Identification of COVID-19 can be quicker through artificial intelligence framework using a mobile phone-based survey when cities and towns are under quarantine.

We propose the use of a machine learning algorithm to improve possible COVID-19 case identification more quickly using a mobile phone-based web survey. This method could reduce the spread of the virus in susceptible populations under quarantine.

Emerging and novel pathogens are a significant problem for global public health. This is especially true for viral diseases that are easily and readily transmissible and have asymptomatic infectivity periods. The novel coronavirus (SARS-CoV-2) described in December 2019 (COVID-19) has resulted in major quarantines to prevent further spread, including major cities, villages, and public areas throughout China and across the globe.[1-3] As of February 25, 2020, the World Health Organization’s situational data indicate ~77,780 confirmed cases in 25 countries, including 2,666 deaths due to COVID-19.[4] Most deaths reported so far have been in China.[5] The Centers for Disease Control and Prevention (CDC) and the World Health Organization have issued interim guidelines to protect the population and to attempt to prevent the further spread of the SARS-CoV-2 virus from infected individuals.[6] Cities and villages throughout China are unable to accommodate such large numbers of infected individuals while maintaining the quarantine, and several new hospitals have been built to manage the infected individuals.[7] It is imperative that we evaluate novel models to attempt to control the rapidly spreading SARS-CoV-2.[8] Technology can assist in faster identification of possible cases to yield more timely interventions.

To reduce the time needed to identify a person under investigation (PUI) for COVID-19 and their rapid isolation, we propose to collect a basic travel history along with the more common signs and symptoms using a mobile phone–based online survey. Such data can be used in the preliminary screening and early identification of possible COVID-19 cases. Thousands of data points can be processed through an artificial intelligence (AI) framework that can evaluate individuals and stratify them into no risk, minimal risk, moderate risk, and high risk groups. The high-risk cases identified can then be quarantined earlier, thus decreasing the chance of spreading the virus (Table 1).

Table 1.

Steps involved in the collection of data through a mobile phone-based survey

Step 1: Record the location details of the house/apartment from where the respondent uses a phone-based web survey/or the respondent’s usual place of stay.

Step 2: Record demographic information like gender (G) (1-male, 2-female, 3-others), age (A), race (R)(1-white, 2-black, 3-Hispanics, 4-Others)

Step 3: Have you traveled to (or living in) any of the COVID-19 affected areas/countries in the last 14 days?(Yes=1/No=0)

Step 4: Have you had any close contact with a person who is known to have COVID-19 during the last 14 days?(Yes=1/No=0)

Step 5: Record the presence or absence of signs and symptoms listed below and the duration of each of the signs and symptoms if yes to any of the signs and symptoms.A) fever (Yes=1/No=0), if yes, then the duration in days ---- B) cough (Yes=1/No=0), if yes, then the duration in days ---- C) shortness of breath (Yes=1/No=0), if yes, then the duration in days ---- D) myalgia or fatigue (Yes=1/No=0), if yes, then the duration in days ---- E) sputum production (Yes=1/No=0), if yes, then the duration in days ---- F) headache (Yes=1/No=0), if yes, then the duration in days ---- G) diarrhea (Yes=1/No=0), if yes, then the duration in days ---- H) pneumonia in both lungs (Yes=1/No=0), if yes, then the duration in days ----

Step 6: Enter the details of steps 1-5 above for any dependents or other individuals who live in the same location and do not have access to web-based survey.

Appendix 1 (online) lists the details of the steps involved in collecting data from all respondents independent of whether or not they think they are infected. The AI algorithm described in Appendix 2 (online) can identify possible cases and send an alert to the nearest health clinic as well as to the respondent for an immediate health visit. We call this an “alert for health check recommendation for COVID-19.” If the respondent is unable to commute to the health center, the health department can send an alert to a mobile health unit to conduct a door-to-door assessment and even test for the virus. If a respondent does not have an immediate risk of symptoms or signs related to the viral infection, then an AI-based health alert cab be sent to the respondent to notify them that there is no current risk of COVID-19. Figure 1 summarizes the outcomes of data collection and identification of possible cases.

Fig. 1.

Conceptual framework of data collection and possible COVID-19 identification. (a) A geographical region (eg, a city, county, town, or village) with households in it. (b) Respondents and nonrespondents of a mobile phone–based web survey. (c) Possible identified cases of COVID-19 among the survey respondents and possible cases of COVID-19 among nonrespondents of the survey.

The signs and symptoms data recorded in step 5 of the algorithm are collected prior to Health Check Recommended for Coronavirus (HCRC) alerts or Health Check Recommended for Coronavirus (MHCRC) alerts (for possible identification and assessment) and No Health Check Recommended for Coronavirus (NCRC) alerts (for nonidentified respondents). These procedures are explained in steps 3 and 4 in Appendix 2. The extended analysis we propose can help determine any association among sociodemographic variables and the signs and symptoms, such as fever and lower respiratory infection including cough and shortness of breath, in individuals with and without possible infection. A 2 x 2 table of number of COVID-19 cases identified through AI and the number of people responded to a mobile survey is described in Figure 2.

Fig. 2.

Number of possible cases identified through artificial intelligence (AI) framework versus the number of individuals who responded to a mobile phone–based web survey.

Applications of AI and deep learning can be useful tools in assisting diagnoses and decision making in treatment.[10,11] Several studies have promoted disease detection through AI models.[12-15] The use of mobile phones[16-19] and web-based portals[20,21] have been tested successfully in health-related data collection. In addition, our proposed algorithm can be easily extended to identify individuals who might have any mild symptoms and signs. However, such techniques must be applied in a timely way for relevant and rapid results. Apart from cost-effectiveness, our proposed modeling method could greatly assist in identifying and controlling COVID-19 in populations under quarantine due to the spread of SARS-CoV-2.