deciding whether to keep or postpone the research appointments. This entry also provides PIs ways to support their research participants in both scenarios, including provision of psychological support. %M 32250281 %R 10.2196/18887 %U http://publichealth.jmir.org/2020/2/e18887/ %U https://doi.org/10.2196/18887 %U http://www.ncbi.nlm.nih.gov/pubmed/32250281 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18844 %T Novel Coronavirus in Cape Town Informal Settlements: Feasibility of Using Informal Dwelling Outlines to Identify High Risk Areas for COVID-19 Transmission From A Social Distancing Perspective %A Gibson,Lesley %A Rush,David %+ School of Engineering, University of Edinburgh, Kings Buildings, University of Edinburgh, Edinburgh, EH9 3FB, United Kingdom, 44 01316501000, lesley.gibson@ed.ac.uk %K COVID-19 %K Cape Town %K informal settlements %K social distancing %K GIS %K pandemic %K outbreak %K infectious disease %K public health %K geographic data %K risk %D 2020 %7 6.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The challenges faced by the Global South during the coronavirus disease (COVID-19) pandemic are compounded by the presence of informal settlements, which are typically densely populated and lacking in formalized sanitation infrastructure. Social distancing measures in informal settlements may be difficult to implement due to the density and layout of settlements. This study measures the distance between dwellings in informal settlements in Cape Town to identify the risk of COVID-19 transmission. Objective: The aim of this paper is to determine if social distancing measures are achievable in informal settlements in Cape Town, using two settlements as an example. We will first examine the distance between dwellings and their first, second, and third nearest neighbors and then identify clusters of dwellings in which residents would be unable to effectively practice social isolation due to the close proximity of their homes. Methods: Dwellings in the settlements of Masiphumelele and Klipfontein Glebe were extracted from a geographic information system data set of outlines of all informal dwellings in Cape Town. The distance to each dwelling’s first, second, and third nearest neighbors was calculated for each settlement. A social distance measure of 2 m was used (buffer of 1 m, as dwellings less than 2 m apart are joined) to identify clusters of dwellings that are unable to effectively practice social distancing in each settlement. Results: The distance to each dwelling’s first 3 nearest neighbors illustrates that the settlement of Masiphumelele is constructed in a denser fashion as compared to the Klipfontein Glebe settlement. This implies that implementing social distancing will likely be more challenging in Masiphumelele than in Klipfontein Glebe. However, using a 2-m social distancing measure, it was demonstrated that large portions of Klipfontein Glebe would also be unable to effectively implement social distancing. Conclusions: Effectively implementing social distancing may be a challenge in informal settlements due to their density. This paper uses dwelling outlines for informal settlements in the city of Cape Town to demonstrate that with a 2 m measure, effective social distancing will be challenging. %M 32250283 %R 10.2196/18844 %U http://publichealth.jmir.org/2020/2/e18844/ %U https://doi.org/10.2196/18844 %U http://www.ncbi.nlm.nih.gov/pubmed/32250283 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18961 %T Population-Level Interest and Telehealth Capacity of US Hospitals in Response to COVID-19: Cross-Sectional Analysis of Google Search and National Hospital Survey Data %A Hong,Young-Rock %A Lawrence,John %A Williams Jr,Dunc %A Mainous III,Arch %+ Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, PO Box 100195, Gainesville, FL, 32610, United States, 1 3522735335, youngrock.h@phhp.ufl.edu %K COVID-19 %K telehealth %K telemedicine %K screening %K pandemic %K outbreak %K infectious disease %K public health %D 2020 %7 7.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As the novel coronavirus disease (COVID-19) is widely spreading across the United States, there is a concern about the overloading of the nation’s health care capacity. The expansion of telehealth services is expected to deliver timely care for the initial screening of symptomatic patients while minimizing exposure in health care facilities, to protect health care providers and other patients. However, it is currently unknown whether US hospitals have the telehealth capacity to meet the increasing demand and needs of patients during this pandemic. Objective: We investigated the population-level internet search volume for telehealth (as a proxy of population interest and demand) with the number of new COVID-19 cases and the proportion of hospitals that adopted a telehealth system in all US states. Methods: We used internet search volume data from Google Trends to measure population-level interest in telehealth and telemedicine between January 21, 2020 (when the first COVID-19 case was reported), and March 18, 2020. Data on COVID-19 cases in the United States were obtained from the Johns Hopkins Coronavirus Resources Center. We also used data from the 2018 American Hospital Association Annual Survey to estimate the proportion of hospitals that adopted telehealth (including telemedicine and electronic visits) and those with the capability of telemedicine intensive care unit (tele-ICU). Pearson correlation was used to examine the relations of population search volume for telehealth and telemedicine (composite score) with the cumulative numbers of COVID-19 cases in the United States during the study period and the proportion of hospitals with telehealth and tele-ICU capabilities. Results: We found that US population–level interest in telehealth increased as the number of COVID-19 cases increased, with a strong correlation (r=0.948, P<.001). We observed a higher population-level interest in telehealth in the Northeast and West census region, whereas the proportion of hospitals that adopted telehealth was higher in the Midwest region. There was no significant association between population interest and the proportion of hospitals that adopted telehealth (r=0.055, P=.70) nor hospitals having tele-ICU capability (r=–0.073, P=.61). Conclusions: As the number of COVID-19 cases increases, so does the US population’s interest in telehealth. However, the level of population interest did not correlate with the proportion of hospitals providing telehealth services in the United States, suggesting that increased population demand may not be met with the current telehealth capacity. Telecommunication infrastructures in US hospitals may lack the capability to address the ongoing health care needs of patients with other health conditions. More practical investment is needed to deploy the telehealth system rapidly against the impending patient surge. %M 32250963 %R 10.2196/18961 %U http://publichealth.jmir.org/2020/2/e18961/ %U https://doi.org/10.2196/18961 %U http://www.ncbi.nlm.nih.gov/pubmed/32250963 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18444 %T Misinformation of COVID-19 on the Internet: Infodemiology Study %A Cuan-Baltazar,Jose Yunam %A Muñoz-Perez,Maria José %A Robledo-Vega,Carolina %A Pérez-Zepeda,Maria Fernanda %A Soto-Vega,Elena %+ Medicine School, Universidad Anáhuac Puebla, Av Orion sn. Colonia Country Club, San Andres Cholula, 72810, Mexico, 52 2225415200, elenasoto_74@hotmail.com %K HONcode %K JAMA benchmarks %K DISCERN instrument %K Wuhan coronavirus %K COVID-19 %K nCoV %K epidemiology %K health information seeking %K information quality %K misinformation %K public health %D 2020 %7 9.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The internet has become an important source of health information for users worldwide. The novel coronavirus caused a pandemic search for information with broad dissemination of false or misleading health information. Objective: The aim of this study was to evaluate the quality and readability of online information about the coronavirus disease (COVID-19), which was a trending topic on the internet, using validated instruments and relating the quality of information to its readability. Methods: The search was based on the term “Wuhan Coronavirus” on the Google website (February 6, 2020). At the search time, the terms “COVID-19” or “SARS-CoV-2” (severe acute respiratory syndrome coronavirus 2) did not exist. Critical analysis was performed on the first 110 hits using the Health on the Net Foundation Code of Conduct (HONcode), the Journal of the American Medical Association (JAMA) benchmark, the DISCERN instrument, and Google ranking. Results: The first 110 websites were critically analyzed, and only 1.8% (n=2) of the websites had the HONcode seal. The JAMA benchmark showed that 39.1% (n=43) of the websites did not have any of the categories required by this tool, and only 10.0% (11/110) of the websites had the four quality criteria required by JAMA. The DISCERN score showed that 70.0% (n=77) of the websites were evaluated as having a low score and none were rated as having a high score. Conclusions: Nonhealth personnel and the scientific community need to be aware about the quality of the information they read and produce, respectively. The Wuhan coronavirus health crisis misinformation was produced by the media, and the misinformation was obtained by users from the internet. The use of the internet has a risk to public health, and, in cases like this, the governments should be developing strategies to regulate health information on the internet without censuring the population. By February 6, 2020, no quality information was available on the internet about COVID-19. %M 32250960 %R 10.2196/18444 %U http://publichealth.jmir.org/2020/2/e18444/ %U https://doi.org/10.2196/18444 %U http://www.ncbi.nlm.nih.gov/pubmed/32250960 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18798 %T Dentists’ Awareness, Perception, and Attitude Regarding COVID-19 and Infection Control: Cross-Sectional Study Among Jordanian Dentists %A Khader,Yousef %A Al Nsour,Mohannad %A Al-Batayneh,Ola Barakat %A Saadeh,Rami %A Bashier,Haitham %A Alfaqih,Mahmoud %A Al-Azzam,Sayer %A AlShurman,Bara’ Abdallah %+ Jordan University of Science and Technology, Alramtha-Amman Street, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K COVID-19 %K infection %K dentist %K infection control %D 2020 %7 9.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite the availability of prevention guidelines and recommendations on infection control, many dental practices lack the minimum requirements for infection control. Objective: This study aimed to assess the level of awareness, perception, and attitude regarding the coronavirus disease (COVID-19) and infection control among Jordanian dentists. Methods: The study population consisted of dentists who worked in private clinics, hospitals, and health centers in Jordan. An online questionnaire was sent to a sample of Jordanian dentists in March 2020. The questionnaire was comprised of a series of questions about dentists’ demographic characteristics; their awareness of the incubation period, the symptoms of the disease, mode of transmission of COVID-19 and infection control measures for preventing COVID-19; and their attitude toward treating patients with COVID-19. Results: This study included a total of 368 dentists aged 22-73 years (mean 32.9 years, SD 10.6 years). A total of 112 (30.4%) dentists had completed a master or residency program in dentistry, 195 (53.0%) had received training in infection control in dentistry, and 28 (7.6%) had attended training or lectures regarding COVID-19. A total of 133 (36.1%) dentists reported that the incubation period is 1-14 days. The majority of dentists were aware of COVID-19 symptoms and ways of identifying patients at risk of having COVID-19, were able to correctly report known modes of transmission, and were aware of measures for preventing COVID-19 transmission in dental clinics. A total of 275 (74.7%) believed that it was necessary to ask patients to sit far from each other, wear masks while in the waiting room, and wash hands before getting in the dental chair to decrease disease transmission. Conclusions: Jordanian dentists were aware of COVID-19 symptoms, mode of transmission, and infection controls and measures in dental clinics. However, dentists had limited comprehension of the extra precautionary measures that protect the dental staff and other patients from COVID-19. National and international guidelines should be sent by the regional and national dental associations to all registered dentists during a crisis, including the COVID-19 pandemic, to make sure that dentists are well informed and aware of best practices and recommended disease management approaches. %M 32250959 %R 10.2196/18798 %U http://publichealth.jmir.org/2020/2/e18798/ %U https://doi.org/10.2196/18798 %U http://www.ncbi.nlm.nih.gov/pubmed/32250959 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18828 %T Predicting COVID-19 Incidence Through Analysis of Google Trends Data in Iran: Data Mining and Deep Learning Pilot Study %A Ayyoubzadeh,Seyed Mohammad %A Ayyoubzadeh,Seyed Mehdi %A Zahedi,Hoda %A Ahmadi,Mahnaz %A R Niakan Kalhori,Sharareh %+ Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, 3rd Floor, No 17, Farredanesh Alley, Ghods St, Enghelab Ave, Tehran, Iran, 98 21 88983025, niakan2@gmail.com %K coronavirus %K COVID-19 %K prediction %K incidence %K Google Trends %K linear regression %K LSTM %K pandemic %K outbreak %K public health %D 2020 %7 14.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The recent global outbreak of coronavirus disease (COVID-19) is affecting many countries worldwide. Iran is one of the top 10 most affected countries. Search engines provide useful data from populations, and these data might be useful to analyze epidemics. Utilizing data mining methods on electronic resources’ data might provide a better insight into the COVID-19 outbreak to manage the health crisis in each country and worldwide. Objective: This study aimed to predict the incidence of COVID-19 in Iran. Methods: Data were obtained from the Google Trends website. Linear regression and long short-term memory (LSTM) models were used to estimate the number of positive COVID-19 cases. All models were evaluated using 10-fold cross-validation, and root mean square error (RMSE) was used as the performance metric. Results: The linear regression model predicted the incidence with an RMSE of 7.562 (SD 6.492). The most effective factors besides previous day incidence included the search frequency of handwashing, hand sanitizer, and antiseptic topics. The RMSE of the LSTM model was 27.187 (SD 20.705). Conclusions: Data mining algorithms can be employed to predict trends of outbreaks. This prediction might support policymakers and health care managers to plan and allocate health care resources accordingly. %M 32234709 %R 10.2196/18828 %U http://publichealth.jmir.org/2020/2/e18828/ %U https://doi.org/10.2196/18828 %U http://www.ncbi.nlm.nih.gov/pubmed/32234709 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18873 %T Urban Intelligence for Pandemic Response: Viewpoint %A Lai,Yuan %A Yeung,Wesley %A Celi,Leo Anthony %+ Laboratory for Computational Physiology, Massachusetts Institute of Technology, 77 Massachusetts Ave, Cambridge, MA, 02139, United States, 1 (617) 253 1000, wesleyyeung123@gmail.com %K urban informatics %K urban science %K data science %K health emergency %K medical informatics %K COVID-19 %K pandemic %K outbreak %K public health %K infectious disease %D 2020 %7 14.4.