# Feasibility of a Pilot Crowdsourced Syndromic and Virological Surveillance Platform for Respiratory Illness in South Africa, CoughWatchSA, 2022

## TL;DR

A pilot study in South Africa tested a digital platform for tracking respiratory illnesses and found it feasible, though with low enrollment and limited correlation to existing data.

## Contribution

The study demonstrates the feasibility of combining digital participatory surveillance with home-based self-swabbing for respiratory illness monitoring in South Africa.

## Key findings

- Twenty-six percent of participants enrolled in the platform, and 92% of eligible participants completed home-based self-swabbing.
- Influenza and SARS-CoV-2 were detected in 7% and 32% of tested samples, respectively.
- There was a low correlation between reported symptoms and private sector respiratory consultations.

## Abstract

Digital participatory surveillance (DPS) may provide information on reported influenza‐like illnesses (ILI). Combining DPS with laboratory testing allows pathogen identification. We assessed the feasibility of DPS and home‐based self‐swabbing (HBSS) in South Africa.

We enrolled a cohort of individuals aged ≥ 18 years who completed weekly respiratory symptoms questionnaires from March to October 2022. We calculated the weekly percentage of reported ILI and COVID‐19 and compared it with weekly private sector respiratory consultations (WPSRC). Symptomatic participants were offered HBSS for influenza and SARS‐CoV‐2 detection by polymerase chain reaction (PCR). We assessed six feasibility indicators.

Recruitment capability: Twenty‐six percent (249/954) of participants accessed the platform and enrolled, and 92% (81/88) of participants eligible for HBSS were enrolled. Acceptability: Fifteen percent (32/249) completed the acceptability questionnaire with 100% (32/32) willing to participate in future studies, and 16% (39/249) withdrew from the study. Representativeness: Fifty percent (125/249) were aged 18–39 years, predominantly female 71%, and 79% had a tertiary qualification. Reliability: Thirty‐eight percent (80/210) were active participants, median weekly active participation of 23% (interquartile range [IQR]: 19%–29%). Accuracy: Two percent (31/1440) and 25% (359/1440) of reports met ILI and COVID‐19, respectively. Influenza and SARS‐CoV‐2 were detected in 7% (6/81) and 32% (26/81) of tested samples, respectively. There was low correlation with WPSRC (0.08, 95% CI, 0.27–0.43) for ILI and (0.36, 95% CI, 0.11–0.62) for COVID19. Usefulness: Symptoms were reported in 32% (459/1440) of reports, and 11% (49/459) sought medical care.

The study was feasible; however, low enrolment numbers limit power. Linkage to HBSS was successful and demonstrates the potential for pathogen confirmation.