Optimising Clinical Epidemiology in Disease Outbreaks: Analysis of ISARIC-WHO COVID-19 Case Report Form Utilisation (2024)

Supplementary Materials

The following supporting information can be downloaded at https://www.mdpi.com/article/10.3390/epidemiologia5030039/s1: ISARIC-WHO COVID-19 CRF 8DEC21; Table S1. Site and patient distribution across 42 institutional datasets, Table S2. Field group inclusion of individual datasets, and Table S3. Utilisation distance of individual fields: analysis code.

Author Contributions

Conceptualisation: L.M.; Data curation: L.M., S.D. and T.O.Y.; Formal analysis: S.D., T.O.Y. and L.M.; Funding acquisition: L.M.; Investigation: L.M., S.D., E.G.-G., T.O.Y., J.R., J.D. and ISARIC Clinical Characterisation Group; Methodology: L.M., S.D., E.G.-G. and T.O.Y.; Project administration: L.M.; Supervision: A.F., J.R. and J.D.; Visualisation: S.D.; Writing—original draft preparation: L.M.; Writing—review and editing: all authors; L.M. is responsible for the overall content. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by Wellcome [225288/Z/22/Z and 303666/Z/23/Z]; UK Foreign, Commonwealth & Development Office [301542-403]; and the Bill & Melinda Gates Foundation [INV-063472].

Institutional Review Board Statement

The WHO Ethics Review Committee approved the original ISARIC-WHO Clinical Characterisation Protocol (RPC571 and RPC572, 25 April 2013). Approval for COVID-19 implementation was obtained from local or national ethics committees by each participating institution according to local regulations. Two projects represent the majority of the data. Approval for the ISARIC4C study in the UK was granted by the Oxford C Research Ethics Committee (Ref. 13/SC/0149) and the Scotland A REC (Ref. 20/SS/0028). The Human Research Ethics Committee (Medical) at the University of the Witwatersrand approved the study managed by the National Institute of Communicable Diseases, South Africa, as part of a national surveillance programme (M160667).

Informed Consent Statement

Requirements for written or oral consent varied across committees responsible for the 1886 participating sites. The majority of patients were recruited under a waiver of consent, approved by the responsible committee in the context of the pandemic—including those in the UK and South African studies listed above.

Data Availability Statement

The data that underpin this analysis are highly detailed clinical data on individuals hospitalised with COVID-19. Due to the sensitive nature of these data and the associated privacy concerns, they are available via a governed data access mechanism following review of a data access committee. Data can be requested via the IDDO COVID-19 Data Sharing Platform (http://www.iddo.org/covid-19 accessed on 1 July 2024). The Data Access Application, Terms of Access, and details of the Data Access Committee are available on the website. Briefly, the requirements for access are a request from a qualified researcher working with a legal entity who have a health and/or research remit and having a scientifically valid reason for data access that adheres to appropriate ethical principles. A small subset of sites who contributed data to this analysis have not agreed to pooled data sharing as above. In the case of requiring access to these data, please contact the corresponding author in the first instance who will look into facilitating access. The analysis code is available in the Supplementary Materials.