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Previous epidemic management research proves the importance of city-level information, but also highlights limited expertise in urban data applications during a pandemic outbreak. In this paper, we provide an overview of city-level information, in combination with analytical and operational capacity, that define urban intelligence for supporting response to disease outbreaks. We present five components (movement, facilities, people, information, and engagement) that have been previously investigated but remain siloed to successfully orchestrate an integrated pandemic response. Reflecting on the coronavirus disease (COVID-19) outbreak that was first identified in Wuhan, China, we discuss the opportunities, technical challenges, and foreseeable controversies for deploying urban intelligence during a pandemic. Finally, we emphasize the urgency of building urban intelligence through cross-disciplinary research and collaborative practice on a global scale. %M 32248145 %R 10.2196/18873 %U http://publichealth.jmir.org/2020/2/e18873/ %U https://doi.org/10.2196/18873 %U http://www.ncbi.nlm.nih.gov/pubmed/32248145 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18668 %T A Mobile Health Platform to Disseminate Validated Institutional Measurements During the COVID-19 Outbreak: Utilization-Focused Evaluation Study %A Zamberg,Ido %A Manzano,Sergio %A Posfay-Barbe,Klara %A Windisch,Olivier %A Agoritsas,Thomas %A Schiffer,Eduardo %+ Division of General Internal Medicine, Department of Medicine, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland, 41 022 372 33 11, idozamberg@gmail.com %K covid-19 %K novel coronavirus %K smartphone %K SARS-COV-2 %K mHealth %K knowledge %K information %K dissemination %K health policy %K infectious disease %K outbreak %K public health %K preparation %D 2020 %7 14.4.2020 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: As part of the response plans for the current outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), authorities are drafting and implementing containment measures across jurisdictions worldwide in the effort to slow down transmission and reduce the infection rate. A solid communication strategy is needed to increase the reach of valid information to health professionals, reduce misinformation, and efficiently implement recommended measures. Objective: The aim of this paper is to describe the utilization of a dedicated mobile health (mHealth) platform to disseminate up-to-date and validated information about SARS-CoV-2 to all medical staff of the Children’s Hospital at the University Hospitals of Geneva. Methods: Three documents containing institutional information concerning screening, local containment procedures, and frequently asked questions and answers for parents were made available to the staff through a mobile app developed in the University of Geneva, Switzerland. Using a third-party statistics tool, we anonymously monitored user activity as well as content utilization patterns since the diagnosis of the first case of SARS-CoV-2 in Switzerland on February 25, 2020. Results: From February 25, 2020, to March 13, 2020 (18 days), information documents on SARS-CoV-2 were viewed 859 times, which accounted for 35.6% of the total content views (total views=332). User activity increased significantly with 50.8 (SD 14.4) users per day in this period as compared to the previous weeks (mean 26.4, SD 9.8; P<.001). In addition, session numbers per day more than doubled during the aforementioned period (P<.001). In a survey, medical staff found the information easy to find within the app. On a 10-point Likert scale, the ability of the app to reassure staff in clinical practice was rated as 7.6 (SD 2.1), time-saving ability was rated as 8.5 (SD 2.1), and the need to look for information from other sources was rated as 5.9 (SD 3.3). Conclusions: The use of an mHealth solution to disseminate novel coronavirus–related information seemed to be an effective and time-saving communication channel within our institution during the SARS-CoV-2 outbreak. Medical staff felt reassured and informed in daily practice. More research should be done on the clinical impact and outcomes of the integration of mHealth solutions as a communication channel of validated information within health institutions. %M 32250958 %R 10.2196/18668 %U http://publichealth.jmir.org/2020/2/e18668/ %U https://doi.org/10.2196/18668 %U http://www.ncbi.nlm.nih.gov/pubmed/32250958 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18811 %T Interpreting COVID-19 and Virtual Care Trends: Cohort Study %A Khairat,Saif %A Meng,Chenlu %A Xu,Yuxuan %A Edson,Barbara %A Gianforcaro,Robert %+ School or Nursing, University of North Carolina at Chapel Hill, 428 Carrington Hall, NC, NC, 27514, United States, 1 9198435416, saif@unc.edu %K virtual care %K COVID-19 %K trends %K patterns %K pandemic %K outbreak %K infectious disease %K public health %D 2020 %7 15.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic is rapidly spreading across the world. As of March 26, 2020, there are more than 500,000 cases and more than 25,000 deaths related to COVID-19, and the numbers are increasing by the hour. Objective: The aim of this study was to explore the trends in confirmed COVID-19 cases in North Carolina, and to understand patterns in virtual visits related to symptoms of COVID-19. Methods: We conducted a cohort study of confirmed COVID-19 cases and patients using an on-demand, statewide virtual urgent care center. We collected data from February 1, 2020, to March 15, 2020. Institutional Review Board exemption was obtained prior to the study. Results: As of March, 18 2020, there were 92 confirmed COVID-19 cases and 733 total virtual visits. Of the total visits, 257 (35.1%) were related to COVID-19-like symptoms. Of the COVID-19-like visits, the number of females was 178 (69.2%). People in the age groups of 30-39 years (n=67, 26.1%) and 40-49 years (n=64, 24.9%) were half of the total patients. Additionally, approximately 96.9% (n=249) of the COVID-like encounters came from within the state of North Carolina. Our study shows that virtual care can provide efficient triaging in the counties with the highest number of COVID-19 cases. We also confirmed that the largest spread of the disease occurs in areas with a high population density as well as in areas with major airports. Conclusions: The use of virtual care presents promising potential in the fight against COVID-19. Virtual care is capable of reducing emergency room visits, conserving health care resources, and avoiding the spread of COVID-19 by treating patients remotely. We call for further adoption of virtual care by health systems across the United States and the world during the COVID-19 pandemic. %M 32252023 %R 10.2196/18811 %U http://publichealth.jmir.org/2020/2/e18811/ %U https://doi.org/10.2196/18811 %U http://www.ncbi.nlm.nih.gov/pubmed/32252023 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18795 %T A Case for Participatory Disease Surveillance of the COVID-19 Pandemic in India %A Garg,Suneela %A Bhatnagar,Nidhi %A Gangadharan,Navya %+ Maulana Azad Medical College, Delhi University, Bahadur Shah Zafar Marg-02, Delhi, 110002, India, 91 08750647995, bhatnagarnidhi.mamc@gmail.com %K participatory %K surveillance %K COVID-19 %K pandemic %K outbreak %K public health %K infectious disease %K India %D 2020 %7 16.4.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The coronavirus disease pandemic requires the deployment of novel surveillance strategies to curtail further spread of the disease in the community. Participatory disease surveillance mechanisms have already been adopted in countries for the current pandemic. India, with scarce resources, good telecom support, and a not-so-robust heath care system, makes a strong case for introducing participatory disease surveillance for the prevention and control of the pandemic. India has just launched Aarogya Setu, which is a first-of-its-kind participatory disease surveillance initiative in India. This will supplement the existing Integrated Disease Surveillance Programme in India by finding missing cases and having faster aggregation, analysis of data, and prompt response measures. This newly created platform empowers communities with the right information and guidance, enabling protection from infection and reducing unnecessary contact with the overburdened health care system. However, caution needs to be exercised to address participation from digitally isolated populations, ensure the reliability of data, and consider ethical concerns such as maintaining individual privacy. %M 32287038 %R 10.2196/18795 %U http://publichealth.jmir.org/2020/2/e18795/ %U https://doi.org/10.2196/18795 %U http://www.ncbi.nlm.nih.gov/pubmed/32287038 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18980 %T Global Preparedness Against COVID-19: We Must Leverage the Power of Digital Health %A Mahmood,Sultan %A Hasan,Khaled %A Colder Carras,Michelle %A Labrique,Alain %+ International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St., W 5501, Baltimore, MD, 21205, United States, 1 443 287 4744, alabriq1@jhu.edu %K informatics %K global health %K developing countries %K internet %K infection %K control %K COVID-19 %K pandemic %D 2020 %7 16.4.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The coronavirus disease (COVID-19) pandemic has revealed many areas of public health preparedness that are lacking, especially in lower- and middle-income countries. Digital interventions provide many opportunities for strengthening health systems and could be vital resources in the current public health emergency. We provide several use cases for infection control, home-based diagnosis and screening, empowerment through information, public health surveillance and epidemiology, and leveraging crowd-sourced data. A thoughtful, concerted effort—leveraging existing experience and robust enterprise-grade technologies—can have a substantive impact on the immediate and distal consequences of COVID-19. %M 32297868 %R 10.2196/18980 %U http://publichealth.jmir.org/2020/2/e18980/ %U https://doi.org/10.2196/18980 %U http://www.ncbi.nlm.nih.gov/pubmed/32297868 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18941 %T Tracking COVID-19 in Europe: Infodemiology Approach %A Mavragani,Amaryllis %+ Department of Computing Science and Mathematics, Faculty of Natural Sciences, University of Stirling, University Campus, Stirling, FK94LA, United Kingdom, 44 7523782711, amaryllis.mavragani1@stir.ac.uk %K big data %K coronavirus %K COVID-19 %K infodemiology %K infoveillance %K Google Trends %D 2020 %7 20.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Infodemiology (ie, information epidemiology) uses web-based data to inform public health and policy. Infodemiology metrics have been widely and successfully used to assess and forecast epidemics and outbreaks. Objective: In light of the recent coronavirus disease (COVID-19) pandemic that started in Wuhan, China in 2019, online search traffic data from Google are used to track the spread of the new coronavirus disease in Europe. Methods: Time series from Google Trends from January to March 2020 on the Topic (Virus) of “Coronavirus” were retrieved and correlated with official data on COVID-19 cases and deaths worldwide and in the European countries that have been affected the most: Italy (at national and regional level), Spain, France, Germany, and the United Kingdom. Results: Statistically significant correlations are observed between online interest and COVID-19 cases and deaths. Furthermore, a critical point, after which the Pearson correlation coefficient starts declining (even if it is still statistically significant) was identified, indicating that this method is most efficient in regions or countries that have not yet peaked in COVID-19 cases. Conclusions: In the past, infodemiology metrics in general and data from Google Trends in particular have been shown to be useful in tracking and forecasting outbreaks, epidemics, and pandemics as, for example, in the cases of the Middle East respiratory syndrome, Ebola, measles, and Zika. With the COVID-19 pandemic still in the beginning stages, it is essential to explore and combine new methods of disease surveillance to assist with the preparedness of health care systems at the regional level. %M 32250957 %R 10.2196/18941 %U http://publichealth.jmir.org/2020/2/e18941/ %U https://doi.org/10.2196/18941 %U http://www.ncbi.nlm.nih.gov/pubmed/32250957 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19145 %T The Role of YouTube and the Entertainment Industry in Saving Lives by Educating and Mobilizing the Public to Adopt Behaviors for Community Mitigation of COVID-19: Successive Sampling Design Study %A Basch,Charles E %A Basch,Corey H %A Hillyer,Grace C %A Jaime,Christie %+ Teachers College, Columbia University, 525 W 120th St, New York, NY, 10027, United States, 1 212 678 3983, ceb35@columbia.edu %K YouTube %K COVID-19 %K social media %K pandemic %K outbreak %K infectious disease %K public health %K prevention %D 2020 %7 21.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Effective community mitigation through voluntary behavior change is currently the best way to reduce mortality caused by coronavirus disease (COVID-19). This study builds on our prior study based on the scientific premise that YouTube is one of the most effective ways to communicate and mobilize the public in community mitigation to reduce exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Objective: Because of the rapidly changing nature of YouTube in the context of the COVID-19 pandemic, we conducted a follow-up study to document how coverage of preventive behaviors for effective community mitigation has changed. Methods: A successive sampling design was used to compare coverage of behaviors to mitigate community transmission of COVID-19 in the 100 most widely viewed YouTube videos in January 2020 and March 2020. Results: Videos in the January and March samples were viewed >125 million times and >355 million times, respectively. Fewer than half of the videos in either sample covered any of the prevention behaviors recommended by the US Centers for Disease Control and Prevention, but many covered key prevention behaviors and were very widely viewed. There were no videos uploaded by entertainment television in the January sample, but this source comprised the majority of videos and garnered the majority of cumulative views in the March sample. Conclusions: This study demonstrates the incredible reach of YouTube and the potential value of partnership with the entertainment industry for communicating and mobilizing the public about community mitigation to reduce mortality from the COVID-19 viral pandemic. %M 32297593 %R 10.2196/19145 %U http://publichealth.jmir.org/2020/2/e19145/ %U https://doi.org/10.2196/19145 %U http://www.ncbi.nlm.nih.gov/pubmed/32297593 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18700 %T Data Mining and Content Analysis of the Chinese Social Media Platform Weibo During the Early COVID-19 Outbreak: Retrospective Observational Infoveillance Study %A Li,Jiawei %A Xu,Qing %A Cuomo,Raphael %A Purushothaman,Vidya %A Mackey,Tim %+ Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, United States, 1 9514914161, tmackey@ucsd.edu %K COVID-19 %K coronavirus %K infectious disease %K social media, surveillance %K infoveillance %K infodemiology %D 2020 %7 21.