key: cord-0871666-zu05e22o authors: Nandy, Kunal; Dhanwate, Anant; Ashok Salunke, Abhijeet; Tank, Tanmay; Patel, Keval; Kumar Pathak, Subodh; Menon, Prem; Upadhay, Sachin; Shanmugasundaram, Sassendar; Bhirud, Chirag; Sharma, Ankit; Patil, Pritam; VijayRao Sonawane, Shivhar; Pandya, Shashank title: A community response survey on an ABCD scoring system for patient's self assessment with symptoms of COVID-19 date: 2021-05-21 journal: Diabetes Metab Syndr DOI: 10.1016/j.dsx.2021.05.014 sha: 3321f30047f652ba3db1d807544229c4d228e260 doc_id: 871666 cord_uid: zu05e22o nan Coronavirus disease 2019 (Covid-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now a worldwide pandemic. The most common symptoms of COVID-19 are fever, cough, and myalgia [1] . Its outburst first started in China in December 2019 and gradually it spread across the globe taking the shape of a global pandemic. Management of a patient infected with coronavirus is a challenging task considering the unpredictable nature and course of the disease. Despite this, the case fatality rate has improved with time because of increased awareness and knowledge about the disease. It is now well known that morbidity and mortality in COVID-19 infections are linked with associated comorbidities like Diabetes mellitus, hypertension, chronic obstructive pulmonary disease, chronic kidney disease and cancer [2] - [4] . It has now become imperative to identify the high-risk patients who are at risk of serious events and keep them under strict observation. Identifying the deterioration at the earliest is a crucial part of management to initiate directed symptomatic treatment at the earliest to stop or derail the disease progression. Because of increased awareness and prolonged lockdown, not just healthcare professionals but also the general population has gained knowledge about the disease which has led to early identification of critical signs like falling saturation even by non-medical population. At a time when our country is reporting around 90000 cases per day with overburdened hospitals, it is very essential to identify patients with severe symptoms requiring admission and promoting the concept of home isolation for asymptomatic or for patients with mild symptoms. J o u r n a l P r e -p r o o f Based on these concepts, an ABCD scoring system was proposed for evaluation at home by the patients to follow a color-coded triage system based on the final score [5] . Our scoring system helps the patients and relatives to identify the high-risk symptoms and makes them self-aware about their disease progression. We conducted this survey to study the popularity of this scoring system across the country and its usefulness in deciding the need for hospitalization and home isolation. Conceiving the survey: The idea of developing this simple yet very useful scoring system was the brainchild of AAS. The concept behind the development of this scoring system is to enable the people using it to decide for themselves their disease severity and need for hospitalization at a time when healthcare workers and hospitals are overburdened in this pandemic. Mild cases (Green) as per the scoring system do not require hospitalization and just need to be kept under observation at home. Moderate cases (Yellow) require consultation with a doctor managing COVID patients with the final call to be taken by the doctor (Fig 1) [5] . Severe cases (Red) need to be hospitalized on an urgent basis. The key questions to be included in the survey were prepared by AAS (Table 1) . It was then converted into an online e-form and circulated amongst the general public including medical professionals during the period of 1st September to 15 September 2020. The specified questionnaire in e-form was made available to the physicians through email and social media. The completed questionnaire received were automatically tabulated in an excel sheet. The target was to collect more than 200 responses and perform their in-depth analysis. Data was collected and analysed in the Microsoft Excel. There was no funding source for this study. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit for publication. A total of 241 responses were received at the end of the survey out of which 70.4% were healthcare professionals and 29.6% were non-medical population (Fig 2a) . 97.5% of respondents were aware of the ongoing pandemic and were conscious of the fact that their family could also be affected by the virus (Fig 2b) . The 97.9% of respondents were aware of the various symptoms of COVID-19 (Fig 2c) and 84.2% were aware that fever, cough, body ache, and diarrhea can occur in COVID-19 ( Fig 3a) . After the relaxation of lockdown 54.2% of respondents had either had COVID-19 patient contact or had an infection in their family (Fig 3b) . 96.3% of respondents were aware of the possible association of disease severity with comorbidities like diabetes mellitus, hypertension, COPD, CKD and cancer (Fig 3c) . 58.8% of respondents acknowledged the problem of overburdened healthcare system due to rising caseloads daily and the need for a scoring system for stratification (Fig 4a) . 76.2% of respondents understood the medical terms used in our scoring system (Fig 4b) . 92.8% of people found that color coding in our scoring system makes it easy to understand and interpret even for non medical respondents (Fig 4c) . 95.8% of respondents said that ABCD score for patient's self assessment at home is easy to understood and would help them in choosing a correct treatment (Fig 5a) and 96.6% of people consider our scoring system very useful and helpful for home self-assessment and they recommend this system (Fig 5b) . [4] , [6] . During the initial phase of the pandemic, there was widespread use of hydroxychloroquine across the world but few meta-analysis proved that there was no role of it in the management of COVID-19 and its use was associated with increased mortality [7] , [8] . Management of COVID-19 has improved with time with better understanding about cytokine storm in its pathogenesis. Incorporation of steroids and antivirals like Favipiravir, Remdesivir, immunomodulators like IL-6 inhibitors like Tocilizumab and convalescent plasma have improved survival when started at appropriate times without delay [9] - [13] . Remdesivir was most effective when initiated early during moderate symptoms like with falling oxygen saturation. Thus it became crucial to identify these patients because many times they had silent hypoxia or 'happy hypoxemia' that is falling oxygen saturation without breathlessness and then they suddenly collapse landing directly on invasive ventilator support with severe ARDS leading to high mortality [14] . With our country reporting approximately 90000 new cases daily, it is not possible to admit all the patients and overburden our already stressed healthcare system. It is thus extremely important to identify patients who require hospital admission at an early stage to benefit the most [15] . The promotion of the concept of J o u r n a l P r e -p r o o f home isolation for asymptomatic and mild symptoms is very important to reduce the burden on hospitals. Salunke et al had described a score based on use of clinical features and radiopathological findings in patients who have been tested positive for COVID-19 [16] . This scoring system was designed to segregate patients on their own at home into three groups based on color-coding. Green coded were advised for home isolation and take symptomatic medications at home. Yellow coded were asked to consult a doctor and advised home isolation but to remain cautious and monitor symptom progression, vitals and saturation in time. Red coded were immediately advised to consult a doctor and get hospitalized. Our survey was responded by not just healthcare workers (70.4%) but also general non-medical respondents (29.6%). More than 95% of respondents were aware of the ongoing pandemic and are following its developments regarding the symptomatology, disease progression and its association with various comorbidities. People understand regarding the high infectivity of the SARS-CoV-2 and are aware of the fact that with more than 90,000 cases reported each day in India, the already stressed out healthcare system will collapse. More than 50% of people understand the need for a scoring system for better patient stratification so that only the red coded patients get hospitalization and green coded remain in home quarantine under self-observation. More than 90% of people accept our scoring system and recommend it. They found it useful and easy to understand. Based on the survey, we recommend our scoring system for a self home assessment. This scoring system helps the patient at home in understanding the disease severity and to seek appropriate treatment if required or undergo home quarantine and self monitor the symptoms and reassess the condition using this scoring system. Table 1 : Questionnaire used a community response survey on an ABCD scoring system for patient's self assessment with symptoms of COVID-19. 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