I Put COVID-19 Symptom Assessment Tools to the Test
Most tools have little or no clinical value
Do you know how many coronavirus disease 2019 (COVID-19) symptom assessment tools are there up until now? I was able to find more than 10 “different” tools, and this number is expected to increase, since there is a whole lot of everything now, and COVID-19 tools will not be an exception. However, most of these tools are raising privacy concerns and are not achieving their goals as they are neither helping users nor assisting healthcare systems.
Symptom assessment tools are self-report questionnaires designed to help healthcare providers assess symptoms and their severity, which in turn allows them to diagnose or detect the risk of developing certain conditions. These validated tools are widely used in healthcare settings for choosing treatments, managing symptoms, and improving the quality of life for patients.
As healthcare is moving online, symptom assessment tools are becoming, more than ever, closer to all people. This means that in the comfort of our own homes, and without any medical supervision, we can use these tools to assess our symptoms and find out the required next steps. Having such tools is not a problem; not having proper monitoring and evaluation is. So, how can we explain the abundance of symptom assessment tools for a virus and disease that we are still learning about?
After exploring almost all COVID-19 symptom assessment tools that are available in English and that are based on international guidelines for the diagnosis of this disease, I discovered that they lack consistency in terms of the required input and final output, and above all, most of them turned out to be an exercise in futility.
The variability in the required input
Despite being symptom assessment tools for the same disease, COVID-19, each tool has its own set of questions related to demographics, symptoms, underlying conditions, risk factors, and lifestyle factors. While the World Health Organization (WHO) clearly states the symptoms associated with COVID-19, as well as their severity and incidence in relation to underlying conditions, some tools omit important factors and others include unlisted ones.
Why do most tools skip questions about smoking habits? Why is the list of underlying conditions and risk factors not comprehensive in most cases? Why are symptoms, regardless of their severity, missed out or added without any clarification? I could not find any clear explanation.
The other thing that is worth mentioning is that most tools are not user-friendly. When offering people worldwide online tools that can be used without any medical supervision, developers must make sure that these tools are self-explanatory. Developers cannot expect people to know what they mean by “extreme obesity”. They should at least add the body mass index (BMI) range they are talking about and link users to BMI calculators. Another example is “diseases or conditions that make it harder to cough”. I could not find any of these conditions when I researched this phrase.
With the huge number of COVID-19 symptom assessment tools and variability in the required input, it is hard to know which tool is the most credible one. It is even harder to evaluate these tools because developers cannot assume that users are giving the right answers when they overwhelm them with a bunch of medical terms with minimal or no explanation.
The contrariety in the final output
Although all COVID-19 symptom assessment tools certify that they are based on guidelines from the WHO and national public health authorities, they all state clearly that they cannot diagnose COVID-19 and must not replace consultation with a healthcare provider. Some tools also inform users that information about COVID-19 is constantly and rapidly changing, and they should keep on checking updates on the official website of the WHO or national public health authorities. It is a little bit disappointing to agree on these disclaimers after going over the questions, but what is even more frustrating is the final output itself.
I tested several profiles on the available tools, and I can guarantee two things. If users do not have any symptom, underlying condition, or risk factor, then all tools will give them the same outcome: “You do not have COVID-19 and you do not need COVID-19 testing”. If users are smokers with a runny nose, then they will get something like: “You are at risk of developing a more serious form of COVID-19”. Several questions arise here. What if users are asymptomatic? What if users have seasonal allergies that cause a runny nose? I honestly do not have answers, but I hope developers do.
Other than the cases mentioned above, and no matter what combination of answers users add to these tools, there is a high chance that they will get contradictory outputs. If users have the most common symptoms of COVID-19 as per the WHO, which are fever, fatigue, and dry cough, but do not have any underlying condition or risk factor, and if these users try out more than one tool, then they will be confused. Some tools will tell them not to worry because these symptoms are most probably related to conditions other than COVID-19, others will mention that these symptoms may be due to COVID-19, and some will go further and ask them to contact their healthcare provider within 12 hours. Yet, what about the fact that symptoms of COVID-19 are similar to many other acute respiratory viral infections?
It is obvious that these tools should not replace professional medical advice. Their ultimate goal is to relieve pressure on the healthcare system, increase awareness on COVID-19, and perhaps in some cases, just track people. Except for the last point, are these tools serving their purpose? Based on the data available from France, we know that these tools should be coupled with medical monitoring at home to support patients and reduce the burden on the healthcare systems. This explains why when these tools are voluntarily used, they are urging people to contact their healthcare providers and seek medical advice.
The information presented above is not intended to trivialize these tools, but to emphasize that health and wellness tools require rigorous scrutiny. These are not games or social networking sites; they are tools that directly and indirectly impact our physical and psychological wellbeing. When these tools are used without any medical supervision, and in the presence of non-stop, live updates on COVID-19, they can instill fear and panic.
We are dealing with a new virus, which is the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); therefore, doctors and researchers do not have yet “final” answers to the prevention, diagnosis, and treatment of COVID-19. This means that international and national public health authorities should not allow “all” symptom assessment tools to go online before reaching a scientific consensus on what they have to include, who should be allowed to use them, and how they will help people.