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic, which began in Wuhan, China in December 2019, is rapidly spreading worldwide with over 1.9 million cases as of mid-April 2020. Infoveillance approaches using social media can help characterize disease distribution and public knowledge, attitudes, and behaviors critical to the early stages of an outbreak. Objective: The aim of this study is to conduct a quantitative and qualitative assessment of Chinese social media posts originating in Wuhan City on the Chinese microblogging platform Weibo during the early stages of the COVID-19 outbreak. Methods: Chinese-language messages from Wuhan were collected for 39 days between December 23, 2019, and January 30, 2020, on Weibo. For quantitative analysis, the total daily cases of COVID-19 in Wuhan were obtained from the Chinese National Health Commission, and a linear regression model was used to determine if Weibo COVID-19 posts were predictive of the number of cases reported. Qualitative content analysis and an inductive manual coding approach were used to identify parent classifications of news and user-generated COVID-19 topics. Results: A total of 115,299 Weibo posts were collected during the study time frame consisting of an average of 2956 posts per day (minimum 0, maximum 13,587). Quantitative analysis found a positive correlation between the number of Weibo posts and the number of reported cases from Wuhan, with approximately 10 more COVID-19 cases per 40 social media posts (P<.001). This effect size was also larger than what was observed for the rest of China excluding Hubei Province (where Wuhan is the capital city) and held when comparing the number of Weibo posts to the incidence proportion of cases in Hubei Province. Qualitative analysis of 11,893 posts during the first 21 days of the study period with COVID-19-related posts uncovered four parent classifications including Weibo discussions about the causative agent of the disease, changing epidemiological characteristics of the outbreak, public reaction to outbreak control and response measures, and other topics. Generally, these themes also exhibited public uncertainty and changing knowledge and attitudes about COVID-19, including posts exhibiting both protective and higher-risk behaviors. Conclusions: The results of this study provide initial insight into the origins of the COVID-19 outbreak based on quantitative and qualitative analysis of Chinese social media data at the initial epicenter in Wuhan City. Future studies should continue to explore the utility of social media data to predict COVID-19 disease severity, measure public reaction and behavior, and evaluate effectiveness of outbreak communication. %M 32293582 %R 10.2196/18700 %U http://publichealth.jmir.org/2020/2/e18700/ %U https://doi.org/10.2196/18700 %U http://www.ncbi.nlm.nih.gov/pubmed/32293582 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19218 %T Regulation and Trust: 3-Month Follow-up Study on COVID-19 Mortality in 25 European Countries %A Oksanen,Atte %A Kaakinen,Markus %A Latikka,Rita %A Savolainen,Iina %A Savela,Nina %A Koivula,Aki %+ Tampere University, Kalevantie 5, Faculty of Social Sciences, Tampere, 33014, Finland, 358 503187279, atte.oksanen@tuni.fi %K mortality %K infectious diseases %K sociability %K trust %K prevention %K Europe %D 2020 %7 24.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The outbreak of the coronavirus disease (COVID-19) has dramatically changed societies in 2020. Since the end of February, Europe has been hit particularly hard by COVID-19, but there are major country differences in both the spread of the virus and measures taken to stop the virus. Social psychological factors such as institutional trust could be important in understanding the development of the epidemic. Objective: The aim of this study was to examine country variations of COVID-19 mortality in Europe by analyzing social risk factors explaining the spread of the disease, restrictions and control measures, and institutional trust. Methods: The present study was based on a background analysis of European Social Survey data on 25 European countries (N=47,802). Multilevel mixed effects linear regression models focused on 84 days of the COVID-19 epidemic (January 22 to April 14, 2020) and modelled the daily COVID-19 mortality. Analysis focused on the impact of social relations, restrictions, and institutional trust within each country. Results: The spread of the COVID-19 epidemic has been fast everywhere, but the findings revealed significant differences between countries in COVID-19 mortality. Perceived sociability predicted higher COVID-19 mortality. Major differences between the 25 countries were found in reaction times to the crisis. Late reaction to the crisis predicted later mortality figures. Institutional trust was associated with lower COVID-19 mortality. Conclusions: The analyses demonstrated the importance of societal and social psychological factors in the spread of the COVID-19 epidemic. By considering multiple perspectives, this study showed that country differences in Europe are major, and this will have an impact on how countries will cope with the ongoing crisis in the following months. The results indicated the importance of timely restrictions and cooperation with people. %M 32301734 %R 10.2196/19218 %U http://publichealth.jmir.org/2020/2/e19218/ %U https://doi.org/10.2196/19218 %U http://www.ncbi.nlm.nih.gov/pubmed/32301734 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19054 %T Detection of SARS-CoV-2 RNA and Antibodies in Diverse Samples: Protocol to Validate the Sufficiency of Provider-Observed, Home-Collected Blood, Saliva, and Oropharyngeal Samples %A Sullivan,Patrick Sean %A Sailey,Charles %A Guest,Jodie Lynn %A Guarner,Jeannette %A Kelley,Colleen %A Siegler,Aaron Julius %A Valentine-Graves,Mariah %A Gravens,Laura %A del Rio,Carlos %A Sanchez,Travis Howard %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 4047272038, pssulli@emory.edu %K SARS-CoV-2 %K RNA-PCR %K serology %K COVID-19 %K PCR %K public health %K outbreak %K infectious disease %K diagnostic %K telemedicine %K testing %D 2020 %7 24.4.2020 %9 Protocol %J JMIR Public Health Surveill %G English %X Background: The response in the United States to the coronavirus disease (COVID-19) pandemic has been hampered by a lack of aggressive testing for the infection. Testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cornerstone of an effective public health response. However, efforts to test have been hampered by limited reagents, limitations in the availability of swabs used for the collection of nasopharyngeal swab (NPS) specimens, limitations in personal protective equipment (PPE) for health care providers collecting the NPS specimens, and limitations in viral transport media for transporting the specimens. Therefore, more flexible options for screening for SARS-CoV-2 RNA and serologic responses are critical to inform clinical and public health responses. Objective: We aim to document the ability of patients to self-collect sufficient specimens for SARS-CoV-2 viral detection and serology. Methods: Patient self-collection of samples will be done with observation by a health care provider during a telemedicine session. Participants will be mailed a specimen collection kit, engage in a telehealth session with a provider through a HIPPA (Health Insurance Portability and Accountability Act of 1996)-compliant video meeting, and collect specimens while being observed by the provider. Providers will record whether they are confident in the suitability of the specimen for laboratory testing that would inform clinical decision making. We will objectively assess the sufficiency of biological material in the mailed-in specimens. Results: The protocol was approved by the Emory University Institutional Review Board (IRB) on March 30, 2020 (Protocol number 371). To date, we have enrolled 159 participants. Conclusions: Defining a conceptual framework for assessing the sufficiency of patient-collected samples for the detection of SARS-CoV-2 RNA and serologic responses to infection is critical for facilitating public health responses and providing PPE-sparing options to increase testing. Validation of alternative methods of specimen collection should include objective measures of the sufficiency of specimens for testing. A strong evidence base for diversifying testing modalities will improve tools to guide public health responses to the COVID-19 pandemic. %M 32310815 %R 10.2196/19054 %U http://publichealth.jmir.org/2020/2/e19054/ %U https://doi.org/10.2196/19054 %U http://www.ncbi.nlm.nih.gov/pubmed/32310815 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18576 %T Surveillance of COVID-19 in the General Population Using an Online Questionnaire: Report From 18,161 Respondents in China %A Luo,Hongxing %A Lie,Yongchan %A Prinzen,Frits W %+ Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Welsdaal 150 C, Maastricht, 6228JG, Netherlands, 31 685704703, h.luo@maastrichtuniversity.nl %K coronavirus %K surveillance %K syndromic surveillance %K participatory surveillance %K online questionnaire %K Wuhan %K COVID-19 %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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 participatory 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 (R2=0.61, P<.001). History of contact significantly decreased with time, both outside Wuhan City (R2=0.35, P=.002) and outside Hubei Province (R2=0.42, P<.001). The percentage of respondents reporting a fever peaked around February 8 (R2=0.57, P<.001) and increased with a history of contact in the areas outside Wuhan City (risk ratio 1.31, 95% CI 1.13-1.52, P<.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. %M 32319956 %R 10.2196/18576 %U http://publichealth.jmir.org/2020/2/e18576/ %U https://doi.org/10.2196/18576 %U http://www.ncbi.nlm.nih.gov/pubmed/32319956 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18808 %T A Guide to Chatbots for COVID-19 Screening at Pediatric Health Care Facilities %A Espinoza,Juan %A Crown,Kelly %A Kulkarni,Omkar %+ Department of Pediatrics, Children's Hospital Los Angeles, 4650 W Sunset Blvd, Mailstop #76, Los Angeles, CA, 90027, United States, 1 3233612721, jespinoza@chla.usc.edu %K chatbots %K COVID-19: pediatrics %K digital health %K screening %D 2020 %7 30.4.2020 %9 Tutorial %J JMIR Public Health Surveill %G English %X The coronavirus disease 2019 (COVID-19) outbreak has required institutions to rapidly adapt to changing public health circumstances. The Centers for Disease Control and Prevention has encouraged health care facilities to explore novel health care delivery modes. However, many institutions may not be prepared to begin offering digital health and telehealth services. Chatbots are one digital health tool that can help evolve triage and screening processes in a scalable manner. Here, we present a decision-making and implementation framework for deploying COVID-19 screening chatbots at pediatric health care facilities. %M 32325425 %R 10.2196/18808 %U http://publichealth.jmir.org/2020/2/e18808/ %U https://doi.org/10.2196/18808 %U http://www.ncbi.nlm.nih.gov/pubmed/32325425 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19106 %T Turning the Crisis Into an Opportunity: Digital Health Strategies Deployed During the COVID-19 Outbreak %A Pérez Sust,Pol %A Solans,Oscar %A Fajardo,Joan Carles %A Medina Peralta,Manuel %A Rodenas,Pepi %A Gabaldà,Jordi %A Garcia Eroles,Luis %A Comella,Adrià %A Velasco Muñoz,César %A Sallent Ribes,Josuè %A Roma Monfa,Rosa %A Piera-Jimenez,Jordi %+ Open Evidence Research Group, Universitat Oberta de Catalunya, Av del Tibidabo 39, Barcelona, 08035, Spain, 34 651041515, jpiera@bsa.cat %K digital health %K eHealth %K telemedicine %K COVID-19 %K coronavirus %K SARS-CoV-2 %K public health %K policymaking %D 2020 %7 4.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Digital health technologies offer significant opportunities to reshape current health care systems. From the adoption of electronic medical records to mobile health apps and other disruptive technologies, digital health solutions have promised a better quality of care at a more sustainable cost. However, the widescale adoption of these solutions is lagging behind. The most adverse scenarios often provide an opportunity to develop and test the capacity of digital health technologies to increase the efficiency of health care systems. Catalonia (Northeast Spain) is one of the most advanced regions in terms of digital health adoption across Europe. The region has a long tradition of health information exchange in the public health care sector and is currently implementing an ambitious digital health strategy. In this viewpoint, we discuss the crucial role digital health solutions play during the coronavirus disease (COVID-19) pandemic to support public health policies. We also report on the strategies currently deployed at scale during the outbreak in Catalonia. %M 32339998 %R 10.2196/19106 %U http://publichealth.jmir.org/2020/2/e19106/ %U https://doi.org/10.2196/19106 %U http://www.ncbi.nlm.nih.gov/pubmed/32339998 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19374 %T COVID-19-Related Web Search Behaviors and Infodemic Attitudes in Italy: Infodemiological Study %A Rovetta,Alessandro %A Bhagavathula,Akshaya Srikanth %+ Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, Abu Dhabi, 17666, United Arab Emirates, 971 54322 ext 6187, akshaypharmd@gmail.com %K novel coronavirus, COVID-19, Google search %K Google Trends %K infodemiology, infodemic monikers, Italy %K behavior %K public health %K communication %K digital health %K online search %D 2020 %7 5.