COVID-19 SYMPTOM STUDY

April 15, 2020, Toronto

- One fifth of Ontario households self-report any of seven listed symptoms of COVID-19 (19%).

- The key symptoms of COVID-19: fever, cough and shortness of breath, are characteristic of just less than a tenth of households (8%).

- Incidence of the three key symptoms (a new fever, cough, or shortness of breath - 8%) is higher among the largest households (five or more - 11%) and the least wealthy (less than $20K - 11%).

- One in fifty households has a member who's been tested for COVID-19 (2%).

- Of these tests, one fifth returned positive (18%). This is less than half of one percent of the population (0.4%).

- More than one third of Ontarians report an underlying condition which might aggravate a COVID-19 infection (37%). Of these, the most common is asthma (24% of those reporting a condition).

- About one fifth report being extremely or very emotionally stressed (20%).

- About one fifth report being somewhat or very pessimistic about the future (22%).

- In order to avoid "social desirability bias", or the impulse to give a socially acceptable answer, researchers often ask how "people in the neighbourhood" behave, as a proxy for respondent behaviour.

DETAILED FINDINGS

ONE-FIFTH OF ONTARIO HOUSEHOLDS HAVE ONE OR MORE SYMPTOMS OF COVID-19

  In a new poll conducted jointly by Forum Research and Mainstreet Research among 5045 randomly selected Ontario households on April 11 and 12, one-fifth reported at least one of seven listed symptoms of COVID-19 (19%). The symptoms listed were a new fever (3%), cough (4%), headaches (10%), sore throat (5%), diarrhea (5%), loss of taste or smell (2%), or shortness of breath (3%).

  Incidence of any symptom is higher among the largest households (five or more - 24%), in the lowest income bracket (less than $20K - 22%), areas serviced by the Mississauga Halton LHIN (22%), the Toronto Central LHIN (22%), and the North East LHIN (23%). Two thirds of those households with any symptoms had 3 or more occupants (61%).

  Among those households interviewed in a Brampton pre-test (n = 4243), just less than one tenth reported one or more of four listed symptoms, all those shown here with the exception of diarrhea, shortness of breath and headaches. In the Fort MacMurray pre-test (Regional Municipality of Wood Buffalo, n = 3643), incidence of any symptom of the four was 1-in-7 (14%).

KEY SYMPTOMS (FEVER, COUGH, SHORTNESS OF BREATH) AFFECT ONE IN TEN HOUSEHOLDS

  Three of the seven listed symptoms are seen as key indicators; fever, cough, and shortness of breath. Together, incidence of having one or more of these three symptoms in the household is just less than a tenth (8%), and this is especially common to the largest households (five or more - 11%), households in the lowest income bracket ($20K or less - 11%) and in the area serviced by the South East LHIN (12%).

TWO PERCENT HAVE BEEN TESTED FOR COVID-19...

  One in fifty households have had a member tested for COVID-19 (2%). This number matches the reported actual penetration of testing in Ontario as of April 12 (2%). Among those reporting any symptoms, 1-in-20 have been tested (5%), while among those with the three key symptoms, one tenth have a-had a test (10%). Of those tested, one seventh (15%) are still awaiting results.

...OF THOSE, ONE FIFTH HAVE TESTED POSITIVE

  Among the very small group of households that report having been tested for COVID-19, just less than a fifth report a positive test (18%), and this may be more common in single person households, in those with less formal education and among the lowest income households (caution: small sample sizes). Among the total population, less than one half of one percent have been tested (0.4%). Among those with any symptoms, one third have received a positive result (32%), while among those with the three key symptoms, slightly more have a positive result (39%).

MORE THAN ONE THIRD HAVE A HEALTH CONDITION WHICH MIGHT AGGRAVATE COVID-19

  More than one third of Ontarians report an underlying health condition which might aggravate a COVID-19 infection (37%), and this is most likely to be asthma (24% among those reporting a condition) followed by diabetes (18%) a lung condition (17%) or a heart condition (13%). Incidence of having this type of condition is most commonin the area serviced by the Central East LHIN (43%), and the North East LHIN (48%).

  In Brampton, incidence of a comorbidity is about 3-in-10 (29%), most commonly diabetes (29%), followed by a heart condition (24%), a lung condition (15%) or asthma (10%). In Fort MacMurray, 3-in-10 also have an underlying condition (31%), most commonly a lung condition (24%), followed by asthma (22%), diabetes (20%), or a heart condition (13%). Among those with any symptoms, one half have an underlying condition (48%).

 ONE FIFTH REPORT BEING "EXTREMELY/VERY STRESSED" EMOTIONALLY

  One fifth of Ontario households say their level of emotional stress is "extremely/very stressed" (20%), and this is especially common in larger households (4 people - 23%, five or more - 24%), in the lowest income group ($20K or less - 23%) and in the area serviced by the Central East LHIN (27%).

  In Brampton, one fifth are also "extremely/very stressed" (18%). In Fort MacMurray, a similar figure applies (23%).

ONE FIFTH REPORT BEING "SOMEWHAT/VERY PESSIMISTIC" ABOUT THE FUTURE

  One fifth of Ontarians say they are "somewhat/very pessimistic" about the future (22%), and this is characteristic of larger households (4 people - 25%), those in the very highest income group, notably, ($100K+ - 28%), and in the areas serviced by the Toronto Central LHIN (26%) and the Hamilton, Niagara, Haldimand, Brant LHIN (25%). In Brampton, this level of pessimism is common to one tenth (12%), whereas in Fort MacMurray it is almost twice as high (21%).

