• Fabrice Denis, Simon Galmiche, Aurélien Dinh, Arnaud Fontanet, Arnaud Scherpereel, Francois Benezit, and François-Xavier Lescure.
• Inter-regional Cancer Institut Jean Bernard, Le Mans, France.
• J. Med. Internet Res. 2020 Jun 11; 22 (6): e19855.

BackgroundWe developed a self-assessment and participatory surveillance web application for coronavirus disease (COVID-19), which was launched in France in March 2020.ObjectiveOur objective was to determine if self-reported symptoms could help monitor the dynamics of the COVID-19 outbreak in France.MethodsUsers were asked questions about underlying conditions, sociodemographic status, zip code, and COVID-19 symptoms. Depending on the symptoms reported and the presence of coexisting disorders, users were told to either stay at home, contact a general practitioner (GP), or call an emergency phone number. Data regarding COVID-19-related hospitalizations were retrieved from the Ministry of Health.ResultsAs of March 29, 2020, the application was opened 4,126,789 times; 3,799,535 electronic questionnaires were filled out; and 2,477,174 users had at least one symptom. In total, 34.8% (n=1,322,361) reported no symptoms. The remaining users were directed to self-monitoring (n=858,878, 22.6%), GP visit or teleconsultation (n=1,033,922, 27.2%), or an emergency phone call (n=584,374, 15.4%). Emergency warning signs were reported by 39.1% of participants with anosmia, a loss of the sense of smell (n=127,586) versus 22.7% of participants without anosmia (n=1,597,289). Anosmia and fever and/or cough were correlated with hospitalizations for COVID-19 (Spearman correlation coefficients=0.87 and 0.82, respectively; P<.001 for both).ConclusionsThis study suggests that anosmia may be strongly associated with COVID-19 and its severity. Despite a lack of medical assessment and virological confirmation, self-checking application data could be a relevant tool to monitor outbreak trends.Trial RegistrationClinicalTrials.gov NCT04331171; https://clinicaltrials.gov/ct2/show/NCT04331171.©Fabrice Denis, Simon Galmiche, Aurélien Dinh, Arnaud Fontanet, Arnaud Scherpereel, Francois Benezit, François-Xavier Lescure. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 11.06.2020.

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