Clinical Inclusion Criteria
Select yes if patient has either clinically suspected or laboratory-confirmed SARS-CoV-2 /COVID-19 infection.
boolean
Demographics
Clinical centre name
text
Country
text
Date of enrolment into the study or for in-patients the date COVID-19 was first assessed as suspected or confirmed by a clinician.
date
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
boolean
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
boolean
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
boolean
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
boolean
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
boolean
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
boolean
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
boolean
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
boolean
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
boolean
Please enter all that apply of the following choices which best describe the patient’s ethnicity or major ethnic group at birth. Please exclude nationality as nations often include many different ethnic groups (For example, Singaporean is the nationality but the ethnic grouping within Singapore could be East Asian, South Asian etc.) Cross (X) all that apply. If ‘Other’ write the full name of the ethnic group of the patient. Please do not enter a letter or number corresponding to a local/national ethnicity coding system. If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
text
If the patient’s ethnicity is not known, please place a cross (X) in the ’Unknown’ box.
boolean
Employed as healthcare worker
integer
Employed in a microbiology laboratory
integer
Sex at birth
integer
Or use "estimated age in months"
integer
Or use "estimated age in years"
integer
Pregnant
integer
Gestational week assessment
integer
Post Partum
Post-partum: Defined as within six week of delivery. If NO or Unknown skip this section
integer
Pregnancy Outcome
integer
Delivery date
date
Baby tested for mother's Sars-Cov-2-infection/COVID-19
integer
If the baby is positive for COVID-19 please complete a separate form for the baby as well.
integer
Infant – Less than 1 year old
If No skip this section
boolean
Birth weight
float
Birth weight Unit/Unknown
integer
Gestational outcome
integer
Breastfed
integer
Vaccinations appropriate for age/country
integer
Onset and admission
Please provide the date of patient reported onset of the first symptom that you clinically believe was related to this episode of COVID-19 infection.
date
Where a patient was admitted via multiple hospital departments, count admission from the time they came to the first department during the visit that led to their admission (e.g. arrival at the Emergency Department). For patients with a clear alternative diagnosis leading to admission who subsequently acquired COVID-19 report the date of admission as the day they were admitted to the healthcare facility.
date
For participants who return for re-admission to the same site, start a new form with the same Participant Identification Number. Please check “YES-admitted previously to this facility”. Enter as 2 separate entries in the electronic database. For participants who transfer between two sites that are both collecting data on this form, it is preferred to have the data entered by a single site as a single admission, under the same Participant Identification Number. When this is not possible, the first site should record “Transfer to other facility” as an OUTCOME, and the second site should start a new form with a new patient number and indicate “YES-transferred from other facility” in ONSET & ADMISSION.
integer
Participant ID at transferring facility
integer
Participant ID at transferring facility
text
Signs and symptoms at hospital admission
Please enter the peripheral body temperature (rectal if < 3 months) in the space provided and indicate the unit of measurement, either degrees Celsius (°C) or Fahrenheit (°F). For all items in this group: Please provide details of clinical observations made as close to presentation/admission, or within 24 hours of admission. For observations not made immediately at admission, please record the first available data (patient reported and/or from medical records) within 24 hours of admission. For patients with a clear alternative diagnosis leading to admission who subsequently acquired COVID-19, complete these observations for the 24 hours after onset of symptoms of suspected or confirmed COVID-19 infection.
float
Please enter the peripheral body temperature (rectal if < 3 months) in the space provided and indicate the unit of measurement, either degrees Celsius (°C) or Fahrenheit (°F).
integer
Enter the heart rate measured in beats per minute. This may be measured manually or by electronic monitoring.
integer
Enter the respiratory rate in breaths per minute. Manual rather than electronic measurement is preferred where possible (this is achieved by counting the number of breaths for one minute, counting how many times the chest rises within this time period). Record the highest respiratory rate documented on admission.
