Epidemiology of SARS-CoV-2 Infection in Italy Using Real-World Data: Methodology and Cohort Description of the Second Phase of Web-Based EPICOVID19 Study

  1. Fulvio Adorni
  2. Nithiya Jesuthasan
  3. Elena Perdixi
  4. Aleksandra Sojic
  5. Andrea Giacomelli
  6. Marianna Noale
  7. Caterina Trevisan
  8. Michela Franchini
  9. Stefania Pieroni
  10. Liliana Cori
  11. Claudio Maria Mastroianni
  12. Fabrizio Bianchi
  13. Raffaele Antonelli-Incalzi
  14. Stefania Maggi
  15. Massimo Galli
  16. Federica Prinelli
  17. on behalf of the EPICOVID19 Working Group

Reviewed by

Read the full article See related articles

Listed in

Log in to save this article

Abstract

Digital technologies have been extensively employed in response to the SARS-CoV-2 pandemic worldwide. This study describes the methodology of the two-phase internet-based EPICOVID19 survey, and the characteristics of the adult volunteer respondents who lived in Italy during the first (April–May 2020) and the second wave (January–February 2021) of the epidemic. Validated scales and ad hoc questionnaires were used to collect socio-demographic, medical and behavioural characteristics, as well as information on COVID-19. Among those who provided email addresses during phase I (105,355), 41,473 participated in phase II (mean age 50.7 years ± 13.5 SD, 60.6% females). After a median follow-up of ten months, 52.8% had undergone nasopharyngeal swab (NPS) testing and 13.2% had a positive result. More than 40% had undergone serological test (ST) and 11.9% were positive. Out of the 2073 participants with at least one positive ST, 72.8% had only negative results from NPS or never performed it. These results indicate that a large fraction of individuals remained undiagnosed, possibly contributing to the spread of the virus in the community. Participatory online surveys offer a unique opportunity to collect relevant data at individual level from large samples during confinement.

Article activity feed

  1. Version published to 10.3390/ijerph19031274
  2. ScreenIT

    SciScore for 10.1101/2022.01.10.22268897: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: The working group tested both questionnaires for two weeks and then edited them according to the feedback before launching them in the general population. 2.2 Content of the EPICOVID19 questionnaire: Participants were asked to complete the two questionnaires (phase I and II) after reading an introductory page (which briefly described the rationale and objectives of the study and the scientific consortium), and after accepting the option to provide consent to participate.
    IRB: 2.6 Ethical Approval: The Ethics Committee of the Istituto Nazionale per le Malattie Infettive IRCCS Lazzaro Spallanzani approved the EPICOVID19 first (protocol No. 70, 12/4/2020) and second phase (protocol No. 249, 14/1/2021) study protocols.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    All of the statistical analyses were carried out using STATA software packages (version 15, StataCorp LP, 347 College Station, Texas, USA) and SPSS (IBM Corp.
    STATA
    suggested: (Stata, RRID:SCR_012763)
    StataCorp
    suggested: (Stata, RRID:SCR_012763)
    Released, IBM SPSS Statistics version 25.0 Armonk, NY: IBM Corp.).
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    Results from OddPub: Thank you for sharing your code.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    4.1 Limitations and Strengths: The present study has some weaknesses, primarily because the online system and voluntary participation suffers from inherent selection bias and generalizability. Similarly to other web-based survey [8,58,59], some of the characteristics of the sample were not adequately representative of the Italian adult population. Indeed, females, younger, healthier and wealthier people were proportionally more represented in the enrolled sample than in the general population. Furthermore, data were self-reported, which might have introduced measurement and recall bias (e.g. survey question misunderstanding, etc.). In addition, the longitudinal design may have led to bias due to the loss of participants during the follow-up period. The response rate to the second survey was 40%, with some differences between included and excluded participants, in particular regarding age, education, employment status and geographical area of residence. The present study also has several strengths including its community-based longitudinal design with two-time point’s measures overlapping with the first and second wave of the epidemic in Italy, thus providing reliable details on the temporal evolution of the symptoms and testing. In addition, although these data were self-reported, almost 50% of the studied sample underwent a NPS or ST, providing an overarching picture of the positivity rate at the population level in a country in which the ability to track COVID-19 cases in r...

    Results from TrialIdentifier: We found the following clinical trial numbers in your paper:

    IdentifierStatusTitle
    NCT04471701RecruitingItalian Web-based Cross-sectional Survey on COVID-19

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2022.01.10.22268897v1 on medRxiv