Rapid COVID-19 Screening Based on Self-Reported Symptoms:Psychometric Assessment and Validation of the EPICOVID19Short Diagnostic Scale

Background: Confirmed COVID-19 cases have been registered in more than 200 countries, and as of July 28, 2020, over 16million cases have been reported to the World Health Organization. This study was conducted during the epidemic peak ofCOVID-19 in Italy. The early identification of individuals with suspected COVID-19 is critical in immediately quarantining suchindividuals. Although surveys are widely used for identifying COVID-19 cases, outcomes, and associated risks, no validatedepidemiological tool exists for surveying SARS-CoV-2 infection in the general population.Objective: We evaluated the capability of self-reported symptoms in discriminating COVID-19 to identify individuals whoneed to undergo instrumental measurements. We defined and validated a method for identifying a cutoff score.Methods: Our study is phase II of the EPICOVID19 Italian national survey, which launched in April 2020 and included aconvenience sample of 201,121 adults who completed the EPICOVID19 questionnaire. The Phase II questionnaire, which focusedon the results of nasopharyngeal swab (NPS) and serological tests, was mailed to all subjects who previously underwent NPStests.Results: Of 2703 subjects who completed the Phase II questionnaire, 694 (25.7%) were NPS positive. Of the 472 subjects whounderwent the immunoglobulin G (IgG) test and 421 who underwent the immunoglobulin M test, 22.9% (108/472) and 11.6%(49/421) tested positive, respectively. Compared to NPS-negative subjects, NPS-positive subjects had a higher incidence of fever(421/694, 60.7% vs 391/2009, 19.5%; P<.001), loss of taste and smell (365/694, 52.6% vs 239/2009, 11.9%; P<.001), and cough(352/694, 50.7% vs 580/2009, 28.9%; P<.001). With regard to subjects who underwent serological tests, IgG-positive subjectshad a higher incidence of fever (65/108, 60.2% vs 43/364, 11.8%; P<.001) and pain in muscles/bones/joints (73/108, 67.6% vs71/364, 19.5%; P<.001) than IgG-negative subjects. An analysis of self-reported COVID-19 symptom items revealed a 1-factorsolution, the EPICOVID19 diagnostic scale. The following optimal scores were identified: 1.03 for respiratory problems, 1.07for chest pain, 0.97 for loss of taste and smell 0.97, and 1.05 for tachycardia (ie, heart palpitations). These were the most importantsymptoms. For adults aged 18-84 years, the cutoff score was 2.56 (sensitivity: 76.56%; specificity: 68.24%) for NPS-positive subjects and 2.59 (sensitivity: 80.37%; specificity: 80.17%) for IgG-positive subjects. For subjects aged ≥60 years, the cutoffscore was 1.28, and accuracy based on the presence of IgG antibodies improved (sensitivity: 88.00%; specificity: 89.58%).Conclusions: We developed a short diagnostic scale to detect subjects with symptoms that were potentially associated withCOVID-19 from a wide population. Our results support the potential of self-reported symptoms in identifying individuals whorequire immediate clinical evaluations. Although these results come from the Italian pandemic period, this short diagnostic scalecould be optimized and tested as a screening tool for future similar pandemics.