AVOIDING "SOCIAL DESIRABILITY BIAS"

  In order to avoid "social desirability bias", or the impulse to give a socially acceptable answer, researchers often ask how "people in the neighbourhood" behave, as a proxy for respondent behaviour.

WIDE MAJORITY OBSERVING SOCIAL DISTANCING AND STAYING HOME

  The very wide majority of Ontario households are observing social distancing (86% reported of neighbours) and are staying home (91%). Among the minority not doing so (14%), are those in the lowest income groups ($20K or less - 18%, $20K to $40K - 17%), in the area serviced by the Erie St Clair LHIN (16%), the Central West LHIN (18%), and the North Simcoe Muskoka LHIN (19%). Somewhat disturbingly, those who report any symptoms of COVID-19 are much more likely to say their neighbourhood doesn't practice social distancing (20%) or staying at home (15%).

ALMOST ALL APPROVE OF SOCIAL DISTANCING AND STAYING HOME

  Virtually all Ontarians approve of social distancing (97%) and staying home (95%). Among those very few who don't approve of social distancing, the largest households are overrepresented (6%), as are respondents in the area serviced by the North East LHIN (6%). Once again, households with potential COVID-19 symptoms are, paradoxically, less likely to approve of social distancing. The same general patterns apply to approval of staying home. 

"Just 5% of households reporting new symptoms consistent with COVID-19 have had testing, and almost two thirds of households with someone experiencing new symptoms had three or more occupants. There is considerable room for expansion of COVID-19 testing among community-dwelling people with symptoms in Ontario.  Syndromic surveillance through phone polling can supplement existing COVID-19 data sources by providing much needed information on community members who are experiencing possible COVID-19 symptoms but have not yet been tested," said Dr. Lauren Lapointe-Shaw of the findings of this survey. Dr. Lapointe-Shaw is supporting this project by sharing her clinical and research expertise to ensure results are directly relevant to public health administrators and other policymakers.

This poll represents an unprecedented collaboration between two of Canada's leading market research and public opinion polling firms, Forum Research and Mainstreet Research. These two firms have come together to demonstrate proof-of-concept of a nationwide symptoms screening poll, conducted by telephone, using Interactive Voice Response (IVR) technology, as an effective method of measuring prevalence and location of people with symptoms of COVID-19 infection, and identifying clusters, or potential "hot spots" before they become too advanced to manage.

"Symptom surveillance will provide a better understanding of the scale and evolution of COVID-19 in Canada. This is because symptoms start 1-2 weeks before test results, and at present many people with symptoms cannot access testing," said Dr Lauren Lapointe-Shaw, when asked about the efficacy of this methodology.

There are key advantages to this methodology:

                - Based on a random probability sample

                - Projectable to the general population

                - Extremely robust sample sizes

                - Conducted in real time

                - Regular tracking, ongoing  reporting, dashboard presentation

                - SMS text messaging included in sampling scheme

                - Interactive functionality allows targeted messaging

                - Eliminates self-selection bias

                - Limits social desirability bias

                - Cost effective

Our methodology captures an extremely robust probability sample, from which statistically valid projections can be made, while the freshness of the data, which can be gathered nightly and reported on a dashboard the next day, ensures key decisions can be made based on real time data. SMS text messaging is included in the data collection protocol. Other benefits include interactive functionality missing in web-based applications, and the elimination of any self-selection bias

This methodology has already been pilot-tested in two municipalities in Canada, the City of Brampton and the Regional Municipality of Wood Buffalo (Fort MacMurray), on very large samples, on March 30. Results from these two pretests have been cited here where indicated.

PARTICIPANTS IN THE STUDY

  With offices across Canada and around the world, 100% Canadian-owned Forum Research is one of the country’s leading survey research firms, having been the only poll to correctly call a Liberal majority in 2015. Forum Research is a member of the American Association for Public Opinion Research (AAPOR) and the Canadian Research and Insights Council (CRIC).

  Differentiated by its large sample sizes, Mainstreet Research provides accurate snapshots of public opinion, predicting the majority NDP government in Alberta, the 2018 Ontario election and a CAQ majority win in the 2018 Quebec election. Mainstreet Research is a member of the World Association for Public Opinion Research (WAPOR) and the Market Research Intelligence Association (MRIA) and meets international and Canadian publication standards.

  Lauren Lapointe-Shaw, MD, PhD, is an Assistant Professor and Clinician Scientist in the Department of Medicine at the University of Toronto, and a Staff General Internal Medicine Physician at the University Health Network. She was previously awarded a CIHR Fellowship Award and CIHR-IHSPR’s Rising Star Award for her doctoral thesis in Clinical Epidemiology and Healthcare Research. Her research is broadly focused on measuring the quality of healthcare and the effects of health policy on patient outcomes.  

MEDIA CONTACTS:

William Schatten, CAIP

Vice President

Forum Research

(416) 960 1310

wschatten@forumresearch.com

Quito Maggi

President

Mainstreet Research

(416) 570 3762

quito@mainstreetresearch.ca

Dr Lauren Lapointe-Shaw, MD, PhD

Assistant Professor of Medicine

University of Toronto

lauren.lapointe-shaw@uhn.ca

@lapointeshaw

 METHODOLOGY