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the beginning of the novel coronavirus disease (COVID-19) outbreak, fake news and misleading information have circulated worldwide, which can profoundly affect public health communication. Objective: We investigated online search behavior related to the COVID-19 outbreak and the attitudes of “infodemic monikers” (ie, erroneous information that gives rise to interpretative mistakes, fake news, episodes of racism, etc) circulating in Italy. Methods: By using Google Trends to explore the internet search activity related to COVID-19 from January to March 2020, article titles from the most read newspapers and government websites were mined to investigate the attitudes of infodemic monikers circulating across various regions and cities in Italy. Search volume values and average peak comparison (APC) values were used to analyze the results. Results: Keywords such as “novel coronavirus,” “China coronavirus,” “COVID-19,” “2019-nCOV,” and “SARS-COV-2” were the top infodemic and scientific COVID-19 terms trending in Italy. The top five searches related to health were “face masks,” “amuchina” (disinfectant), “symptoms of the novel coronavirus,” “health bulletin,” and “vaccines for coronavirus.” The regions of Umbria and Basilicata recorded a high number of infodemic monikers (APC weighted total >140). Misinformation was widely circulated in the Campania region, and racism-related information was widespread in Umbria and Basilicata. These monikers were frequently searched (APC weighted total >100) in more than 10 major cities in Italy, including Rome. Conclusions: We identified a growing regional and population-level interest in COVID-19 in Italy. The majority of searches were related to amuchina, face masks, health bulletins, and COVID-19 symptoms. Since a large number of infodemic monikers were observed across Italy, we recommend that health agencies use Google Trends to predict human behavior as well as to manage misinformation circulation in Italy. %M 32338613 %R 10.2196/19374 %U http://publichealth.jmir.org/2020/2/e19374/ %U https://doi.org/10.2196/19374 %U http://www.ncbi.nlm.nih.gov/pubmed/32338613 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19297 %T Agile Requirements Engineering and Software Planning for a Digital Health Platform to Engage the Effects of Isolation Caused by Social Distancing: Case Study %A Meinert,Edward %A Milne-Ives,Madison %A Surodina,Svitlana %A Lam,Ching %+ Digitally Enabled PrevenTative Health Research Group, Department of Paediatrics, University of Oxford, Level 2, Children's Hospital, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 7824446808, e.meinert14@imperial.ac.uk %K telemedicine %K information science %K data science %K COVID-19 %K coronavirus %K public reporting of healthcare data %K health care quality, access and evaluation %K aged %K mental health %K exercise %K cellphone %K artificial intelligence %K agile %K requirements engineering %K social distancing %K digital health %K app %D 2020 %7 6.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social distancing and shielding measures have been put in place to reduce social interaction and slow the transmission of the coronavirus disease (COVID-19). For older people, self-isolation presents particular challenges for mental health and social relationships. As time progresses, continued social distancing could have a compounding impact on these concerns. Objective: This project aims to provide a tool for older people and their families and peers to improve their well-being and health during and after regulated social distancing. First, we will evaluate the tool’s feasibility, acceptability, and usability to encourage positive nutrition, enhance physical activity, and enable virtual interaction while social distancing. Second, we will be implementing the app to provide an online community to assist families and peer groups in maintaining contact with older people using goal setting. Anonymized data from the app will be aggregated with other real-world data sources to develop a machine learning algorithm to improve the identification of patients with COVID-19 and track for real time use by health systems. Methods: Development of this project is occurring at the time of publication, and therefore, a case study design was selected to provide a systematic means of capturing software engineering in progress. The app development framework for software design was based on agile methods. The evaluation of the app’s feasibility, acceptability and usability shall be conducted using Public Health England's guidance on evaluating digital health products, Bandura’s model of health promotion, the Reach Effectiveness Adoption Implementation Maintenance (RE-AIM) framework and the Nonadoption, Abandonment and Challenges to the Scale-up, Spread and Suitability (NASSS) framework. Results: Making use of a pre-existing software framework for health behavior change, a proof of concept was developed, and a multistage app development and deployment for the solution was created. Grant submissions to fund the project and study execution have been sought at the time of publication, and prediscovery iteration of the solution has begun. Ethical approval for a feasibility study design is being sought. Conclusions: This case study lays the foundations for future app development to combat mental and societal issues arising from social distancing measures. The app will be tested and evaluated in future studies to allow continuous improvement of the app. This novel contribution will provide an evidence-based exemplar for future app development in the space of social isolation and loneliness. %M 32348293 %R 10.2196/19297 %U http://publichealth.jmir.org/2020/2/e19297/ %U https://doi.org/10.2196/19297 %U http://www.ncbi.nlm.nih.gov/pubmed/32348293 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19368 %T Mathematical Modelling to Assess the Impact of Lockdown on COVID-19 Transmission in India: Model Development and Validation %A Ambikapathy,Bakiya %A Krishnamurthy,Kamalanand %+ Department of Instrumentation Engineering, Madras Institute of Technology Campus, Anna University, Chromepet, Chennai, Tamil Nadu, 600044, India, 91 9884948410, bakiya88@gmail.com %K covid-19 %K coronavirus %K epidemic %K mathematical modelling %K pandemic %K sars %D 2020 %7 7.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The World Health Organization has declared the novel coronavirus disease (COVID-19) to be a public health emergency; at present, India is facing a major threat of community spread. We developed a mathematical model for investigating and predicting the effects of lockdown on future COVID-19 cases with a specific focus on India. Objective: The objective of this work was to develop and validate a mathematical model and to assess the impact of various lockdown scenarios on COVID-19 transmission in India. Methods: A model consisting of a framework of ordinary differential equations was developed by incorporating the actual reported cases in 14 countries. After validation, the model was applied to predict COVID-19 transmission in India for different intervention scenarios in terms of lockdown for 4, 14, 21, 42, and 60 days. We also assessed the situations of enhanced exposure due to aggregation of individuals in transit stations and shopping malls before the lockdown. Results: The developed model is efficient in predicting the number of COVID-19 cases compared to the actual reported cases in 14 countries. For India, the model predicted marked reductions in cases for the intervention periods of 14 and 21 days of lockdown and significant reduction for 42 days of lockdown. Such intervention exceeding 42 days does not result in measurable improvement. Finally, for the scenario of “panic shopping” or situations where there is a sudden increase in the factors leading to higher exposure to infection, the model predicted an exponential transmission, resulting in failure of the considered intervention strategy. Conclusions: Implementation of a strict lockdown for a period of at least 21 days is expected to reduce the transmission of COVID-19. However, a further extension of up to 42 days is required to significantly reduce the transmission of COVID-19 in India. Any relaxation in the lockdown may lead to exponential transmission, resulting in a heavy burden on the health care system in the country. %M 32365045 %R 10.2196/19368 %U http://publichealth.jmir.org/2020/2/e19368/ %U https://doi.org/10.2196/19368 %U http://www.ncbi.nlm.nih.gov/pubmed/32365045 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19462 %T Considerations for Postacute Rehabilitation for Survivors of COVID-19 %A Sheehy,Lisa Mary %+ Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N5C8, Canada, 1 6135626262 ext 1593, lsheehy@bruyere.org %K covid-19 %K rehabilitation %K subacute care %K inpatient rehabilitation %K public health %K infectious disease %K virus %K patient outcome %K geriatric %K treatment %K recovery %D 2020 %7 8.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Coronavirus disease (COVID-19), the infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported on December 31, 2019. Because it has only been studied for just over three months, our understanding of this disease is still incomplete, particularly regarding its sequelae and long-term outcomes. Moreover, very little has been written about the rehabilitation needs of patients with COVID-19 after discharge from acute care. The objective of this report is to answer the question “What rehabilitation services do survivors of COVID-19 require?” The question was asked within the context of a subacute hospital delivering geriatric inpatient and outpatient rehabilitation services. Three areas relevant to rehabilitation after COVID-19 were identified. First, details of how patients may present have been summarized, including comorbidities, complications from an intensive care unit stay with or without intubation, and the effects of the virus on multiple body systems, including those pertaining to cardiac, neurological, cognitive, and mental health. Second, I have suggested procedures regarding the design of inpatient rehabilitation units for COVID-19 survivors, staffing issues, and considerations for outpatient rehabilitation. Third, guidelines for rehabilitation (physiotherapy, occupational therapy, speech-language pathology) following COVID-19 have been proposed with respect to recovery of the respiratory system as well as recovery of mobility and function. A thorough assessment and an individualized, progressive treatment plan which focuses on function, disability, and return to participation in society will help each patient to maximize their function and quality of life. Careful consideration of the rehabilitation environment will ensure that all patients recover as completely as possible. %M 32369030 %R 10.2196/19462 %U http://publichealth.jmir.org/2020/2/e19462/ %U https://doi.org/10.2196/19462 %U http://www.ncbi.nlm.nih.gov/pubmed/32369030 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19161 %T Knowledge and Behaviors Toward COVID-19 Among US Residents During the Early Days of the Pandemic: Cross-Sectional Online Questionnaire %A Clements,John M %+ Master of Public Health Program, Division of Public Health, College of Human Medicine, Michigan State University, 130 E 2nd Street, Suite 202, Flint, MI, 48502, United States, 1 989 708 6338, clemen69@msu.edu %K public health %K surveillance %K COVID-19 %K knowledge %K behavior %K outbreak %K infectious disease %K health information %D 2020 %7 8.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The early days of the coronavirus disease (COVID-19) pandemic in the United States brought uncertainty in the knowledge about COVID-19 and what to do about it. It is necessary to understand public knowledge and behaviors if we are to effectively address the pandemic. Objective: The aim of this study is to test the hypothesis that knowledge about COVID-19 influences participation in different behaviors including self-reports of purchasing more goods than usual, attending large gatherings, and using medical masks. Methods: This study was funded and approved by the Institutional Review Board on March 17, 2020. The cross-sectional online survey of 1034 US residents aged 18 years or older was conducted on March 17, 2020. Results: For every point increase in knowledge, the odds of participation in purchasing more goods (odds ratio [OR] 0.88, 95% CI 0.81-0.95), attending large gatherings (OR 0.87, 95% CI 0.81-0.93), and using medical masks (OR 0.56, 95% CI 0.50-0.62) decreased by 12%, 13%, and 44%, respectively. Gen X and millennial participants had 56% and 76% higher odds, respectively, of increased purchasing behavior compared to baby boomers. The results suggest that there is a politicization of response recommendations. Democrats had 30% lower odds of attending large gatherings (OR 0.70, 95% CI 0.50-0.97) and 48% lower odds of using medical masks (OR 0.52, 95% CI 0.34-0.78) compared to Republicans. Conclusions: This survey is one of the first attempts to study determinants of knowledge and behaviors in response to the COVID-19 pandemic in the United States. A national, coordinated effort toward a pandemic response may ensure better compliance with behavioral recommendations to address this public health emergency. %M 32369759 %R 10.2196/19161 %U http://publichealth.jmir.org/2020/2/e19161/ %U https://doi.org/10.2196/19161 %U http://www.ncbi.nlm.nih.gov/pubmed/32369759 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18821 %T Preparation for Quarantine on the Cruise Ship Diamond Princess in Japan due to COVID-19 %A Yamahata,Yoshihiro %A Shibata,Ayako %+ Obstetrics & Gynecology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashiyodogawa-ku, Osaka, 533-0024, Japan, 81 6 6322 2250, sibata700@gmail.com %K SARS-CoV-2 %K COVID-19 %K infectious control %K cruise ship quarantine %K pandemic %K outbreak %K surveillance %K preparation %K infectious disease %K public health %K quarantine %D 2020 %7 11.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Background: Japan implemented a large-scale quarantine on the Diamond Princess cruise ship in an attempt to control the spread of the novel coronavirus severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in February 2020. Objective: We aim to describe the medical activities initiated and difficulties in implementing quarantine on a cruise ship. Methods: Reverse transcription–polymerase chain reaction (RT-PCR) tests for SARS-CoV-2 were performed for all 3711 people (2666 passengers and 1045 crew) on board. Results: Of those tested, 696 (18.8%) tested positive for coronavirus disease (COVID-19), of which 410 (58.9%) were asymptomatic. We also confirmed that 54% of the asymptomatic patients with a positive RT-PCR result had lung opacities on chest computed tomography. There were many difficulties in implementing quarantine, such as creating a dividing traffic line between infectious and noninfectious passengers, finding hospitals and transportation providers willing to accept these patients, transporting individuals, language barriers, and supporting daily life. As of March 8, 2020, 31 patients (4.5% of patients with positive RT-PCR results) were hospitalized and required ventilator support or intensive care, and 7 patients (1.0% of patients with positive RT-PCR results) had died. Conclusions: There were several difficulties in implementing large-scale quarantine and obtaining medical support on the cruise ship. In the future, we need to prepare for patients’ transfer and the admitting hospitals when disembarking the passengers. We recommend treating the crew the same way as the passengers to control the infection. We must also draw a plan for the future, to protect travelers and passengers from emerging infectious diseases on cruise ships. %M 32365046 %R 10.2196/18821 %U http://publichealth.jmir.org/2020/2/e18821/ %U https://doi.org/10.2196/18821 %U http://www.ncbi.nlm.nih.gov/pubmed/32365046 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19199 %T Delivering Benefits at Speed Through Real-World Repurposing of Off-Patent Drugs: The COVID-19 Pandemic as a Case in Point %A Rogosnitzky,Moshe %A Berkowitz,Esther %A Jadad,Alejandro R %+ MedInsight Research Institute, Pekeris 4,, Weizmann Science Park,, Rehovot, 7670204, Israel, 972 86220942, moshe@medinsight.org %K COVID-19 %K drug costs %K drug repositioning %K drugs, generic %K off-label use %K public health %K severe acute respiratory syndrome coronavirus 2 %K pandemic %K crisis %D 2020 %7 13.