Detecting COVID-19 infection hotspots in England using large-scale self-reported data from a mobile application

Background As many countries seek to slow the spread of COVID-19 without reimposing national restrictions, it has become important to track the disease at a local level to identify areas in need of targeted intervention. Methods We performed modelling on longitudinal, self-reported data from users of the COVID Symptom Study app in England between 24 March and 29 September, 2020. Combining a symptom-based predictive model for COVID-19 positivity and RT-PCR tests provided by the Department of Health we were able to estimate disease incidence, prevalence and effective reproduction number. Geographically granular estimates were used to highlight regions with rapidly increasing case numbers, or hotspots. Findings More than 2.6 million app users in England provided 115 million daily reports of their symptoms, and recorded the results of 170,000 PCR tests. On a national level our estimates of incidence and prevalence showed similar sensitivity to changes as two national community surveys: the ONS and REACT studies. On a geographically granular level, our estimates were able to highlight regions before they were subject to local government lockdowns. Between 12 May and 29 September we were able to flag between 35-80% of regions appearing in the Government's hotspot list. Interpretation Self-reported data from mobile applications can provide a cost-effective and agile resource to inform a fast-moving pandemic, serving as an independent and complementary resource to more traditional instruments for disease surveillance. Funding Zoe Global Limited, Department of Health, Wellcome Trust, EPSRC, NIHR, MRC, Alzheimer's Society. Research in context Evidence before this study: To identify instances of the use of digital tools to perform COVID-19 surveillance, we searched PubMed for peer-reviewed articles between 1 January and 14 October 2020, using the keywords COVID-19 AND ((mobile application) OR (web tool) OR (digital survey)). Of the 382 results, we found eight that utilised user-reported data to ascertain a user's COVID-19 status. Of these, none sought to provide disease surveillance on a national level, or to compare these predictions to other tools to ascertain their accuracy. Furthermore, none of these papers sought to use their data to highlight geographical areas of concern.Added value of this study: To our knowledge, we provide the first demonstration of mobile technology to provide national-level disease surveillance. Using over 115 million reports from more than 2.6 million users across England, we estimate incidence, prevalence, and the effective reproduction number. We compare these estimates to those from national community surveys to understand the effectiveness of these digital tools. Furthermore, we demonstrate the large number of users can be used to provide disease surveillance with high geographical granularity, potentially providing a valuable source of information for policymakers seeking to understand the spread of the disease.Implications of all the available evidence: Our findings suggest that mobile technology can be used to provide real-time data on the national and local state of the pandemic, enabling policymakers to make informed decisions in a fast-moving pandemic.