• Anjana Rajan, Ravi Sharaf, Robert S Brown, Reem Z Sharaiha, Benjamin Lebwohl, and SriHari Mahadev.
• Department of Gastroenterology and Hepatology, Weill Cornell Medicine, New York, NY, United States.
• JMIR Public Health Surveill. 2020 Jul 17; 6 (3): e19354.

BackgroundCoronavirus disease (COVID-19) is a novel viral illness that has rapidly spread worldwide. While the disease primarily presents as a respiratory illness, gastrointestinal symptoms such as diarrhea have been reported in up to one-third of confirmed cases, and patients may have mild symptoms that do not prompt them to seek medical attention. Internet-based infodemiology offers an approach to studying symptoms at a population level, even in individuals who do not seek medical care.ObjectiveThis study aimed to determine if a correlation exists between internet searches for gastrointestinal symptoms and the confirmed case count of COVID-19 in the United States.MethodsThe search terms chosen for analysis in this study included common gastrointestinal symptoms such as diarrhea, nausea, vomiting, and abdominal pain. Furthermore, the search terms fever and cough were used as positive controls, and constipation was used as a negative control. Daily query shares for the selected symptoms were obtained from Google Trends between October 1, 2019 and June 15, 2020 for all US states. These shares were divided into two time periods: pre-COVID-19 (prior to March 1) and post-COVID-19 (March 1-June 15). Confirmed COVID-19 case numbers were obtained from the Johns Hopkins University Center for Systems Science and Engineering data repository. Moving averages of the daily query shares (normalized to baseline pre-COVID-19) were then analyzed against the confirmed disease case count and daily new cases to establish a temporal relationship.ResultsThe relative search query shares of many symptoms, including nausea, vomiting, abdominal pain, and constipation, remained near or below baseline throughout the time period studied; however, there were notable increases in searches for the positive control symptoms of fever and cough as well as for diarrhea. These increases in daily search queries for fever, cough, and diarrhea preceded the rapid rise in number of cases by approximately 10 to 14 days. The search volumes for these terms began declining after mid-March despite the continued rises in cumulative cases and daily new case counts.ConclusionsGoogle searches for symptoms may precede the actual rises in cases and hospitalizations during pandemics. During the current COVID-19 pandemic, this study demonstrates that internet search queries for fever, cough, and diarrhea increased prior to the increased confirmed case count by available testing during the early weeks of the pandemic in the United States. While the search volumes eventually decreased significantly as the number of cases continued to rise, internet query search data may still be a useful tool at a population level to identify areas of active disease transmission at the cusp of new outbreaks.©Anjana Rajan, Ravi Sharaf, Robert S Brown, Reem Z Sharaiha, Benjamin Lebwohl, SriHari Mahadev. Originally published in JMIR Public Health and Surveillance (http://publichealth.jmir.org), 17.07.2020.

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