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Real-world drug repurposing—the immediate “off-label” prescribing of drugs to address urgent clinical needs—is a widely overlooked opportunity. Off-label prescribing (ie, for a nonapproved indication) is legal in most countries and tends to shift the burden of liability and cost to physicians and patients, respectively. Nevertheless, health crises may mean that real-world repurposing is the only realistic source for solutions. Optimal real-world repurposing requires a track record of safety, affordability, and access for drug candidates. Although thousands of such drugs are already available, there is no central repository of off-label uses to facilitate immediate identification and selection of potentially useful interventions during public health crises. Using the current coronavirus disease (COVID-19) pandemic as an example, we provide a glimpse of the extensive literature that supports the rationale behind six generic drugs, in four classes, all of which are affordable, supported by decades of safety data, and targeted toward the underlying pathophysiology that makes COVID-19 so deadly. This paper briefly summarizes why cimetidine or famotidine, dipyridamole, fenofibrate or bezafibrate, and sildenafil citrate are worth considering for patients with COVID-19. Clinical trials to assess efficacy are already underway for famotidine, dipyridamole, and sildenafil, and further trials of all these agents will be important in due course. These examples also reveal the unlimited opportunity to future-proof our health care systems by proactively mining, synthesizing, cataloging, and evaluating the off-label treatment opportunities of thousands of safe, well-established, and affordable generic drugs. %M 32374264 %R 10.2196/19199 %U http://publichealth.jmir.org/2020/2/e19199/ %U https://doi.org/10.2196/19199 %U http://www.ncbi.nlm.nih.gov/pubmed/32374264 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19097 %T Estimation of the Probability of Reinfection With COVID-19 by the Susceptible-Exposed-Infectious-Removed-Undetectable-Susceptible Model %A Victor Okhuese,Alexander %+ Department of Mathematics, Nasarawa State University Keffi, Nasarawa State, Lafiya, Keffi, 234, Nigeria, 234 8060273138, alexandervictor16@yahoo.com %K infectious %K disease %K reinfection %K model %K math %K COVID-19 %K coronavirus %K pandemic %K outbreak %K SEIRUS %D 2020 %7 13.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With the sensitivity of the polymerase chain reaction test used to detect the presence of the virus in the human host, the worldwide health community has been able to record a large number of the recovered population. Objective: The aim of this study was to evaluate the probability of reinfection in the recovered class and the model equations, which exhibits the disease-free equilibrium state for the coronavirus disease. Methods: The model differential equation was evaluated for the disease-free equilibrium for the case of reinfection as well as the existence and stability criteria for the disease, using the model proportions. This evaluation shows that the criteria for a local or worldwide asymptotic stability with a basic reproductive number (R0=0) were satisfied. Hence, there is a chance of no secondary reinfections from the recovered population, as the rate of incidence of the recovered population vanishes (ie, B=0). Results: With a total of about 900,000 infected cases worldwide, numerical simulations for this study were carried out to complement the analytical results and investigate the effect that the implementation of quarantine and observation procedures has on the projection of further virus spread. Conclusions: As shown by the results, the proportion of the infected population, in the absence of a curative vaccination, will continue to grow worldwide; meanwhile, the recovery rate will continue slowly, which means that the ratio of infection rate to recovery rate will determine the death rate that is recorded. Most significant for this study is the rate of reinfection by the recovered population, which will decline to zero over time as the virus is cleared clinically from the system of the recovered class. %M 32369029 %R 10.2196/19097 %U http://publichealth.jmir.org/2020/2/e19097/ %U https://doi.org/10.2196/19097 %U http://www.ncbi.nlm.nih.gov/pubmed/32369029 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18995 %T Emergency Response to COVID-19 in Canada: Platform Development and Implementation for eHealth in Crisis Management %A Krausz,Michael %A Westenberg,Jean Nicolas %A Vigo,Daniel %A Spence,Richard Trafford %A Ramsey,Damon %+ Department of Psychiatry, University of British Columbia, 5950 University Boulevard, Room 430, Vancouver, BC, V6T 1Z3, Canada, 1 604 827 4381, jean.westenberg@alumni.ubc.ca %K eHealth %K digital health %K web-based intervention %K crisis management %K COVID-19 %K public health %K health care system %D 2020 %7 15.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Public health emergencies like epidemics put enormous pressure on health care systems while revealing deep structural and functional problems in the organization of care. The current coronavirus disease (COVID-19) pandemic illustrates this at a global level. The sudden increased demand on delivery systems puts unique pressures on pre-established care pathways. These extraordinary times require efficient tools for smart governance and resource allocation. Objective: The aim of this study is to develop an innovative web-based solution addressing the seemingly insurmountable challenges of triaging, monitoring, and delivering nonhospital services unleashed by the COVID-19 pandemic. Methods: An adaptable crisis management digital platform was envisioned and designed with the goal of improving the system’s response on the basis of the literature; an existing shared health record platform; and discussions between health care providers, decision makers, academia, and the private sector in response to the COVID 19 epidemic. Results: The Crisis Management Platform was developed and offered to health authorities in Ontario on a nonprofit basis. It has the capability to dramatically streamline patient intake, triage, monitoring, referral, and delivery of nonhospital services. It decentralizes the provision of services (by moving them online) and centralizes data gathering and analysis, maximizing the use of existing human resources, facilitating evidence-based decision making, and minimizing the risk to both users and providers. It has unlimited scale-up possibilities (only constrained by human health risk resource availability) with minimal marginal cost. Similar web-based solutions have the potential to fill an urgent gap in resource allocation, becoming a unique asset for health systems governance and management during critical times. They highlight the potential effectiveness of web-based solutions if built on an outcome-driven architecture. Conclusions: Data and web-based approaches in response to a public health crisis are key to evidence-driven oversight and management of public health emergencies. %M 32401218 %R 10.2196/18995 %U http://publichealth.jmir.org/2020/2/e18995/ %U https://doi.org/10.2196/18995 %U http://www.ncbi.nlm.nih.gov/pubmed/32401218 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19702 %T Correlations of Online Search Engine Trends With Coronavirus Disease (COVID-19) Incidence: Infodemiology Study %A Higgins,Thomas S %A Wu,Arthur W %A Sharma,Dhruv %A Illing,Elisa A %A Rubel,Kolin %A Ting,Jonathan Y %A , %+ Rhinology, Sinus & Skull Base, Kentuckiana Ear Nose Throat, 6420 Dutchman's Parkway, STE 380, Louisville, KY, 40205, United States, 1 502 894 8441, thomas.higgins@louisville.edu %K COVID-19 %K coronavirus %K big data %K infodemiology %K infoveillance %K Baidu %K SARS-CoV-2 %K Google Trends %K digital health %K epidemiology %K China %K Italy %K Spain %K New York %K Washington %D 2020 %7 21.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) is the latest pandemic of the digital age. With the internet harvesting large amounts of data from the general population in real time, public databases such as Google Trends (GT) and the Baidu Index (BI) can be an expedient tool to assist public health efforts. Objective: The aim of this study is to apply digital epidemiology to the current COVID-19 pandemic to determine the utility of providing adjunctive epidemiologic information on outbreaks of this disease and evaluate this methodology in the case of future pandemics. Methods: An epidemiologic time series analysis of online search trends relating to the COVID-19 pandemic was performed from January 9, 2020, to April 6, 2020. BI was used to obtain online search data for China, while GT was used for worldwide data, the countries of Italy and Spain, and the US states of New York and Washington. These data were compared to real-world confirmed cases and deaths of COVID-19. Chronologic patterns were assessed in relation to disease patterns, significant events, and media reports. Results: Worldwide search terms for shortness of breath, anosmia, dysgeusia and ageusia, headache, chest pain, and sneezing had strong correlations (r>0.60, P<.001) to both new daily confirmed cases and deaths from COVID-19. GT COVID-19 (search term) and GT coronavirus (virus) searches predated real-world confirmed cases by 12 days (r=0.85, SD 0.10 and r=0.76, SD 0.09, respectively, P<.001). Searches for symptoms of diarrhea, fever, shortness of breath, cough, nasal obstruction, and rhinorrhea all had a negative lag greater than 1 week compared to new daily cases, while searches for anosmia and dysgeusia peaked worldwide and in China with positive lags of 5 days and 6 weeks, respectively, corresponding with widespread media coverage of these symptoms in COVID-19. Conclusions: This study demonstrates the utility of digital epidemiology in providing helpful surveillance data of disease outbreaks like COVID-19. Although certain online search trends for this disease were influenced by media coverage, many search terms reflected clinical manifestations of the disease and showed strong correlations with real-world cases and deaths. %M 32401211 %R 10.2196/19702 %U https://publichealth.jmir.org/2020/2/e19702 %U https://doi.org/10.2196/19702 %U http://www.ncbi.nlm.nih.gov/pubmed/32401211 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19447 %T Global Sentiments Surrounding the COVID-19 Pandemic on Twitter: Analysis of Twitter Trends %A Lwin,May Oo %A Lu,Jiahui %A Sheldenkar,Anita %A Schulz,Peter Johannes %A Shin,Wonsun %A Gupta,Raj %A Yang,Yinping %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore, 637718, Singapore, 65 69083444, anitas@ntu.edu.sg %K COVID-19 %K Twitter %K pandemic %K social sentiments %K emotions %K infodemic %D 2020 %7 22.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With the World Health Organization’s pandemic declaration and government-initiated actions against coronavirus disease (COVID-19), sentiments surrounding COVID-19 have evolved rapidly. Objective: This study aimed to examine worldwide trends of four emotions—fear, anger, sadness, and joy—and the narratives underlying those emotions during the COVID-19 pandemic. Methods: Over 20 million social media twitter posts made during the early phases of the COVID-19 outbreak from January 28 to April 9, 2020, were collected using “wuhan,” “corona,” “nCov,” and “covid” as search keywords. Results: Public emotions shifted strongly from fear to anger over the course of the pandemic, while sadness and joy also surfaced. Findings from word clouds suggest that fears around shortages of COVID-19 tests and medical supplies became increasingly widespread discussion points. Anger shifted from xenophobia at the beginning of the pandemic to discourse around the stay-at-home notices. Sadness was highlighted by the topics of losing friends and family members, while topics related to joy included words of gratitude and good health. Conclusions: Overall, global COVID-19 sentiments have shown rapid evolutions within just the span of a few weeks. Findings suggest that emotion-driven collective issues around shared public distress experiences of the COVID-19 pandemic are developing and include large-scale social isolation and the loss of human lives. The steady rise of societal concerns indicated by negative emotions needs to be monitored and controlled by complementing regular crisis communication with strategic public health communication that aims to balance public psychological wellbeing. %M 32412418 %R 10.2196/19447 %U http://publichealth.jmir.org/2020/2/e19447/ %U https://doi.org/10.2196/19447 %U http://www.ncbi.nlm.nih.gov/pubmed/32412418 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18638 %T Mathematical Modeling of COVID-19 Control and Prevention Based on Immigration Population Data in China: Model Development and Validation %A Huang,Qiangsheng %A Kang,Yu Sunny %+ Ping An Technology (Shenzhen) Co, Ltd, Ping An Wealth Building, 1088 Yuanshen Road, Pudong New District, Shanghai, 200135, China, 86 13761879218, hqsh@live.cn %K COVID-19 %K 2019-ncov %K epidemic control and prevention %K epidemic risk time series model %K incoming immigration population %K new diagnoses per day %D 2020 %7 25.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: At the end of February 2020, the spread of coronavirus disease (COVID-19) in China had drastically slowed and appeared to be under control compared to the peak data in early February of that year. However, the outcomes of COVID-19 control and prevention measures varied between regions (ie, provinces and municipalities) in China; moreover, COVID-19 has become a global pandemic, and the spread of the disease has accelerated in countries outside China. Objective: This study aimed to establish valid models to evaluate the effectiveness of COVID-19 control and prevention among various regions in China. These models also targeted regions with control and prevention problems by issuing immediate warnings. Methods: We built a mathematical model, the Epidemic Risk Time Series Model, and used it to analyze two sets of data, including the daily COVID-19 incidence (ie, newly diagnosed cases) as well as the daily immigration population size. Results: Based on the results of the model evaluation, some regions, such as Shanghai and Zhejiang, were successful in COVID-19 control and prevention, whereas other regions, such as Heilongjiang, yielded poor performance. The evaluation result was highly correlated with the basic reproduction number (R0) value, and the result was evaluated in a timely manner at the beginning of the disease outbreak. Conclusions: The Epidemic Risk Time Series Model was designed to evaluate the effectiveness of COVID-19 control and prevention in different regions in China based on analysis of immigration population data. Compared to other methods, such as R0, this model enabled more prompt issue of early warnings. This model can be generalized and applied to other countries to evaluate their COVID-19 control and prevention. %M 32396132 %R 10.2196/18638 %U http://publichealth.jmir.org/2020/2/e18638/ %U https://doi.org/10.2196/18638 %U http://www.ncbi.nlm.nih.gov/pubmed/32396132 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19501 %T Online National Health Agency Mask Guidance for the Public in Light of COVID-19: Content Analysis %A Laestadius,Linnea %A Wang,Yang %A Ben Taleb,Ziyad %A Kalan,Mohammad Ebrahimi %A Cho,Young %A Manganello,Jennifer %+ Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI, 53201, United States, 1 414 227 4512, llaestad@uwm.edu %K public health policy %K