integer
Please enter the systolic blood pressure measured in millimetres of mercury (mmHg), in the relevant sections. For example, if the blood pressure is 120/85 mmHg, enter 120 in the section marked ‘systolic BP’. Use any recognised method for measuring blood pressure.
integer
Please enter the diastolic blood pressure measured in millimetres of mercury (mmHg), in the relevant sections. For example, if the blood pressure is 120/85 mmHg, enter 85 in the section marked ‘diastolic BP’. Use any recognised method for measuring blood pressure.
integer
For all patients, irrespective of ventilation or supplemental oxygen requirement, please enter the percentage oxygen saturation (the percentage of haemoglobin binding sites in the bloodstream occupied by oxygen) at the time of admission. This may be measured by pulse oximetry or by arterial blood gas analysis.
integer
Oxygen saturation condition
integer
Sternal capillary refill time is measured by pressing on the sternum for five seconds with a finger or thumb until the underlying skin turns white and then noting the time in seconds needed for the colour to return once the pressure is released.
integer
Height
integer
Weight
integer
Admission signs and symptoms
History of fever
integer
Cough
integer
Sore throat
integer
Rhinorrhoea
integer
Wheezing
integer
Shortness of breath
integer
Lower chest wall indrawing
integer
Chest pain
integer
Conjunctivitis
integer
Lymphadenopathy
integer
Headache
integer
Loss of smell (Anosmia)
integer
Loss of taste (Ageusia)
integer
Seizures
integer
Fatigue / Malaise
integer
Anorexia
integer
Altered consciousness/confusion
integer
Muscle aches
integer
Joint pain
integer
Inability to walk
integer
Abdominal pain
integer
Diarrhoea
integer
Vomiting / Nausea
integer
Skin rash
integer
Haemorrhage
integer
Haemorrhage Site
text
Other symptom(s)
integer
Other symptom(s)
text
Pre-admission medication (taken within 14 days of admission/presentation at healthcare facility)
Include alacepril, captopril, zefnopril, enalapril, ramipril, quinapril, perindopril, lisinopril, benazepril, imidapril, trandolapril, and cilazapril.
integer
Examples include losartan, irbesartan, olmesartan, candesartan, valsartan, fimasartan, azilsartan, saprisartan and telmisartan
integer
Examples include aspirin, ibuprofen, naproxen, celecoxib, diclofenac, diflunisal, etodolac, indomethacin, ketoprofen, ketorolac, nabumetone, oxaprozin, piroxicam, salsalate, sulindac, tolmetin
integer
Examples include prednisolone, betamethasone, dexamethasone, hydrocortisone, methylprednisolone, deflazacort and fludrocortisone. Only list medications taken orally. Please list generic names.
integer
Examples include prednisolone, betamethasone, dexamethasone, hydrocortisone, methylprednisolone, deflazacort and fludrocortisone. Only list medications taken orally. Please list generic names.
text
Examples include tofacitinib, cyclosporine, tacrolimus, sirolimus, everolimus, azathioprine, leflunomide, mycophenolate and biologics such as abatacept, adalimumab, anakinra, certolizumab, etanercept, adalimumab, infliximab and rituximab. Please list generic names.
integer
Examples include tofacitinib, cyclosporine, tacrolimus, sirolimus, everolimus, azathioprine, leflunomide, mycophenolate and biologics such as abatacept, adalimumab, anakinra, certolizumab, etanercept, adalimumab, infliximab and rituximab. Please list generic names.
text
Examples include ribavirin, lopinavir, ritonavir, remdesivir, oseltamivir, zanamivir, acyclovir, ganciclovir, and interferons. Please list generic names. Topical preparations should not be recorded.
integer
Examples include ribavirin, lopinavir, ritonavir, remdesivir, oseltamivir, zanamivir, acyclovir, ganciclovir, and interferons. Please list generic names. Topical preparations should not be recorded.