Acknowledgments

This work was made possible with the support of the UK Foreign, Commonwealth and Development Office and Wellcome [215091/Z/18/Z, 222410/Z/21/Z, 225288/Z/22/Z and 220757/Z/20/Z]; the Bill & Melinda Gates Foundation [OPP1209135]; the philanthropic support of the donors to the University of Oxford’s COVID-19 Research Response Fund (0009109); grants from the National Institute for Health Research (NIHR; award CO-CIN-01/DH_/Department of Health/United Kingdom), the Medical Research Council (MRC; grant MC_PC_19059), and by the NIHR Health Protection Research Unit (HPRU) in Emerging and Zoonotic Infections at University of Liverpool in partnership with Public Health England (PHE), (award 200907), NIHR HPRU in Respiratory Infections at Imperial College London with PHE (award 200927), Liverpool Experimental Cancer Medicine Centre (grant C18616/A25153), NIHR Biomedical Research Centre at Imperial College London (award ISBRC-1215-20013), and NIHR Clinical Research Network providing infrastructure support; the Comprehensive Local Research Networks (CLRNs), of which PJMO is an NIHR Senior Investigator (NIHR201385); Cambridge NIHR Biomedical Research Centre (award NIHR203312); CIHR Coronavirus Rapid Research Funding Opportunity OV2170359 and was coordinated out of Sunnybrook Research Institute; endorsem*nt of the Irish Critical Care-Clinical Trials Group, co-ordinated in Ireland by the Irish Critical Care-Clinical Trials Network at University College Dublin and funded by the Health Research Board of Ireland [CTN-2014-12]; Australian Department of Health grant (3273191); Gender Equity Strategic Fund at University of Queensland, Artificial Intelligence for Pandemics (A14PAN) at University of Queensland, The Australian Research Council Centre of Excellence for Engineered Quantum Systems (EQUS, CE170100009), The Prince Charles Hospital Foundation, Australia; a Research Council of Norway grant no 312780, and a philanthropic donation from Vivaldi Invest A/S owned by Jon Stephenson von Tetzchner; the South Eastern Norway Health Authority and the Research Council of Norway; Innovative Medicines Initiative Joint Undertaking under Grant Agreement No. 115523 COMBACTE, resources of which are composed of financial contribution from the European Union’s Seventh Framework Programme (FP7/2007-2013) and EFPIA companies, in-kind contribution; grants from Instituto de Salud Carlos III, Ministerio de Ciencia, Spain; the French COVID cohort (NCT04262921) is sponsored by INSERM and is funded by the REACTing (REsearch & ACtion emergING infectious diseases) consortium and by a grant of the French Ministry of Health (PHRC n°20-0424); Stiftungsfonds zur Förderung der Bekämpfung der Tuberkulose und anderer Lungenkrankheiten of the City of Vienna; Project Number: APCOV22BGM; Brazil, National Council for Scientific and Technological Development Scholarship number 303953/2018-7; the Firland Foundation, Shoreline, Washington, USA; Institute for Clinical Research (ICR), National Institutes of Health (NIH) supported by the Ministry of Health Malaysia; a grant from foundation Bevordering Onderzoek Franciscus; funding from Saisei Mirai/Saisei Pharma, Japan; the U.S. DoD Armed Forces Health Surveillance Division, Global Emerging Infectious Diseases Branch to the U.S Naval Medical Research Unit No. TWO (NAMRU-2) (Work Unit #: P0153_21_N2). The Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit is funded by the Wellcome Trust. The ISARIC Clinical Characterisation Group acknowledge the COVID clinical management team, AIIMS, Rishikesh, India; the COVID-19 Clinical Management team, Manipal Hospital Whitefield, Bengaluru, India; the Italian Ministry of Health “Fondi Ricerca corrente–L1P6” to IRCCS Ospedale Sacro Cuore–Don Calabria; the Groote Schuur Hospital Covid ICU Team, supported by the Groote Schuur nursing; the University of Cape Town registrar bodies coordinated by the Division of Critical Care at the University of Cape Town; Vysnova Partners, Inc.; the Norwegian SARS-CoV-2 study team; the clinical, laboratory, research, and support staff at EFSTH and MRCG; and the Short Period Incidence Study of Severe Acute Respiratory Infection; and the support of Jeremy J Farrar and Nahoko Shindo. This work uses data provided by patients and collected by the NHS as part of their care and support #DataSavesLives. The data used for this research were obtained from ISARIC4C. We are extremely grateful to the 2648 front-line NHS clinical and research staff and volunteer medical students who collected these data in challenging circ*mstances, and the generosity of the patients and their families for their individual contributions in these difficult times. The COVID-19 Clinical Information Network (CO-CIN) data were collated by ISARIC4C investigators.

Conflicts of Interest

The authors declare no conflicts of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Appendix A. ISARIC-WHO Clinical Characterisation Protocol: Sampling Strategies to Reduce Bias

Robust analysis requires methodical selection of patients for data collection. Each site has its own requirements, abilities, and limitations to participant recruitment and should select the sampling approach that fits the best. Record the sampling approach taken for each unique date range in your site-level CRF.