infectious disease %K personal protective equipment %K public health %K COVID-19 %K pandemic %K online health information %K content analysis %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The rapid global spread of the coronavirus disease (COVID-19) has compelled national governments to issue guidance on the use of face masks for members of the general public. To date, no work has assessed how this guidance differs across governments. Objective: This study seeks to contribute to a rational and consistent global response to infectious disease by determining how guidelines differ across nations and regions. Methods: A content analysis of health agency mask guidelines on agency websites was performed in late March 2020 among 25 countries and regions with large numbers of COVID-19 cases. Countries and regions were assigned across the coding team by language proficiency, with Google Translate used as needed. When available, both the original and English language version of guidance were reviewed. Results: All examined countries and regions had some form of guidance online, although detail and clarity differed. Although 9 countries and regions recommended surgical, medical, or unspecified masks in public and poorly ventilated places, 16 recommended against people wearing masks in public. There were 2 countries that explicitly recommended against fabric masks. In addition, 12 failed to outline the minimum basic World Health Organization guidance for masks. Conclusions: Online guidelines for face mask use to prevent COVID-19 in the general public are currently inconsistent across nations and regions, and have been changing often. Efforts to create greater standardization and clarity should be explored in light of the status of COVID-19 as a global pandemic. %M 32427103 %R 10.2196/19501 %U http://publichealth.jmir.org/2020/2/e19501/ %U https://doi.org/10.2196/19501 %U http://www.ncbi.nlm.nih.gov/pubmed/32427103 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19464 %T Comparison of Transmissibility of Coronavirus Between Symptomatic and Asymptomatic Patients: Reanalysis of the Ningbo COVID-19 Data %A Yin,Guosheng %A Jin,Huaqing %+ Department of Statistics and Actuarial Science, The University of Hong Kong, Pokfulam Road, Hong Kong, China, 852 3917 8313, gyin@hku.hk %K asymptomatic case %K close contact %K coronavirus %K COVID-19 %K Fisher exact test %K transmission rate %K transmission %K virus %K immunology %K analysis %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the outbreak of the novel coronavirus disease (COVID-19) in December 2019, the coronavirus has spread all over the world at an unprecedented rate. The transmissibility of the coronavirus from asymptomatic patients to healthy individuals has received enormous attention. An important study using COVID-19 data from the city of Ningbo, China, was carried out to estimate and compare the transmission rates of the coronavirus by the symptomatic and asymptomatic patients. However, in the original analysis, the usual chi-square tests were unduly used for some contingency tables with small cell counts including zero, which may violate the assumptions for the chi-square test. Objective: We reanalyze the data from the city of Ningbo with more appropriate statistical methods to draw more reliable and sound conclusions on the transmission rates of the coronavirus by the symptomatic and asymptomatic patients. Methods: We excluded the cases associated with the super-spreader and adopted a more appropriate statistical method, including the permutation test and the Fisher exact test, to reanalyze the COVID-19 data from the city of Ningbo. Results: After excluding the cases related to the super-spreader, the Fisher exact test yields a P value of .84, which indicates stronger evidence of no difference in the transmission rates compared with the original analysis. The odds ratio of the coronavirus transmission rates between the symptomatic and asymptomatic patients is 1.2 with a 95% confidence interval 0.5-2.8. Conclusions: Through a more in-depth and comprehensive statistical analysis of the Ningbo data, we concluded that there is no difference in the transmission rates of coronavirus between symptomatic and asymptomatic patients. %M 32442131 %R 10.2196/19464 %U http://publichealth.jmir.org/2020/2/e19464/ %U https://doi.org/10.2196/19464 %U http://www.ncbi.nlm.nih.gov/pubmed/32442131 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19862 %T No Place Like Home: Cross-National Data Analysis of the Efficacy of Social Distancing During the COVID-19 Pandemic %A Delen,Dursun %A Eryarsoy,Enes %A Davazdahemami,Behrooz %+ Center for Health Systems Innovation, Department of Management Science and Information Systems, Oklahoma State University, 700 N Greenwood Ave, NH302, Tulsa, OK, 74106, United States, 1 9185948283, dursun.delen@okstate.edu %K COVID-19 %K public health %K social distancing %K machine learning %K pandemic %D 2020 %7 28.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In the absence of a cure in the time of a pandemic, social distancing measures seem to be the most effective intervention to slow the spread of disease. Various simulation-based studies have been conducted to investigate the effectiveness of these measures. While those studies unanimously confirm the mitigating effect of social distancing on disease spread, the reported effectiveness varies from 10% to more than 90% reduction in the number of infections. This level of uncertainty is mostly due to the complex dynamics of epidemics and their time-variant parameters. However, real transactional data can reduce uncertainty and provide a less noisy picture of the effectiveness of social distancing. Objective: The aim of this paper was to integrate multiple transactional data sets (GPS mobility data from Google and Apple as well as disease statistics from the European Centre for Disease Prevention and Control) to study the role of social distancing policies in 26 countries and analyze the transmission rate of the coronavirus disease (COVID-19) pandemic over the course of 5 weeks. Methods: Relying on the susceptible-infected-recovered (SIR) model and official COVID-19 reports, we first calculated the weekly transmission rate (β) of COVID-19 in 26 countries for 5 consecutive weeks. Then, we integrated these data with the Google and Apple mobility data sets for the same time frame and used a machine learning approach to investigate the relationship between the mobility factors and β values. Results: Gradient boosted trees regression analysis showed that changes in mobility patterns resulting from social distancing policies explain approximately 47% of the variation in the disease transmission rates. Conclusions: Consistent with simulation-based studies, real cross-national transactional data confirms the effectiveness of social distancing interventions in slowing the spread of COVID-19. In addition to providing less noisy and more generalizable support for the idea of social distancing, we provide specific insights for public health policy makers regarding locations that should be given higher priority for enforcing social distancing measures. %M 32434145 %R 10.2196/19862 %U http://publichealth.jmir.org/2020/2/e19862/ %U https://doi.org/10.2196/19862 %U http://www.ncbi.nlm.nih.gov/pubmed/32434145 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19279 %T COVID-19: Putting the General Data Protection Regulation to the Test %A McLennan,Stuart %A Celi,Leo Anthony %A Buyx,Alena %+ Institute of History and Ethics in Medicine, Technical University of Munich, Ismaninger Straße 22, Munich, 81675, Germany, 49 089 4140 4041, stuart.mclennan@tum.de %K COVID-19 %K data sharing %K GDPR %K research exemption %K global health %K public health %K research %K digital health %K electronic health records %K EHR %D 2020 %7 29.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The coronavirus disease (COVID-19) pandemic is very much a global health issue and requires collaborative, international health research efforts to address it. A valuable source of information for researchers is the large amount of digital health data that are continuously collected by electronic health record systems at health care organizations. The European Union’s General Data Protection Regulation (GDPR) will be the key legal framework with regard to using and sharing European digital health data for research purposes. However, concerns persist that the GDPR has made many organizations very risk-averse in terms of data sharing, even if the regulation permits such sharing. Health care organizations focusing on individual risk minimization threaten to undermine COVID-19 research efforts. In our opinion, there is an ethical obligation to use the research exemption clause of the GDPR during the COVID-19 pandemic to support global collaborative health research efforts. Solidarity is a European value, and here is a chance to exemplify it by using the GDPR regulatory framework in a way that does not hinder but actually fosters solidarity during the COVID-19 pandemic. %M 32449686 %R 10.2196/19279 %U http://publichealth.jmir.org/2020/2/e19279/ %U https://doi.org/10.2196/19279 %U http://www.ncbi.nlm.nih.gov/pubmed/32449686 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19273 %T Tracking Social Media Discourse About the COVID-19 Pandemic: Development of a Public Coronavirus Twitter Data Set %A Chen,Emily %A Lerman,Kristina %A Ferrara,Emilio %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way, #1001, Marina del Rey, CA, 90292, United States, 1 310 448 8661, emiliofe@usc.edu %K COVID-19 %K SARS-CoV-2 %K social media %K network analysis %K computational social sciences %D 2020 %7 29.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: At the time of this writing, the coronavirus disease (COVID-19) pandemic outbreak has already put tremendous strain on many countries' citizens, resources, and economies around the world. Social distancing measures, travel bans, self-quarantines, and business closures are changing the very fabric of societies worldwide. With people forced out of public spaces, much of the conversation about these phenomena now occurs online on social media platforms like Twitter. Objective: In this paper, we describe a multilingual COVID-19 Twitter data set that we are making available to the research community via our COVID-19-TweetIDs GitHub repository. Methods: We started this ongoing data collection on January 28, 2020, leveraging Twitter’s streaming application programming interface (API) and Tweepy to follow certain keywords and accounts that were trending at the time data collection began. We used Twitter’s search API to query for past tweets, resulting in the earliest tweets in our collection dating back to January 21, 2020. Results: Since the inception of our collection, we have actively maintained and updated our GitHub repository on a weekly basis. We have published over 123 million tweets, with over 60% of the tweets in English. This paper also presents basic statistics that show that Twitter activity responds and reacts to COVID-19-related events. Conclusions: It is our hope that our contribution will enable the study of online conversation dynamics in the context of a planetary-scale epidemic outbreak of unprecedented proportions and implications. This data set could also help track COVID-19-related misinformation and unverified rumors or enable the understanding of fear and panic—and undoubtedly more. %M 32427106 %R 10.2196/19273 %U http://publichealth.jmir.org/2020/2/e19273/ %U https://doi.org/10.2196/19273 %U http://www.ncbi.nlm.nih.gov/pubmed/32427106 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19033 %T A Web- and App-Based Connected Care Solution for COVID-19 In- and Outpatient Care: Qualitative Study and Application Development %A Schinköthe,Timo %A Gabri,Mariano Rolando %A Mitterer,Manfred %A Gouveia,Pedro %A Heinemann,Volker %A Harbeck,Nadia %A Subklewe,Marion %+ CANKADO, Eupener Sraße 165, Cologne, 50933, Germany, 49 221 429 153 00, t.schinkoethe@cankado.com %K COVID-19 %K eHealth %K connected care %K telecare %K cloud solution %K telehealth %K public health %K infectious disease %K pandemic %K outbreak %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: From the perspective of health care professionals, coronavirus disease (COVID-19) brings many challenges as well as opportunities for digital health care. One challenge is that health care professionals are at high risk of infection themselves. Therefore, in-person visits need to be reduced to an absolute minimum. Connected care solutions, including telehealth, remote patient monitoring, and secure communications between clinicians and their patients, may rapidly become the first choice in such public health emergencies. Objective: The aim of the COVID-19 Caregiver Cockpit (C19CC) was to implement a free-of-charge, web- and app-based tool for patient assessment to assist health care professionals working in the COVID-19 environment. Methods: Physicians in Argentina, Germany, Iran, Italy, Portugal, Switzerland, and the United States explained their challenges with COVID-19 patient care through unstructured interviews. Based on the collected feedback, the first version of the C19CC was built. In the second round of interviews, the application was presented to physicians, and more feedback was obtained. Results: Physicians identified a number of different scenarios where telemedicine or connected care solutions could rapidly improve patient care. These scenarios included outpatient care, discharge management, remote tracking of patients with chronic diseases, as well as incorporating infected physicians under quarantine into telehealth services. Conclusions: The C19CC is the result of an agile and iterative development process that complements the work of physicians. It aims to improve the care and safety of people who are infected by COVID-19. %M 32406855 %R 10.2196/19033 %U http://publichealth.jmir.org/2020/2/e19033/ %U https://doi.org/10.2196/19033 %U http://www.ncbi.nlm.nih.gov/pubmed/32406855 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19170 %T A Snapshot of SARS-CoV-2 Genome Availability up to April 2020 and its Implications: Data Analysis %A Mavian,Carla %A Marini,Simone %A Prosperi,Mattia %A Salemi,Marco %+ Emerging Pathogens Institute, University of Florida, Mowry Rd 2055, Gainesville, FL, United States, 1 352 273 9567, salemi@pathology.ufl.edu %K covid-19 %K sars-cov-2 %K phylogenetics %K genome %K evolution %K genetics %K pandemic %K infectious disease %K virus %K sequence %K transmission %K tracing %K tracking %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been growing exponentially, affecting over 4 million people and causing enormous distress to economies and societies worldwide. A plethora of analyses based on viral sequences has already been published both in scientific journals and through non–peer-reviewed channels to investigate the genetic heterogeneity and spatiotemporal dissemination of SARS-CoV-2. However, a systematic investigation of phylogenetic information and sampling bias in the available data is lacking. Although the number of available genome sequences of SARS-CoV-2 is growing daily and the sequences show increasing phylogenetic information, country-specific data still present severe limitations and should be interpreted with caution. Objective: The objective of this study was to