Seattle Flu Study
Traditional approaches to respiratory virus surveillance may not identify novel pathogens in time to implement crucial public health interventions. The Seattle Flu Study was a multi-institutional, community-wide pandemic surveillance platform that was established in November 2018. Persons reporting symptoms of respiratory illness provided informed consent for testing to identify influenza and other respiratory pathogens. In one study group, persons enrolled online and were sent kits, by rapid-delivery services, for home collection of a midnasal swab; samples were returned by mail. After identification of the first case of Covid-19 in Washington State, the samples that were collected were also tested for SARS-CoV-2. After March 4, 2020, a human subjects institutional review board determined that results could be reported to public health authorities and to participants, who were notified under a public health surveillance exemption. The first Covid-19 case detected through the Seattle Flu Study, in a specimen collected on February 24, 2020, was the first documented U.S. case of community transmission at the time. These results initiated assessment of the spread of the virus in the Seattle region, which in turn accelerated public health efforts to mitigate the emerging pandemic.
The Seattle Flu Study platform allowed for identification of novel methods of surveillance, testing, and synthesis of data to rapidly identify outbreaks.
The key components of the Seattle Flu Study were:
Development of contactless methods for home-based swab collection and community-based surveillance strategies
Establishment of a high throughput laboratory infrastructure for early detection of novel pathogens
Synthesis of laboratory and clinical data, including genomic data, to guide outbreak response and mitigation efforts
Publications
Chu HY, et al. Early Detection of Covid-19 through a Citywide Pandemic Surveillance Platform. N Engl J Med. 2020 Jul 9.
Chu HY, et al. The Seattle Flu Study: a multiarm community-based prospective study protocol for assessing influenza prevalence, transmission and genomic epidemiology. BMJ Open. 2020 Oct 7.
Bedford T, et al. Cryptic transmission of SARS-CoV-2 in Washington state. Science. 2020 Oct 30.
McCulloch DJ, et al. Comparison of Unsupervised Home Self-collected Midnasal Swabs With Clinician-Collected Nasopharyngeal Swabs for Detection of SARS-CoV-2 Infection. JAMA Netw Open. 2020 Jul 1.
Müller NF, et al. Viral genomes reveal patterns of the SARS-CoV-2 outbreak in Washington State. Sci Transl Med. 2021 May 26.
Jackson ML, et al. Effects of weather-related social distancing on city-scale transmission of respiratory viruses: a retrospective cohort study. BMC Infect Dis. 2021 Apr 9.
Jackson ML, et al. Incidence of medically attended acute respiratory illnesses due to respiratory viruses across the life course during the 2018/19 influenza season. Clin Infect Dis. 2021 Feb 16.
Weil AA, et al. Cross-Sectional Prevalence of SARS-CoV-2 Among Skilled Nursing Facility Employees and Residents Across Facilities in Seattle. J Gen Intern Med. 2020 Nov.
Zigman Suchsland ML, et al. Evaluating an app-guided self-test for influenza: lessons learned for improving the feasibility of study designs to evaluate self-tests for respiratory viruses. BMC Infect Dis. 2021 Jun 29.
Kim AE, et al. Evaluating Specimen Quality and Results from a Community-Wide, Home-Based Respiratory Surveillance Study. J Clin Microbiol. 2021 Apr 20.
Truong M, et al. Comparable Specimen Collection from Both Ends of At-Home Midturbinate Swabs. J Clin Microbiol. 2021 Apr 20.
Chung E, et al. Comparison of Symptoms and RNA Levels in Children and Adults With SARS-CoV-2 Infection in the Community Setting. JAMA Pediatr. 2021 Jun 11.
Srivatsan S, et al. SwabExpress: An end-to-end protocol for extraction-free covid-19 testing. Clin Chem. 2021 Jul 21.
Chung E, et al. Factors and Challenges in Understanding SARS-CoV-2 RNA Levels, Symptoms, and Transmissibility-Reply. JAMA Pediatr. 2021 Sep 20.
Boeckh M, et al. The Seattle Flu Study: when regulations hinder pandemic surveillance. Nat Med. 2022 Jan.
Geyer RE, et al. Diagnostic Accuracy of an At-Home, Rapid Self-test for Influenza: Prospective Comparative Accuracy Study. JMIR Public Health Surveill. 2022 Feb 22.
Newman KL, Wolf CR, Logue JK, Englund JA, Boeckh M, Chu HY. Nausea, Vomiting, and Diarrhea Are Common in Community-Acquired Acute Viral Respiratory Illness. Dig Dis Sci. 2023 Aug;68(8):3383-3389. doi: 10.1007/s10620-023-07976-4. Epub 2023 Jun 3.
Emanuels A, Casto AM, Heimonen J, O'Hanlon J, Chow EJ, Ogokeh C, Rolfes MA, Han PD, Hughes JP, Uyeki TM, Frazar C, Chung E, Starita LM, Englund JA, Chu HY; Seattle Flu Study Investigators. Remote surveillance and detection of SARS-CoV-2 transmission among household members in King County, Washington. BMC Infect Dis. 2024 Mar 13;24(1):309. doi: 10.1186/s12879-024-09160-z.
Media
https://www.youtube.com/watch?v=4HlhKrd3Jcw
https://www.hcplive.com/view/helen-chu-seattle-flu-study
https://www.kuow.org/stories/flu-study
https://www.youtube.com/watch?v=LA4PTvEHzxw
https://www.king5.com/article/news/flu-study-kiosks-aim-to-improve-detection-treatment/281-13b752e3-ed27-4192-b00a-00ef1c3b5702
https://newsroom.uw.edu/news/study-map-seasons-flu-virus-seattle
https://patch.com/washington/seattle/amp/27887452/study-needs-10k-flu-suffers-from-seattle-area
https://www.seattlepi.com/seattlenews/article/Flu-Seattle-study-germs-track-spread-swab-nose-13558201.php
Funding
Gates Ventures