Designing and Launching Coronavirus Disease 19 Electronic Registry in Shiraz, Iran: A Brief Report

Introduction: The emergence of severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) has created a global concern for public health. Having sufficient data is the first step to understand the behavior of contagious diseases such as the COVID-19 pandemic. Although various studies have assessed COVID-19 features, there are many limitations about patients’ characteristics, complications, and outcomes in different countries including Iran. The present study reported launching an electronic database for COVID-19 patients in Fars province, Iran. Method: A comprehensive web-based multicenter registry was designed and launched by Shiraz University of Medical Sciences in order to collect all information about COVID-19 hospitalized patients in Fars province, Iran. Results: In this registry, patients’ demographic characteristics, chest computed tomography scan findings, laboratory tests, complications during hospitalization, treatments, and disease course in Intensive Care units are recorded on a web-based electronic database. The virtual statues of the patient’s family are evaluated by telephone calls, and the proceeding will be implemented for quarantine and hospitalization if required. Conclusion: The registry is hoped to help all scientists to understand the current challenges and be prepared for possible future waves of the epidemic. Finally, this registry is a resource for all researchers who are interested in coronavirus and plays an important role in supporting the scientific community on the frontlines of combating the virus.

over the world, the most effective initial managements are infection control measures which are defined as social distancing and immediate isolation of infected patients. 6 Exact information about infected individuals, symptoms, and specific characteristics is required in order to clarify the uncertainties and ambiguities of this respiratory syndrome. Thus, a comprehensive database about patients with COVID-19 help specialists and health policymakers to reduce the transmission rate and mortality. 7 Despite health authorities' efforts, Iran was not an exception to this outbreak. So far (8 April 2020), there has been no specific treatment for COVID-19. To have better management in the prevention, treatment, and diagnosis of patients, it is of utmost importance to conduct high-quality research on COVID-19. Hence, the present study aimed to establish an electronic registration system for suspected and confirmed individuals with COVID-19 at Shiraz University of Medical Sciences, Iran.

Materials and Methods tudy Design and Settings
From the beginning of the COVID-19 outbreak in Fars province, a comprehensive form was designed based on the recommended WHO checklist. 8 All suspected and confirmed individuals with COVID-19 will be followed during hospitalization and one month afterward. Moreover, family members are screened and hospitalized if required. The current registry is designed in compliance with standard STORBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines, along with the Declaration of Helsinki principles. 9,10 It should be noted that this registry is approved by Shiraz University of Medical Sciences under the ethical code of IR.SUMS. REC.1399.022

Inclusion and Exclusion Criteria
Initial information was recorded for individuals with COVID-19 symptoms (i.e., fever, cough, and dyspnea) who referred to different centers in Fars province, Iran. To confirm the disease, the chest computed tomography (CT) scan and real-time polymerase chain reaction (RT-PCR) test were performed for all patients. On the other hand, individuals were excluded from the registry if they were not satisfied with information recording and the follow-up.

Bias and Quality Assurance
As it is known, SARS-CoV-2 is a new infection and the disease has an unknown nature thus treatment protocols and guidelines may change during the study. Hence, a committee consisting of specialists in all aspects of this multi-factorial disease is meticulously monitoring data collection procedures. Table 1 provides information about the quality control team and the involved specialists.

Measures and Outcomes
After initial information gathering, chest CT scan findings, laboratory tests, and complications during hospitalization, treatments, and the intensive care unit course were recorded on a web-based electronic database (ardr.sums. ac.ir). Then, the virtual statues of the patient's family were evaluated by telephone calls, and the proceedings are implemented for quarantine and hospitalization if necessary. Figure 1 displays the diagnostic algorithm for people with respiratory symptoms. In addition, flow charts for assessing the COVID-19 risk in pregnant women and neonates are provided in Figures 2 and 3, respectively.
Further investigations are performed for inpatients during the hospital stay. Table 2 presents related investigations for COVID-19 patients.

Discussion
Since COVID-19 spread across the world, public health has been confronted by a serious crisis. According to clinical manifestations, the severity of the symptoms of this respiratory infection ranges from a common cold-like illness to a severe viral pneumonia that may cause death. 12 The greatest risk of COVID-19 is rapid transmission communities. To date (8 April 2020), COVID-19 has affected 209 countries and territories with 1,491,785 confirmed cases. In Iran, total cases and total death are 64 586, and 3993, respectively (8 April 2020). 13 According to different works of literature, most victims are susceptible individuals thus special attention is needed for elderly people, medical staff, immunosuppressed patients, pregnant women, and those with other underlying diseases. 14   Note. *Fever: Temperature ≥ 37.3°C and ≥37.7°C in the morning and evening, respectively; **High-risk groups: Immunocompromised patients including those with malignancy, organ transplant, HIV, cardiovascular diseases, diabetes, cirrhosis, and aged more than 50. Although this new virus is from the same family of SARS-CoV, various ambiguous points exist, and prior recommendations are insufficient to confine the disease. To block the routes of transmission, epidemiological changes should be monitored carefully and further studies are essential, especially since no one is assured of SARS-CoV-2 immunity. 15 Accordingly, a comprehensive database is helpful to support medical researchers and healthcare professionals in their efforts regarding better understanding and combating the disease associated with this novel coronavirus. In this manuscript introduced our electronic web-based registry, which was designed and launched by Shiraz University of Medical Sciences. In this system, monitoring patients and frequently checking back for additional content could be implemented with detail. According to laboratory tests, we could also find a cut-off to predict the disease in suspicious individuals. 16 A similar registry has been set up to support rapid evidence synthesis in Europe and Tehran. 17,18 It is hoped that this valuable database provides extensive knowledge about different aspects of this disease such as demographic characteristics, comorbidities, laboratory findings, risk factors, and the safety and efficacy of various treatments.

Conclusion
The current study provided a brief report about our electronic registry system for patients with COVID-19 in Fars province, Iran. For those researchers who are interested in the field and wish to follow the last updates on SARS-CoV-2 in particular, this registry helps them collect reliable and especially up-to-date information on this issue.

Ethical Approval
This study was approved by the ethical committee code of IR.SUMS.REC.1399.022.

Conflict of Interest Disclosure
The authors declare that they have no conflict of interests.

Funding/Support
This work was supported by the Vice-chancellor of Research and University Resources.