Online symptoms self-assessment during COVID-19 pandemic: an analysis of a COVID-19 portal responses from Canada.

COVID-19 case was first identified in Canada on January 25, 2020, on a Toronto resident who had travelled to Wuhan China, and not long after, the WHO declared the viral infection a pandemic. Ontario health West created an online self-assessment portal that allowed individuals in the health region and adjourning areas to report any COVID related symptoms. The purpose of this study was to evaluate the utility and usefulness of the Ontario Heath West online COVID-19 self-assessment portal. Record level data obtained from the Ontario Health West self-assessment portal was analyzed. Descriptive statistics using charts and graphs were used to characterize the distribution of responses to the portal. In-depth analysis using correlation, lead-lag analysis, and trend comparison with actual Government of Ontario COVID-19 cases for the region were also conducted. A total of 34,144 distinct responses were recorded on the portal between April 10 and July 29, 2020, with 1,250 (3.7%) responding positively to one of the emergency symptoms questions. Trend analysis showed a peak portal response in May 2020 with a smaller rise subsequently in July 2020, coinciding with the actual COVID-19 peak in the region. The five most reported symptoms on the portal were sore throat (17.2%), headache (12.9%), fatigue (12.3%), digestive problems (12.2%) and cough (9.1%). For four sub-regions, the trend of self-report on the portal positively lagged actual Public Health Ontario reported COVID-19 cases, while for one sub-region, the trend positively led the actual Public Health Ontario reported COVID-19 cases for the area. We found correlation between online COVID-19 self- assessment data and the confirmed COVID-19 cases in the Southwestern region of Ontario. Trends in the COVID-19 associated emergency symptoms reported on the portal also tracked confirmed COVID-19 cases in the community. Peak response to the portal coincided with the peak volume of confirmed cases in Ontario during the first wave of COVID-19 pandemic in Canada, suggesting some consistency between the experiences of portal users and patterns of COVID-19 illness in the community. The portal was a useful tool at the person-level because it provided guidance to individuals about how to access appropriate health services according to the symptoms that they reported and connected them with primary care, reducing unnecessary visit to health facilities for COVID-19 related care.

Availability and affordability of essential medicines for diabetes across high-income, middle-income, and low-income countries: a prospective epidemiological study.

BACKGROUND: Data are scarce on the availability and affordability of essential medicines for diabetes. Our aim was to examine the availability and affordability of metformin, sulfonylureas, and insulin across multiple regions of the world and explore the effect of these on medicine use. METHODS: In the Prospective Urban Rural Epidemiology (PURE) study, participants aged 35-70 years (n=156 625) were recruited from 110 803 households, in 604 communities and 22 countries; availability (presence of any dose of medication in the pharmacy on the day of audit) and medicine cost data were collected from pharmacies with the Environmental Profile of a Community's Health audit tool. Our primary analysis was to describe the availability and affordability of metformin and insulin and also commonly used and prescribed combinations of two medicines for diabetes management (two oral drugs, metformin plus a sulphonylurea [either glibenclamide (also known as glyburide) or gliclazide] and one oral drug plus insulin [metformin plus insulin]). Medicines were defined as affordable if the cost of medicines was less than 20% of capacity-to-pay (the household income minus food expenditure). Our analyses included data collected in pharmacies and data from representative samples of households. Data on availability were ascertained during the pharmacy audit, as were data on cost of medications. These cost data were used to estimate the cost of a month's supply of essential medicines for diabetes. We estimated affordability of medicines using income data from household surveys. FINDINGS: Metformin was available in 113 (100%) of 113 pharmacies from high-income countries, 112 (88·2%) of 127 pharmacies in upper-middle-income countries, 179 (86·1%) of 208 pharmacies in lower-middle-income countries, 44 (64·7%) of 68 pharmacies in low-income countries (excluding India), and 88 (100%) of 88 pharmacies in India. Insulin was available in 106 (93·8%) pharmacies in high-income countries, 51 (40·2%) pharmacies in upper-middle-income countries, 61 (29·3%) pharmacies in lower-middle-income countries, seven (10·3%) pharmacies in lower-income countries, and 67 (76·1%) of 88 pharmacies in India. We estimated 0·7% of households in high-income countries and 26·9% of households in low-income countries could not afford metformin and 2·8% of households in high-income countries and 63·0% of households in low-income countries could not afford insulin. Among the 13 569 (8·6% of PURE participants) that reported a diagnosis of diabetes, 1222 (74·0%) participants reported diabetes medicine use in high-income countries compared with 143 (29·6%) participants in low-income countries. In multilevel models, availability and affordability were significantly associated with use of diabetes medicines. INTERPRETATION: Availability and affordability of essential diabetes medicines are poor in low-income and middle-income countries. Awareness of these global differences might importantly drive change in access for patients with diabetes. FUNDING: Full funding sources listed at the end of the paper (see Acknowledgments).