Developing and testing of an Early Warning mobileHealth screening and risk scoring application for preventing heath worker in-hospital transmission of Covid-19: A feasibility study. (Preprint)

BACKGROUND Hospitals have been identified as very high-risk places for Covid-19 transmission between health workers and non-covid-19 patients. Health care workers are the most at risk population to contract and transmit the infection especially to the already vulnerable non-Covid-19 patients. In Low-income countries, routine testing is not feasible due to the high cost of testing therefore presenting the risk of un-controlled transmission within the non Covid-19 treatment wards. This challenge necessitated the development of an affordable intermediary screening tool that would enable early identification of potentially infected health care workers and for early real time DNA-PCR testing prioritization. This would limit the contact time of potentially infected health care workers with the patients but also efficiently utilize the limited testing kits. OBJECTIVE To describe an early warning in-hospital risk analysis mobile application for screening Covid-19 and determine the feasibility and user friendliness among health care workers. METHODS Materials and methods: Using the WHO, Ministry of Health of Uganda guidelines on the case definition of Covid-19, we developed a screening questionnaire tool for risk assessment of Covid-19. Specific signs and symptoms were weighted based on how prevalent they were among Covid-19 patients and subsequently an algorithm developed for the various case scenarios of Covid-19. Risk sores were computed based on the symptoms and contact history and a daily risk category assigned based on the risk score. The questionnaire, flow charts and algorithms were then integrated into an android mobile application. Following the launch, 100 health care workers in the directorate of surgical services used the application for one month and the feasibility and consistence of use as well as user friendliness was evaluated. Health care workers would submit their daily risk scores and high-risk staff would be selected for testing and further intervention including treatment. RESULTS Results: The primary result of this research project was the development of a mobile based daily early warning system for in-hospital transmission of Covid-19. Overall, the EWAS mobile application was found to be feasible with over 69% of the health care workers having logged more than 67% of the required times. Over 93% of the participants reported the tool as easy to use. CONCLUSIONS Conclusion: The EWAS mobile application is a feasible and user-friendly daily risk scoring tool for preventing in-hospital transmission of Covid-19. Despite it, not being designed to be a diagnostic but a screening tool, there is a need to evaluate its sensitivity in predicting persons likely to have contracted Covid-19. CLINICALTRIAL