The Coronavirus QuestionnaireThis questionnaire was created for the emergency services of the French health system due to the coronavirus pandemic. While intended for the people of France, being an unrestricted Web application, it is available to the French speaking world at https://www.maladiecoronavirus.fr/se-tester. It is designed to assist the lay person answer the question: "Is it possible that I have been infected by the coronavirus and should I seek medical help?" The application does not provide a medical opinion and should in no manner take the place of an opinion provided by a medical provider. The application scores the answers to a series of questions and recommends that the user should/should not seek medical help.
The questions are translated and listed here. Unlike the French application, THIS TRANSLATION DOES NOT EVALUATE THE ANSWERS AND MAKES NO RECOMMENDATION AS TO WHETHER THE USER SHOULD SEEK MEDICAL CARE. This English version remembers no answers and stores no cookies. It does not know who the user is or how the questions have been answered.
Furthermore, there is no guarantee that these questions are appropriate, nor precludes that there may be other important questions that are not included. Also, as researchers discover more about the COVID-19 virus, some of the questions may be judged simply erroneous. Nonetheless, we feel that simply knowing what the questions currently are can help a lay person decide if he/she should provide the questions and answers to a medical provider to see if medical intervention is warranted.
Since the pandemic risks overwhelming the world's medical infrastructure, this may also assist in efficiently providing medical personnel with the data needed for a recommendation. The user can simply print the form, fill it out and make it availble to a provider.
We provide this list because we feel that existing sites such as Google's and the CDC site, while providing much text and information (in our view, not very well organized) forces a perhaps worried person to wade through much boilerplate before deciding to perhaps get medical help. These questions "cut to the chase."
QuestionnaireTo help you decide whether to seek additional medical attention, print this form, fill it out, and make it available it to a medical provider.This will help them evaluate whether you need medical attention. Place a check mark or write in the number for the answer.
1. Have you had a fever in the last few days (chills or sweating)? yes___ no____
Non steroidal anti-inflammatories: Taking anti-inflammatory drugs (ibuprofen, cortisone ...) could worsen the infection. If you are already taking an anti-inflammatory or are not sure, ask your doctor.2. In recent days, have you had a cough or more coughing than usual? yes___ no____
3. In recent days, have you had a large loss in your sense of taste or smell? yes___ no____
4. In recent days, have you had a sore throat? yes___ no____
5. In the last 24 hours, have you had diarrhea or at least three soft stools? yes___ no____
6. In recent days, have you had unusual fatigue? yes___ no____
7. Have you been unable to eat or drink in the last 24 hours? yes___ no____
8. In the last 24 hours, have you gotten UNUSUALLY out of breath from talking or making a slight effort? yes___ no____
9. What is your age? age _____
10. What is your height? feet_____ inches_____
11. What is your weight? This is to calculate your body mass index which is a risk factor for complications from infection. pounds_____
12. Do you have high blood pressure or do you have a cardiac or vascular illness or are you in cardiac treatment? yes___ no____ don't know____
13. Are you diabetic? yes___ no____
14. Do you have or have you had cancer? yes___ no____
15. Do you have any respiratory illnesses? Or are you being treated for such? yes___ no____
16. Are you receiving dialysis? yes___ no____
17. Do you have a chronic liver ailment? yes___ no____
18. Are you pregnant? yes___ no____ not applicable _____
19. Do you have any illnesses known to suppress
immunological defenses? yes___ no____ don't know_____
20. Are you undergoing an immunological
suppression treatment? yes___ no____ don't know ______
21. zip code_______ I do not wish to answer ______