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COVID-19-Outbreak Response combining E-health, Serolomics, Modelling, Artificial Intelligence and Implementation Research

Periodic Reporting for period 2 - CORESMA (COVID-19-Outbreak Response combining E-health, Serolomics, Modelling, Artificial Intelligence and Implementation Research)

Reporting period: 2021-04-01 to 2022-03-31

The primary main objective of CORESMA is to generate the most needed clinical and epidemiological data required for defining targeted public health measures at national and global level to become effective during this pandemic.
The secondary main objective is to develop and establish tools and methodologies to improve the global public health preparedness for outbreaks emerging in the future. Our approach is innovative in combining the unique mHealth technology SORMAS, multiplex serolomics, state of the art modelling, artificial intelligence and implementation research also applying them to particularly vulnerable countries outside Europe.

SORMAS – the Surveillance Outbreak Response Management and Analysis System - is a mobile eHealth System that organizes and facilitates disease control and outbreak management in addition to disease surveillance and epidemiological analysis for all administrative levels of the public health system. In February 2020, we made a specific COVID-19 module in SORMAS available to address particular information for this pandemic.

The specific objectives are:
- To capture and provide real-time data through mHealth approaches on spread, transmission and clinical information of COVID-19 infections from Nepal and Côte d'Ivoire, so to guide risk assessment and targeted interventions in- and outside the EU.
- To measure the sero-prevalence of pre-existing cross or partial immunity against COVID-19 in samples from the general population in Germany and Nepal through multiplex serolomics, in order to estimate susceptibility in different populations.
- Enhance the first two objectives through respondent driven sampling, comprehensive modelling and artificial intelligence in order to increase efficiency of intervention measures.
- Improve effectiveness of containment measures in countries particularly vulnerable to the COVID19 epidemic by harnessing concepts of field implementation research, in order to reduce the societal burden of the epidemic for the EU and globally.
In WP 1 of CORESMA the objectives are
• to collect and provide real-time data on the spread, transmission and clinical information of COVID-19 from Nepal and Côte d'Ivoire through the SORMAS mHealth approach to improve risk assessment;
• to strengthen surveillance and outbreak management of COVID-19 in Nepal and Côte d'Ivoire by complementing existing systems with SORMAS.

Embedding SORMAS in the country's surveillance systems makes an important contribution to a long-term eSurveillance strategy enabling early detection and improved response to many endemic and epidemic-prone diseases. SORMAS shall be deployed in the districts of the capital and in strategic entry points and laboratories in Côte d'Ivoire.
During the first reporting period, preparations for the start of SORMAS piloting have begun in both countries, with a focus on the pilot areas. The speed and impact by which the pandemic has interrupted communication and travels activities has also absorbed the capacity of the respective partner organisations in executing respective logistic measures especially in the two countries where the fieldwork is done. This has led to unforeseeable and unavoidable delay in the first reporting period. Meanwhile the piloting of SORMAS is finished in pilot provinces in Côte d'Ivoire since 2021 and in Nepal SORMAS piloting are ongoing and user trainings were held in the first week of April 2022.

In WP 2, the assessment of seroprevalence in the project includes previous infections with coronaviruses, examining the corresponding implications for pre-existing cross-immunity or partial immunity to COVID-19. We completed the identification of a suitable antigen set that meets the assay objectives and allows the development of a multiplex seroassay with human coronavirus antigens. Technical and clinical validation of the multiplex serological immunoassay was successfully performed with samples from the German population and published in Nature Communications, Additionally, extension of the assay to include antigens for other respiratory pathogens has begun.

In WP3, we conducted interviews and surveys for the sequential exploratory mixed methods study in the Netherlands and are in the process of analyzing them.We collaborated in international groups to contribute to policy making for COVID-19 response.

The main objective in WP4 is to investigate the uptake of SORMAS among district and local users as well as regional and national decision makers.
This will be done by examining the learning outcomes (improvement of knowledge about COVID-19) among stakeholders participating in the implementation of the tools and training, as well as the reliability of data entry. Furthermore, we will analyse the tracking of the number of COVID-19 cases as well as the availability and use of the data at different levels in parallel with the use of SORMAS. The second objective is to analyse how SORMAS contributes to improving COVID-19 preparedness, in particular system set-up and use as well as quality and speed of data provision, in order to investigate whether the use of SORMAS improves the use of data for COVID-19 pandemic surveillance. In December 2021, another comparison of the COVID-19 cases and deaths and the Oxford stringency index was conducted.

In WP5, several meetings took place including a kick-off meeting and the General Assembly of CORESMA. The first Project Advisory Board (PAB) meeting took place in April 2021 and the second PAB Meeting was held in March 2022. We designed and set-up a project website, see including a social networking account (Twitter: EUcoresma). There is a regular exchange in monthly virtual meetings of the WP leader.

In WP6 compliance to ethical requirement was confirmed by a report of our external ethics advisor.
Our findings will provide unique and reliable evidence for improving risk assessment and response management for this pandemic and for future emerging public health threats to come. Furthermore, our methodologies are scalable to larger population sizes and other countries. Demonstrating fully digitalized and real time provision of complex clinical and epidemiological information shall make SORMAS the best practice use case implementing International Health Regulations (IHR) even in countries with weak health information infrastructure. The project will also provide continuously updated evidence for agile risk assessment and thus de-escalation of measures to limit undesired effects on mobility and trade to the least necessary. Highest technical data protection and security standards of SORMAS serve the patient rights, prevent for abuse from third parties while serving the global community and maintaining national sovereignty. SORMAS will significantly reduce work burden for the public health service as already evidenced by systematic analyses in other occasions. Our innovative differential serolomics approach will also support clinical trials for potential novel vaccines and thus accelerate their development. The combination of state of the art modelling and innovative artificial intelligence will result in more accurate disease metrics to improve public health interventions and medical treatment.