text
‘Antibiotic’ refers to any agent(s) that selectively target bacteria. Please list generic names. Topical preparations should not be recorded.
integer
‘Antibiotic’ refers to any agent(s) that selectively target bacteria. Please list generic names. Topical preparations should not be recorded.
text
Includes for example: chloroquine, hydroxychloroquine, Interferon antibodies, convalescent plasma or any other COVID-19 therapeutics not included in the categories listed above. Please list generic names.
integer
Includes for example: chloroquine, hydroxychloroquine, Interferon antibodies, convalescent plasma or any other COVID-19 therapeutics not included in the categories listed above. Please list generic names.
text
Co-morbidities and risk factors
Please include any of coronary artery disease, heart failure, congenital heart disease, cardiomyopathy, rheumatic heart disease. For all items in this group: Please record if any of these comorbidities existed prior to admission. In general, do not include past comorbidities that are no longer ongoing. Additional details are given below. Where example conditions are given, these are not intended to be exhaustive and other conditions of equivalent severity should be included.
integer
Elevated arterial blood pressure diagnosed clinically, >140mmHg systolic or >90mmHg diastolic.
integer
Please include any of chronic obstructive pulmonary disease (chronic bronchitis, emphysema), cystic fibrosis, bronchiectasis, interstitial lung disease, pre-existing requirement for long term oxygen therapy. Do not include asthma.
integer
Clinician-diagnosed asthma
integer
Please include any of clinician-diagnosed chronic kidney disease, chronic estimated glomerular filtration rate < 60 mL/min/1.73 squaremetre , history of kidney transplantation
integer
This is defined as cirrhosis with portal hypertension, with or without bleeding or a history of variceal bleeding
integer
This is defined as cirrhosis without portal hypertension or chronic hepatitis
integer
Please include any of splenectomy, non-functional spleen, and congenital asplenia.
integer
Please include any of cerebral palsy, multiple sclerosis, motor neurone disease, muscular dystrophy, myasthenia gravis, Parkinson’s disease, stroke, severe learning difficulty
integer
Current solid organ or haematological malignancy. Please do not include malignancies that have been declared ‘cured’ ≥5 years ago with no evidence of ongoing disease. Do not include non- melanoma skin cancers. Do not include benign growths or dysplasia.
integer
Any long-term disorder of the red or white blood cells, platelets or coagulation system requiring regular or intermittent treatment. Do not include leukaemia, lymphoma or myeloma, which should be entered under malignancy. Do not include iron-deficiency anaemia which is explained by diet or chronic blood loss.
integer
History of laboratory-confirmed HIV infection.
integer
This refers to patients for whom an attending clinician has assessed them to be obese - ideally but not necessarily with an objective measurement of obesity, such as calculation of the body mass index (BMI of 30 or more) or measurement of abdominal girth.
integer
Type 1 or Type 2 diabetes mellitus requiring oral or subcutaneous treatment. Please indicate whether type 1 or type 2.
integer
This is defined as an inflammatory and degenerative diseases of connective tissue structures. It includes chronic arthropathies and arthritis, connective tissue disorders and vasculitides.
integer
This is defined as clinical diagnosis of dementia
integer
Patients currently receiving treatment for tuberculosis. Do not include latent tuberculosis.
integer
Any clinically identified deficiency in intake, either of total energy or of specific nutrients that led to a dietetic intervention or referral prior to the onset of COVID-19 symptoms. Do not include people who needed supplementary nutrition solely due to reduced intake during their current illness episode.
integer
Smoking at least one cigarette, cigar, pipe or equivalent per day before the onset of the current illness. Do not include smoke-free tobacco products such as chewed tobacco or electronic nicotine delivery devices.
integer
List any significant risk factors or comorbidities that existed prior to admission, are ongoing, that are not already listed.
integer
List any significant risk factors or comorbidities that existed prior to admission, are ongoing, that are not already listed.
text