Since its emergence, the coronavirus disease 2019 (COVID-19) has spread rapidly and has had profound effects on the lives and health of people globally. As of July 2022, the WHO reported a total of 572 million confirmed cases globally including 6.4 million deaths and 12 million vaccine doses administered [1]. The clinical spectrum of COVID-19 infection varies widely from asymptomatic to mild cough, fever, pneumonia, sepsis, respiratory failure, and death. Early detection of patients who are likely to progress to critical illness can aid in delivery of proper care and optimization of limited resources.
Equally important, the COVID-19 pandemic has disproportionately impacted Black, Indigenous, and other people of color (BIPOC) in the United States in terms of increased risk for COVID-19 related hospitalization and death [2–4]. To respond to this pandemic and future pandemics, it is essential to have comprehensive knowledge of infection and vaccination rates, the population proportion that will progress to differing stages of illness, symptomatic infection, hospitalization, ICU admission and death, and the population proportion that will develop antibody responses.
Policymakers urgently need accurate information about true infection rates and progression risks, along with how those risks vary with demographic and health characteristics in order to make well-informed COVID-19 related decisions. At the individual level, this information is also valuable to determine levels of risk and behavioral precautions necessary to avoid severe illness. Numerous COVID risk assessment tools have been developed in the US as well as abroad [5, 6]; however, current approaches to estimating the number of infected persons use statistical models applied to confirmed cases of COVID-19 adjusted to identify possible sources of under detection [7]. The true population infection rate, however, is predicted to be much higher than the infection rate based on viral testing; thus, current assessments will overestimate risk.
Information about risks must be conveyed effectively to the public and especially to vulnerable communities. Fight COVID MKE is a multifaceted research project that utilizes antibody test data, surveys, focus groups and health records from adults living in Milwaukee County to analyze COVID-19 risks from a population perspective. Using these tools, Fight COVID MKE allows researchers to assess risks for hospitalization and death if infected with SARS-CoV-2 and develop and continually update a nationally available web-based individual risk assessment tool. (https://fightcovidmilwaukee.org/individual-risk-estimator)
In this paper, we introduce the Fight COVID MKE individual risk estimator tool, a web-based model that provides individuals with estimates of the risk of dying from COVID-19 for people like themselves, based on various demographic and health-related information. This tool leverages data from Wisconsin, Indiana, and Cook County, Illinois as well as a national 5% Medicare sample of deaths to measure the population proportion infected and how this proportion varies over time, geographically, and with comorbidities. These data calculate the risk that infection for that individual may result in death as a function of individual and community characteristics such as age, gender, race/ethnicity, zip code of residence, body mass index, several chronic health conditions, and importantly, vaccination or past infection status. The risk assessment tool predicts individual risk of life expectancy loss due to COVID depending upon past vaccination and/or infection and community infection prevalence. It compares risk of COVID death and life expectancy loss compared with cancer, car crashes, and pneumonia/influenza. As of August 2022, the risk tool has been used 40,000 times by adults in Milwaukee, Chicago, New York, Los Angeles, and other communities across the US.
The risk assessment tool predicts COVID-19 burden, individual risk to oneself today, and comparison of COVID-19 illness to other common risks. Current literature surrounding COVID-19 risk focuses on public perception of risk and health protective behaviors. However, it is essential to provide a better understanding of the perceptions of risk assessment tools including trust in and understanding of them. This paper uses data from nine community focus groups held between July and October 2021 to explore ways participants reduced their risk of exposure to COVID-19 over time and their perceptions of the risk assessment tool. During community focus groups, the risk assessment tool was introduced to participants to gauge individual risk perception and obtain feedback regarding accessibility, understanding and usefulness of the tool.