determine the quality of the currently available SARS-CoV-2 full genome data in terms of sampling bias as well as phylogenetic and temporal signals to inform and guide the scientific community. Methods: We used maximum likelihood–based methods to assess the presence of sufficient information for robust phylogenetic and phylogeographic studies in several SARS-CoV-2 sequence alignments assembled from GISAID (Global Initiative on Sharing All Influenza Data) data released between March and April 2020. Results: Although the number of high-quality full genomes is growing daily, and sequence data released in April 2020 contain sufficient phylogenetic information to allow reliable inference of phylogenetic relationships, country-specific SARS-CoV-2 data sets still present severe limitations. Conclusions: At the present time, studies assessing within-country spread or transmission clusters should be considered preliminary or hypothesis-generating at best. Hence, current reports should be interpreted with caution, and concerted efforts should continue to increase the number and quality of sequences required for robust tracing of the epidemic. %M 32412415 %R 10.2196/19170 %U http://publichealth.jmir.org/2020/2/e19170/ %U https://doi.org/10.2196/19170 %U http://www.ncbi.nlm.nih.gov/pubmed/32412415 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19927 %T Primary Health Care Facility Preparedness for Outpatient Service Provision During the COVID-19 Pandemic in India: Cross-Sectional Study %A Garg,Suneela %A Basu,Saurav %A Rustagi,Ruchir %A Borle,Amod %+ Department of Community Medicine, Maulana Azad Medical College, 2 BSZ Marg, New Delhi, 110002, India, 91 8447527452, saurav.basu1983@gmail.com %K primary health care %K COVID-19 %K pandemic %K health systems %K India %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Primary health centers (PHCs) represent the first tier of the Indian health care system, providing a range of essential outpatient services to people living in the rural, suburban, and hard-to-reach areas. Diversion of health care resources for containing the coronavirus disease (COVID-19) pandemic has significantly undermined the accessibility and availability of essential health services. Under these circumstances, the preparedness of PHCs in providing safe patient-centered care and meeting the current health needs of the population while preventing further transmission of the severe acute respiratory syndrome coronavirus 2 infection is crucial. Objective: The aim of this study was to determine the primary health care facility preparedness toward the provision of safe outpatient services during the COVID-19 pandemic in India. Methods: We conducted a cross-sectional study among supervisors and managers of primary health care facilities attached to medical colleges and institutions in India. A list of 60 faculties involved in the management and supervision of PHCs affiliated with the community medicine departments of medical colleges and institutes across India was compiled from an accessible private organization member database. We collected the data through a rapid survey from April 24 to 30, 2020, using a Google Forms online digital questionnaire that evaluated preparedness parameters based on self-assessment by the participants. The preparedness domains assessed were infrastructure availability, health worker safety, and patient care. Results: A total of 51 faculties responded to the survey. Each medical college and institution had on average a total of 2.94 (SD 1.7) PHCs under its jurisdiction. Infrastructural and infection control deficits at the PHC were reported in terms of limited physical space and queuing capacity, lack of separate entry and exit gates (n=25, 49%), inadequate ventilation (n=29, 57%), and negligible airborne infection control measures (n=38, 75.5%). N95 masks were available at 26 (50.9%) sites. Infection prevention and control measures were also suboptimal with inadequate facilities for handwashing and hand hygiene reported in 23.5% (n=12) and 27.4% (n=14) of sites, respectively. The operation of outpatient services, particularly related to maternal and child health, was significantly disrupted (P<.001) during the COVID-19 pandemic. Conclusions: Existing PHC facilities in India providing outpatient services are constrained in their functioning during the COVID-19 pandemic due to weak infrastructure contributing to suboptimal patient safety and infection control measures. Furthermore, there is a need for effective planning, communication, and coordination between the centralized health policy makers and health managers working at primary health care facilities to ensure overall preparedness during public health emergencies. %M 32452819 %R 10.2196/19927 %U http://publichealth.jmir.org/2020/2/e19927/ %U https://doi.org/10.2196/19927 %U http://www.ncbi.nlm.nih.gov/pubmed/32452819 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19509 %T Machine Learning to Detect Self-Reporting of Symptoms, Testing Access, and Recovery Associated With COVID-19 on Twitter: Retrospective Big Data Infoveillance Study %A Mackey,Tim %A Purushothaman,Vidya %A Li,Jiawei %A Shah,Neal %A Nali,Matthew %A Bardier,Cortni %A Liang,Bryan %A Cai,Mingxiang %A Cuomo,Raphael %+ Department of Anesthesiology and Division of Global Public Health and Infectious Diseases, School of Medicine, University of California San Diego, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, United States, 1 9514914161, tmackey@ucsd.edu %K infoveillance %K COVID-19 %K Twitter %K machine learning %K surveillance %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic is a global health emergency with over 6 million cases worldwide as of the beginning of June 2020. The pandemic is historic in scope and precedent given its emergence in an increasingly digital era. Importantly, there have been concerns about the accuracy of COVID-19 case counts due to issues such as lack of access to testing and difficulty in measuring recoveries. Objective: The aims of this study were to detect and characterize user-generated conversations that could be associated with COVID-19-related symptoms, experiences with access to testing, and mentions of disease recovery using an unsupervised machine learning approach. Methods: Tweets were collected from the Twitter public streaming application programming interface from March 3-20, 2020, filtered for general COVID-19-related keywords and then further filtered for terms that could be related to COVID-19 symptoms as self-reported by users. Tweets were analyzed using an unsupervised machine learning approach called the biterm topic model (BTM), where groups of tweets containing the same word-related themes were separated into topic clusters that included conversations about symptoms, testing, and recovery. Tweets in these clusters were then extracted and manually annotated for content analysis and assessed for their statistical and geographic characteristics. Results: A total of 4,492,954 tweets were collected that contained terms that could be related to COVID-19 symptoms. After using BTM to identify relevant topic clusters and removing duplicate tweets, we identified a total of 3465 (<1%) tweets that included user-generated conversations about experiences that users associated with possible COVID-19 symptoms and other disease experiences. These tweets were grouped into five main categories including first- and secondhand reports of symptoms, symptom reporting concurrent with lack of testing, discussion of recovery, confirmation of negative COVID-19 diagnosis after receiving testing, and users recalling symptoms and questioning whether they might have been previously infected with COVID-19. The co-occurrence of tweets for these themes was statistically significant for users reporting symptoms with a lack of testing and with a discussion of recovery. A total of 63% (n=1112) of the geotagged tweets were located in the United States. Conclusions: This study used unsupervised machine learning for the purposes of characterizing self-reporting of symptoms, experiences with testing, and mentions of recovery related to COVID-19. Many users reported symptoms they thought were related to COVID-19, but they were not able to get tested to confirm their concerns. In the absence of testing availability and confirmation, accurate case estimations for this period of the outbreak may never be known. Future studies should continue to explore the utility of infoveillance approaches to estimate COVID-19 disease severity. %M 32490846 %R 10.2196/19509 %U http://publichealth.jmir.org/2020/2/e19509/ %U https://doi.org/10.2196/19509 %U http://www.ncbi.nlm.nih.gov/pubmed/32490846 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19276 %T Mining Physicians’ Opinions on Social Media to Obtain Insights Into COVID-19: Mixed Methods Analysis %A Wahbeh,Abdullah %A Nasralah,Tareq %A Al-Ramahi,Mohammad %A El-Gayar,Omar %+ Supply Chain and Information Management Group, D’Amore-McKim School of Business, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, United States, 1 617 373 4460, t.nasralah@northeastern.edu %K pandemic %K coronavirus %K COVID-19 %K social media %K infodemiology %K infoveillance %K medical professionals %K opinion analysis %D 2020 %7 18.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic is considered to be the most daunting public health challenge in decades. With no effective treatments and with time needed to develop a vaccine, alternative approaches are being used to control this pandemic. Objective: The objective of this paper was to identify topics, opinions, and recommendations about the COVID-19 pandemic discussed by medical professionals on the Twitter social medial platform. Methods: Using a mixed methods approach blending the capabilities of social media analytics and qualitative analysis, we analyzed COVID-19–related tweets posted by medical professionals and examined their content. We used qualitative analysis to explore the collected data to identify relevant tweets and uncover important concepts about the pandemic using qualitative coding. Unsupervised and supervised machine learning techniques and text analysis were used to identify topics and opinions. Results: Data were collected from 119 medical professionals on Twitter about the coronavirus pandemic. A total of 10,096 English tweets were collected from the identified medical professionals between December 1, 2019 and April 1, 2020. We identified eight topics, namely actions and recommendations, fighting misinformation, information and knowledge, the health care system, symptoms and illness, immunity, testing, and infection and transmission. The tweets mainly focused on needed actions and recommendations (2827/10,096, 28%) to control the pandemic. Many tweets warned about misleading information (2019/10,096, 20%) that could lead to infection of more people with the virus. Other tweets discussed general knowledge and information (911/10,096, 9%) about the virus as well as concerns about the health care systems and workers (909/10,096, 9%). The remaining tweets discussed information about symptoms associated with COVID-19 (810/10,096, 8%), immunity (707/10,096, 7%), testing (605/10,096, 6%), and virus infection and transmission (503/10,096, 5%). Conclusions: Our findings indicate that Twitter and social media platforms can help identify important and useful knowledge shared by medical professionals during a pandemic. %M 32421686 %R 10.2196/19276 %U http://publichealth.jmir.org/2020/2/e19276/ %U https://doi.org/10.2196/19276 %U http://www.ncbi.nlm.nih.gov/pubmed/32421686 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19606 %T Distribution of Patients at Risk for Complications Related to COVID-19 in the United States: Model Development Study %A Smith-Ray,Renae %A Roberts,Erin E %A Littleton,Devonee E %A Singh,Tanya %A Sandberg,Thomas %A Taitel,Michael %+ Walgreens Center for Health and Wellbeing Research, Health Analytics, Research, and Reporting, Walgreen Co, 102 Wilmot Rd, MS 125D, Deerfield, IL, 60015, United States, 1 8472268552, renae.smith-ray@walgreens.com %K COVID-19 %K modeling %K chronic conditions %K older adults %D 2020 %7 18.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Coronavirus disease (COVID-19) has spread exponentially across the United States. Older adults with underlying health conditions are at an especially high risk of developing life-threatening complications if infected. Most intensive care unit (ICU) admissions and non-ICU hospitalizations have been among patients with at least one underlying health condition. Objective: The aim of this study was to develop a model to estimate the risk status of the patients of a nationwide pharmacy chain in the United States, and to identify the geographic distribution of patients who have the highest risk of severe COVID-19 complications. Methods: A risk model was developed using a training test split approach to identify patients who are at high risk of developing serious complications from COVID-19. Adult patients (aged ≥18 years) were identified from the Walgreens pharmacy electronic data warehouse. Patients were considered eligible to contribute data to the model if they had at least one prescription filled at a Walgreens location between October 27, 2019, and March 25, 2020. Risk parameters included age, whether the patient is being treated for a serious or chronic condition, and urban density classification. Parameters were differentially weighted based on their association with severe complications, as reported in earlier cases. An at-risk rate per 1000 people was calculated at the county level, and ArcMap was used to depict the rate of patients at high risk for severe complications from COVID-19. Real-time COVID-19 cases captured by the Johns Hopkins University Center for Systems Science and Engineering (CSSE) were layered in the risk map to show where cases exist relative to the high-risk populations. Results: Of the 30,100,826 adults included in this study, the average age is 50 years, 15% have at least one specialty medication, and the average patient has 2 to 3 comorbidities. Nearly 28% of patients have the greatest risk score, and an additional 34.64% of patients are considered high-risk, with scores ranging from 8 to 10. Age accounts for 53% of a patient’s total risk, followed by the number of comorbidities (29%); inferred chronic obstructive pulmonary disease, hypertension, or diabetes (15%); and urban density classification (5%). Conclusions: This risk model utilizes data from approximately 10% of the US population. Currently, this is the most comprehensive US model to estimate and depict the county-level prognosis of COVID-19 infection. This study shows that there are counties across the United States whose residents are at high risk of developing severe complications from COVID-19. Our county-level risk estimates may be used alongside other data sets to improve the accuracy of anticipated health care resource needs. The interactive map can also aid in proactive planning and preparations among employers that are deemed critical, such as pharmacies and grocery stores, to prevent the spread of COVID-19 within their facilities. %M 32511100 %R 10.2196/19606 %U https://publichealth.jmir.org/2020/2/e19606 %U https://doi.org/10.2196/19606 %U http://www.ncbi.nlm.nih.gov/pubmed/32511100 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19353 %T Modeling COVID-19 Latent Prevalence to Assess a Public Health Intervention at a State and Regional Scale: Retrospective Cohort Study %A Turk,Philip J %A Chou,Shih-Hsiung %A Kowalkowski,Marc A %A Palmer,Pooja P %A Priem,Jennifer S %A Spencer,Melanie D %A Taylor,Yhenneko J %A McWilliams,Andrew D %+ Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Office 124, Charlotte, NC, 28203, United States, 1 304 376 5377, Philip.Turk@atriumhealth.org %K COVID-19 %K public health surveillance %K novel coronavirus 2019 %K pandemic %K forecasting %K SIR model %K detection probability %K latent prevalence %D 2020 %7 19.