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COVID-19 Symptom Tracking Can Be An Early Warning System, Says UWM Epidemiologist

Angelina Bambina
Confirmed COVID-19 tests are only "the tip of the iceberg" of who may be sick, says UW-Milwaukee epidemiologist Amy Kalkbrenner. To help track the potential spread of the coronavirus, she developed an online symptom survey,

It’s been over a month since President Trump declared a national emergency due to the coronavirus pandemic. Despite a national campaign for screening and drive-thru testing, most Americans still can’t get a laboratory test to confirm whether or not they have COVID-19, the disease caused by the coronavirus — even if they show symptoms.

With backlogs and delays throughout private, federal and local health care systems, health officials don’t have the information they need to really understand the scope of this pandemic.

"In a nutshell, it's a little bit like flying blind," says Dr. Amy Kalkbrenner, an epidemiologist at UW-Milwaukee's Zilber School of Public Health. "We know that the case counts, as important as they are, are only representing the tip of the iceberg."

>>The Latest WUWM & NPR Coronavirus Coverage

Kalkbrenner says that in a time where testing isn't distributed evenly or widely available, we must also turn to symptom tracking. So, she developed the online symptom tracking survey We Count COVID-19.

"You can call it citizen science," says Kalkbrenner. "It means that everyone in the public becomes a part of the effort to track what's happening."

We Count COVID-19 allows people to confidentially report the symptoms they're experiencing, "and if enough people do this, we will get a better sense of what's going on on the ground that's not limited by that barrier of testing," she explains.

In responses so far, 40% experienced symptoms of illness and wanted to take a COVID-19 test but could not, according to Kalkbrenner.

"In a nutshell, it's a little bit like flying blind. We know that the case counts, as important as they are, are only representing the tip of the iceberg."

The survey only needs to be taken once. It's accessible on a computer or a smartphone and also available in Spanish. Kalkbrenner says the survey takes less than five minutes. It asks if you've had a fever, what your highest temperature has been, and whether you've had "none, mild, moderate or severe" symptoms of things like a cough, headache, chest pain or nausea. Some questions see if other sicknesses like the flu could rule out COVID-19.

"We're asking people to fill this out if they're sick — it's really that simple," notes Kalkbrenner. 

READ: Coronavirus Symptoms: Defining Mild, Moderate And Severe

But she stresses that the symptom tracker is for research and surveillance, not to find out if you need to go to a doctor.

Other countries, including Isreal and Great Britain, have also used symptom trackers with wide participation that demonstrated a large uptick of illness days before case testing confirmed coronavirus geographically. With enough widespread participation, symptom tracking can actually become an early warning system, according to Kalkbrenner.

"It takes several days to get [testing] results, so the symptom data can actually be a better detection system," she explains.

Kalkbrenner admits that there have been missteps in how this pandemic has been handled in the United States. "Public health is tremendously important, but people only really become aware of it when things are going wrong," she says.

"Public health is tremendously important, but people only really become aware of it when things are going wrong."

In the short-term, the data collected through the survey will be analyzed daily until the numbers are robust enough to show ZIP code data. Maps will then be made and accessible to the public to help "people understand what's going on and the need for social distancing," says Kalkbrenner. 

In the long-term, Kalkbrenner hopes the data will help implement change.

"One of the things that is, unfortunately, going on in Milwaukee is that we are seeing that the very people who are marginalized or disadvantaged or genuinely struggling seem to be those that are being hit the hardest with coronavirus," she says. "And assuming that we have people from those ZIP codes reporting their symptoms, it allows us to document the extent of those possible problems down the line — always with the goal then of figuring out how can we make Milwaukee and Wisconsin healthier for everyone?"

During this pandemic, WUWM's Bubbler Talk is focusing on the coronavirus and its impact on the Milwaukee area. If you have a question, submit it below.


Audrey Nowakowski hosts and produces Lake Effect. She joined WUWM in 2014.