key: cord-0743216-zqn9aavy
authors: Jeong, Hyeongseok; Lee, Jooyeon; Kim, Jungok; Choen, Shinhye; Sohn, Kyung Mok; Kim, Yeon-Sook; Kiem, Sungmin
title: Self-Assessment Questionnaire for Efficient and Safe Evaluation of Patients with Mild COVID-19
date: 2020-06-23
journal: Infect Chemother
DOI: 10.3947/ic.2020.52.2.212
sha: f261a837e91f80a2f0d300098a00847c6ef7452f
doc_id: 743216
cord_uid: zqn9aavy

As the outbreak of coronavirus disease 2019 continues and the number of confirmed cases requiring isolation increases, there is a need for a safe and efficient system to assess patients' condition. We developed and evaluated a self-assessment questionnaire consisting of 23 symptoms with linear-scale scores from 0 to 10. Patients were asked to indicate their worst score for each symptom daily, and medical personnel assessed clinical improvement or deterioration based on the changes in scores. Focused communication on severity of specific symptoms was the primary advantage for the clinicians, and a thorough check for their symptoms was helpful for patients.

As the number of infected patients has rapidly increased, isolation of a large number of mild cases has become an important issue. Potential viral shedding during asymptomatic (or subclinical) periods characterizes this respiratory disease [2, 3] , and about 80% of confirmed cases display just mild or even no definite subjective symptoms [4, 5] . In Korea, asymptomatic confirmed cases and patients with mild COVID-19 are transferred to isolation wards or Living and Treatment Centers [6] . Living and Treatment Centers are facilities specialized to isolate patients who have little need in-hospital treatment. In March 2020, there were 16 Living and Treatment Centers in Korea, accommodating about 4,000 cases.

As medical resources are insufficient, there is a need for a safe and efficient method for evaluating the mild cases in isolation wards and Living and Treatment Centers. For this purpose, we developed a self-assessment questionnaire to evaluate the condition of patients with mild COVID-19, and we share our experience with healthcare authorities and providers all over the world. of items with high scores and omit items with low scores, leading to more informative communication with patients. This was significant because healthcare workers could not endure long hours of work in personal protective equipment of level D. We received feedback from patients one week after they used the questionnaire (Fig. 2) . From the patients' point of view, first, the 23 intensive items made it possible to check symptoms that the patients had not previously recognized (e.g., ageusia and anosmia). Patients were also able to explain their symptoms to the medical personnel easily and encourage themselves by seeing their scores improving every day. It took less than three minutes to complete the daily questionnaire.

Given the current global burden of mild COVID-19, there are not enough medical resources to manage the high number of patients. Moreover, considering the current epidemic, we expect this situation to persist for a long time. For the safety of healthcare workers and the efficient evaluation of patients, several evaluation methods have been attempted. The Korean government developed a mobile self-diagnosis application and provided it to passengers entering from risky countries to check their symptoms daily for 14 days. However, there are just a few self-diagnosis items, including fever or febrile sense, cough, sore throat, and dyspnea. In some Living and Treatment Centers, patients are asked to measure their temperatures, blood pressures, and pulse rates by themselves with automated equipment and to report the data to healthcare workers via telephone or a social network system. Our questionnaire has an advantage in that it includes many symptoms and adopts a scaling system to check the changes of symptoms. We did not include self-assessment of vital signs, because nurses assessed these. However, a self-check of vital signs could also be included in our questionnaire.

Regarding limitations of the self-assessment questionnaire, first, the questionnaire sheet filled out by an isolated patient cannot be moved out from the isolation area; therefore, patients were asked to take photos of the sheets and deliver them to our staff via a social network system. Second, as the isolation period extended, the number of sheets increased, which made it difficult to manage scores and store papers. A mobile application connected to the network could be developed to avoid these inconveniences. Then, patients could score the symptoms with their mobile devices without pen or paper, and the data could be transferred and an alyzed automatically. Another possible advantage of the mobile application is that patients could use symptom scores continually, from the time of active inspection or self-quarantine (before diagnosis) to during hospitalization/Living and Treatment Center residence to discharge and the end of isolation. Third, very elderly or patients with mental disorders may not be able to answer the questionnaire; therefore contact examination needs to be performed in these cases.

We believe the self-assessment system we developed is a useful tool for evaluating mild COVID-19 patients in isolation. We hope that it will be developed as a mobile application and spread widely over the world to cope with global diseases.

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