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Emergence of the coronavirus disease (COVID-19) caught the world off guard and unprepared, initiating a global pandemic. In the absence of evidence, individual communities had to take timely action to reduce the rate of disease spread and avoid overburdening their health care systems. Although a few predictive models have been published to guide these decisions, most have not taken into account spatial differences and have included assumptions that do not match the local realities. Access to reliable information that is adapted to local context is critical for policy makers to make informed decisions during a rapidly evolving pandemic. Objective: The goal of this study was to develop an adapted susceptible-infected-removed (SIR) model to predict the trajectory of the COVID-19 pandemic in North Carolina and the Charlotte Metropolitan Region, and to incorporate the effect of a public health intervention to reduce disease spread while accounting for unique regional features and imperfect detection. Methods: Three SIR models were fit to infection prevalence data from North Carolina and the greater Charlotte Region and then rigorously compared. One of these models (SIR-int) accounted for a stay-at-home intervention and imperfect detection of COVID-19 cases. We computed longitudinal total estimates of the susceptible, infected, and removed compartments of both populations, along with other pandemic characteristics such as the basic reproduction number. Results: Prior to March 26, disease spread was rapid at the pandemic onset with the Charlotte Region doubling time of 2.56 days (95% CI 2.11-3.25) and in North Carolina 2.94 days (95% CI 2.33-4.00). Subsequently, disease spread significantly slowed with doubling times increased in the Charlotte Region to 4.70 days (95% CI 3.77-6.22) and in North Carolina to 4.01 days (95% CI 3.43-4.83). Reflecting spatial differences, this deceleration favored the greater Charlotte Region compared to North Carolina as a whole. A comparison of the efficacy of intervention, defined as 1 – the hazard ratio of infection, gave 0.25 for North Carolina and 0.43 for the Charlotte Region. In addition, early in the pandemic, the initial basic SIR model had good fit to the data; however, as the pandemic and local conditions evolved, the SIR-int model emerged as the model with better fit. Conclusions: Using local data and continuous attention to model adaptation, our findings have enabled policy makers, public health officials, and health systems to proactively plan capacity and evaluate the impact of a public health intervention. Our SIR-int model for estimated latent prevalence was reasonably flexible, highly accurate, and demonstrated efficacy of a stay-at-home order at both the state and regional level. Our results highlight the importance of incorporating local context into pandemic forecast modeling, as well as the need to remain vigilant and informed by the data as we enter into a critical period of the outbreak. %M 32427104 %R 10.2196/19353 %U http://publichealth.jmir.org/2020/2/e19353/ %U https://doi.org/10.2196/19353 %U http://www.ncbi.nlm.nih.gov/pubmed/32427104 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19847 %T Perspective of Medical Students on the COVID-19 Pandemic: Survey of Nine Medical Schools in Uganda %A Olum,Ronald %A Kajjimu,Jonathan %A Kanyike,Andrew Marvin %A Chekwech,Gaudencia %A Wekha,Godfrey %A Nassozi,Dianah Rhoda %A Kemigisa,Juliet %A Mulyamboga,Paul %A Muhoozi,Oscar Kabagambe %A Nsenga,Lauryn %A Lyavala,Musilim %A Asiimwe,Asaph %A Bongomin,Felix %+ School of Medicine, College of Health Sciences, Makerere University, Mulago Hospital Complex, Kampala, , Uganda, +256 775 512 540, olum.ronald@gmail.com %K knowledge %K attitude %K practices %K COVID-19 %K medical students %K Uganda %K medical education %K perspective %D 2020 %7 19.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic is a global public health concern affecting over 5 million people and posing a great burden on health care systems worldwide. Objective: The aim of this study is to determine the knowledge, attitude, and practices of medical students in Uganda on the COVID-19 pandemic. Methods: We conducted an online, descriptive cross-sectional study in mid-April 2020, using WhatsApp Messenger. Medical students in 9 of the 10 medical schools in Uganda were approached through convenience sampling. Bloom’s cut-off of 80% was used to determine good knowledge (≥12 out of 15), positive attitude (≥20 out of 25), and good practice (≥12 out of 15). Results: The data of 741 first- to fifth-year medical students, consisting of 468 (63%) males with a mean age of 24 (SD 4) years, were analyzed. The majority (n=626, 84%) were pursuing Bachelor of Medicine and Bachelor of Surgery degrees. Overall, 671 (91%) had good knowledge, 550 (74%) had a positive attitude, and 426 (57%) had good practices. Knowledge was associated with the 4th year of study (adjusted odds ratio [aOR] 4.1, 95% CI 1.6-10.3; P<.001). Attitude was associated with the female sex (aOR 0.7, 95% CI 0.5-1; P=.04) and TV or radio shows (aOR 1.1, 95% CI 0.6-2.1; P=.01). Practices were associated with the ≥24 years age category (aOR 1.5, 95% CI 1.1-2.1; P=.02) and online courses (aOR 1.8, 95% CI 1.1-3.2; P=.03). In total, 592 (80%) medical students were willing to participate in frontline care if called upon. Conclusions: Medical students in Uganda have sufficient knowledge of COVID-19 and will be a large reservoir for health care response when the need arises. %M 32530815 %R 10.2196/19847 %U http://publichealth.jmir.org/2020/2/e19847/ %U https://doi.org/10.2196/19847 %U http://www.ncbi.nlm.nih.gov/pubmed/32530815 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18928 %T COVID-19 and Laparoscopic Surgery: Scoping Review of Current Literature and Local Expertise %A de Leeuw,Robert Adrianus %A Burger,Nicole Birgit %A Ceccaroni,Marcello %A Zhang,Jian %A Tuynman,Jurriaan %A Mabrouk,Mohamed %A Barri Soldevila,Pere %A Bonjer,Hendrik Jaap %A Ankum,Pim %A Huirne,Judith %+ Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, 1081HV, Netherlands, 31 618390269, r.a.deleeuw@amsterdamumc.nl %K laparoscopy %K COVID-19 %K surgical procedures, operative %K corona 2019 %K surgery %K pandemic %K outbreak %K infectious disease %K health care provider %K physician %D 2020 %7 23.6.2020 %9 Review %J JMIR Public Health Surveill %G English %X Background: The current coronavirus disease (COVID-19) pandemic is holding the world in its grip. Epidemiologists have shown that the mortality risks are higher when the health care system is subjected to pressure from COVID-19. It is therefore of great importance to maintain the health of health care providers and prevent contamination. An important group who will be required to treat patients with COVID-19 are health care providers during semiacute surgery. There are concerns that laparoscopic surgery increases the risk of contamination more than open surgery; therefore, balancing the safety of health care providers with the benefit of laparoscopic surgery for the patient is vital. Objective: We aimed to provide an overview of potential contamination routes and possible risks for health care providers; we also aimed to propose research questions based on current literature and expert opinions about performing laparoscopic surgery on patients with COVID-19. Methods: We performed a scoping review, adding five additional questions concerning possible contaminating routes. A systematic search was performed on the PubMed, CINAHL, and Embase databases, adding results from gray literature as well. The search not only included COVID-19 but was extended to virus contamination in general. We excluded society and professional association statements about COVID-19 if they did not add new insights to the available literature. Results: The initial search provided 2007 records, after which 267 full-text papers were considered. Finally, we used 84 papers, of which 14 discussed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Eight papers discussed the added value of performing intubation in a low-pressure operating room, mainly based on the SARS outbreak experience in 2003. Thirteen papers elaborated on the risks of intubation for health care providers and SARS-CoV-2, and 19 papers discussed this situation with other viruses. They conclude that there is significant evidence that intubation and extubation is a high-risk aerosol-producing procedure. No papers were found on the risk of SARS-CoV-2 and surgical smoke, although 25 papers did provide conflicting evidence on the infection risk of human papillomavirus, hepatitis B, polio, and rabies. No papers were found discussing tissue extraction or the deflation risk of the pneumoperitoneum after laparoscopic surgery. Conclusions: There seems to be consensus in the literature that intubation and extubation are high-risk procedures for health care providers and that maximum protective equipment is needed. On the other hand, minimal evidence is available of the actual risk of contamination of health care providers during laparoscopy itself, nor of operating room pressure, surgical smoke, tissue extraction, or CO2 deflation. However, new studies are being published daily from current experiences, and society statements are continuously updated. There seems to be no reason to abandon laparoscopic surgery in favor of open surgery. However, the risks should not be underestimated, surgery should be performed on patients with COVID-19 only when necessary, and health care providers should use logic and common sense to protect themselves and others by performing surgery in a safe and protected environment. %M 32406853 %R 10.2196/18928 %U http://publichealth.jmir.org/2020/2/e18928/ %U https://doi.org/10.2196/18928 %U http://www.ncbi.nlm.nih.gov/pubmed/32406853 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19045 %T Telehealth as a Bright Spot of the COVID-19 Pandemic: Recommendations From the Virtual Frontlines ("Frontweb") %A Olayiwola,J Nwando %A Magaña,Candy %A Harmon,Ashley %A Nair,Shalina %A Esposito,Erica %A Harsh,Christine %A Forrest,L Arick %A Wexler,Randy %+ Department of Family Medicine, The Ohio State University Wexner Medical Center, 2231 N High Street, Suite 250, Columbus, OH, 43210, United States, 1 6142932652, nwando.olayiwola@osumc.edu %K telehealth %K telemedicine %K primary care %K COVID-19 %K pandemic %K outbreak %K public health %K infectious disease %D 2020 %7 25.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X The coronavirus disease (COVID-19) pandemic has accelerated the telehealth tipping point in the practice of family medicine and primary care in the United States, making telehealth not just a novel approach to care but also a necessary one for public health safety. Social distancing requirements and stay-at-home orders have shifted patient care from face-to-face consultations in primary care offices to virtual care from clinicians’ homes or offices, moving to a new frontline, which we call the “frontweb.” Our telehealth workgroup employed the Clinical Transformation in Technology implementation framework to accelerate telehealth expansion and to develop a consensus document for clinician recommendations in providing remote virtual care during the pandemic. In a few weeks, telehealth went from under 5% of patient visits to almost 93%, while maintaining high levels of patient satisfaction. In this paper, we share clinician recommendations and guidance gleaned from this transition to the frontweb and offer a systematic approach for ensuring “webside” success. %M 32479413 %R 10.2196/19045 %U http://publichealth.jmir.org/2020/2/e19045/ %U https://doi.org/10.2196/19045 %U http://www.ncbi.nlm.nih.gov/pubmed/32479413 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19731 %T Suitability and Sufficiency of Telehealth Clinician-Observed, Participant-Collected Samples for SARS-CoV-2 Testing: The iCollect Cohort Pilot Study %A Guest,Jodie L %A Sullivan,Patrick S %A Valentine-Graves,Mariah %A Valencia,Rachel %A Adam,Elizabeth %A Luisi,Nicole %A Nakano,Mariko %A Guarner,Jeannette %A del Rio,Carlos %A Sailey,Charles %A Goedecke,Zoe %A Siegler,Aaron J %A Sanchez,Travis H %+ Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, United States, 1 4046802450, Jodie.Guest@emory.edu %K COVID-19 %K testing %K home testing %K telehealth %K pilot study %K diagnostic %K diagnosis %D 2020 %7 25.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic calls for expanded opportunities for testing, including novel testing strategies such as home-collected specimens. Objective: We aimed to understand whether oropharyngeal swab (OPS), saliva, and dried blood spot (DBS) specimens collected by participants at home and mailed to a laboratory were sufficient for use in diagnostic and serology tests of SARS-CoV-2. Methods: Eligible participants consented online and were mailed a participant-collection kit to support collection of three specimens for SARS-CoV-2 testing: saliva, OPS, and DBS. Participants performed the specimen collection procedures during a telehealth video appointment while clinical observers watched and documented the suitability of the collection. The biological sufficiency of the specimens for detection of SARS-CoV-2 by reverse transcriptase–polymerase chain reaction and serology testing was assessed by laboratorians using visual inspection and quantification of the nucleic acid contents of the samples by ribonuclease P (RNase P) measurements. Results: Of the enrolled participants,153/159 (96.2%) returned their kits, which were included in this analysis. All these participants attended their video appointments. Clinical observers assessed that of the samples collected, 147/153 (96.1%) of the saliva samples, 146/151 (96.7%) of the oropharyngeal samples, and 135/145 (93.1%) of the DBS samples were of sufficient quality for submission for laboratory testing; 100% of the OPS samples and 98% of the saliva samples had cycle threshold values for RNase P <30, indicating that the samples contained sufficient nucleic acid for RNA-PCR testing for SARS-CoV-2. Conclusions: These pilot data indicate that most participant-collected OPS, saliva, and DBS specimens are suitable and sufficient for testing for SARS-CoV-2 RNA and serology. Clinical observers rated the collection of specimens as suitable for testing, and visual and quantitative laboratory assessment indicated that the specimens were biologically sufficient. These data support the utility of participant-collected and mailed-in specimens for SARS-CoV-2 testing. International Registered Report Identifier (IRRID): RR2-10.2196/19054 %M 32479412 %R 10.2196/19731 %U http://publichealth.jmir.org/2020/2/e19731/ %U https://doi.org/10.2196/19731 %U http://www.ncbi.nlm.nih.gov/pubmed/32479412