Optimization of the Management of COVID-19 Through Tailored Recommendations to the Citizens

The COVID-19 pandemic is raging in the world, including Quebec. As of May 22, 2020, more than 46,141 cases have been identified in Quebec, including 3,865 deaths. The virus causes heterogeneous clinical manifestations. People may be asymptomatic, have mild to moderate symptoms (cough, fever, myalgia), or a severe form requiring hospitalization and transfer to intensive care units. In a small proportion of people, it can cause death. Health emergency status was declared in Quebec on March 13, 2020 to allow the deployment of the measures suggested by the Public Health Department (PHD). Different types of recommendations (general, targeted, personalized and tailored) are available to optimize the prevention and management of COVID-19. General interventions are aimed at the entire population (eg: washing hands, keeping 2 meters apart). Targeted interventions target a vulnerable population (eg: patients with diabetes, the elderly, etc.). Personalized interventions are addressed specifically to a person, without necessarily being adapted to that person (eg: a general letter addressed to an individual by his name written in the header). The appropriate intervention considers the individual's reality (eg medical, environmental). Tailored interventions require a capacity for dynamic analysis and evaluation of information but are generally more effective in changing behavior (3). This evaluation also allows sorting of relevant information. Indeed, during a pandemic, a citizen may have a perception of contradictory information or be overloaded with information from different media. The tailored assessment allows citizens to have a clearer message in their reality. As mentioned above, in the case of COVID-19, the heterogeneity of symptom presentation implies different realities for each individual. In a potentially large proportion of cases, people may be asymptomatic or have mild to moderate flu-like symptoms. Thus, many infected people will not consult in the health network. It has been estimated that there are 10 times more people infected than those who are screened. Establishing a diagnosis of infected people is a key factor in ensuring a coherent epidemiological watch at the PHD. It is an indicator to monitor deconfinement and predict the second wave. COVID-19 infection is therefore a reportable disease. Moreover, diagnosing the disease in individuals with low symptoms makes them aware of their risk of transmission, as well as that of their contacts, so that they can adapt their behavior to the recommendations of the PHD. In addition, medical monitoring is critical in some vulnerable people with COVID-19. In fact, people aged 70 and / or suffering from certain chronic diseases (such as high blood pressure, atherosclerotic heart disease, obesity and diabetes) are at greater risk of developing the severe form of the disease. Citizens seem less inclined to consult their doctors during this period of disruption in the network. The preventive recommendations for these people, whether or not they have COVID-19, must be absolutely tailored in order to provide health care. Stricter preventive containment measures can have a negative impact on functional capacity or the risk of co-morbidities in this population due to changes in healthy lifestyle habits. Providing recommendations tailored to their situation on these habits (eg physical activity, healthy eating, sleep) could help reduce these negative effects.

In order to improve the health and safety of the population, the investigators propose to co-develop, with citizens, patient partners, clinicians, companies, managers, decision-makers and representatives of the PHD, a citizen portal in order to produce appropriate recommendations related to the COVID-19 status (positive or negative), the risk of complications (severity of symptoms and medical history), the risk of contamination (environmental prevalence of the disease) and the risks related to confinement. This portal will be adapted to level 2 literacy and validated by usability tests. From questionnaires self-administered to citizens, the tool will allow dynamic monitoring of symptoms related to COVID-19, collaborate with the PHD to improve the epidemiological portrait of the situation by identifying people who do not consult in the health system network and to bridge the gap with their family doctor.

Objectives: 1) Evaluate the feasibility of an efficient collaborative system between the PHD, citizens, patients and health professionals allowing the optimization of appropriate recommendations in both prevention and detection during the COVID-19 pandemic; 2) Produce recommendations concerning preventive behaviors related to COVID-19 tailored to the medical and environmental reality of each citizen; 3) Compare the proportion of users complying with the recommendations between those receiving tailored recommendations and those receiving general recommendations; 4) Observe the evolution of the state of health of individuals in real time by collecting socio-demographic, psychosocial and physiological data, including symptoms related to COVID-19, and data from measures surrounding confinement to the using a self-administered assessment tool.

Methodology:

Specification: This is a clinical intervention study of a cohort including a nested and randomized double-blind experimental design, where the tailored recommendations will be compared to the general recommendations. Population and sample: People aged 18 and over, residing in the Quebec City area, will be solicited according to an advertising strategy and different collaborations which will enable the access to a cohort of 1407 participants (as of May 22, 2020).