Type of Sampling	Explanation
Census	Enrol all potential participants who present to your setting.
Sequential/systematic sampling	Enrol patients based on their time of presentation, e.g., every 3rd patient who presents to the hospital, or all patients who present on even calendar days (2nd, 4th, 6th).
Simple random sampling	Use a tool to randomly determine if each patient is enrolled, e.g., use an online tool to generate a random list of Yes/No variables in the desired proportion and apply them sequentially as patients present (note: this should be conducted so that no one knows the next variable).
Defined population census, e.g., ICU patients	Enrol all patients admitted to the ICU.

Appendix B. ISARIC Clinical Characterisation Group

Sabriya Abdalasalam, Alaa Abdalfattah Abdalhadi, Walaa Abdalla, Naana Reyam Abdalla, Almthani Hamza Abdalrheem, Ashraf Abdalsalam, Saedah Abdeewi, Esraa Hassan Abdelgaum, Mohamed Abdelhalim, Mohammed Abdelkabir, Sheryl Ann Abdukahil, Lamees Adil Abdulbaqi, Widyan Abdulhamid, Salaheddin Abdulhamid, Nurul Najmee Abdulkadir, Eman Abdulwahed, Rawad Abdunabi, Ryuzo Abe, Laurent Abel, Ahmed Mohammed Abodina, Khaled Abouelmagd, Amal Abrous, Kamal Abu Jabal, Nashat Abu Salah, Salsabeel M. A. Abukhalaf, Abdurraouf Abusalama, Tareg Abdallah Abuzaid, Subhash Acharya, Andrew Acker, Safia Adem, Manuella Ademnou, Francisca Adewhajah, Neill KJ Adhikari, Diana Adrião, Samuel Yaw Adu, Anthony Afum-Adjei Awuah, Melvin Agbogbatey, Saleh Al Ageel, Musaab Mohammed Ahmed, Aya Mustafa Ahmed, Shakeel Ahmed, Zainab Ahmed Alaraji, Abdulrahman Ahmed Elhefnawy Enan, Reham Abdelhamid Ahmed Khalil, Ali Mostafa Ahmed Mohamed Abdelaziz, Marina Aiello, Kate Ainscough, Eka Airlangga, Tharwat Aisa, Ali Aisha, Bugila Aisha, Ali Ait Hssain, Takako Akimoto, Ernita Akmal, Chika Akwani, Eman Al Qasim, Yasmina Alaa, Ahmed Alajeeli, Ahmed Alali, Razi Alalqam, Aliya Mohammed Alameen, Mohammed Al-Aquily, Zinah A. Alaraji, Khalid Albakry, Safa Albatni, Angela Alberti, Tala Al-dabbous, Amer Aldhalia, Abdulkarim Aldoukali, Marta Alessi, Beatrice Alex, Kévin Alexandre, Abdulrahman Al-Fares, Asil Alflite, Huda Alfoudri, Khadeejeh M. A. Alfroukh, Qamrah Alhadad, Hoda Salem Alhaddad, Maali Khalid Mohamed Abdalla Alhasan, Ahmad Nabil Alhouri, Hasan Alhouri, Adam Ali, Maha TagElser Mohammed Ali, Imran Ali, Syed Ali Abbas, Yomna Ali Abdelghafar, Naseem Ali Shah, Kazali Enagnon Alidjnou, Mahmoud Aljadi, Sarah Aljamal, Mohammed Alkahlout, Khalid Jehad Khalid Alkaraki, Akram Alkaseek, Qabas Alkhafajee, Clotilde Allavena, Nathalie Allou, Lana Almasri, Abdulrahman Almjersah, Raja Ahmed Alqandouz, Walaa Alrfaea, Moayad Alrifaee, Rawan Alsaadi, Yousef Al-Saba’a, Entisar Alshareea, Eslam Alshenawy, Aneela Altaf, Rita Alves, João Melo Alves, João Alves, Joana Alves Cabrita, Maria Amaral, Amro Essam Amer, Nur Amira, Heidi Ammerlaan, Amos Amoako Adusei, John Amuasi, Roberto Andini, Margarita Andreeva, Claire Andrejak, Andrea Angheben, François Angoulvant, Sophia Ankrah, Séverine Ansart, Massimo Antonelli, Carlos Alexandre Antunes de Brito, Kazi Rubayet Anwar, Ardiyan Apriyana, Yaseen Arabi, Irene Aragao, Francisco Arancibia, Carolline Araujo, Antonio Arcadipane, Patrick Archambault, Lukas Arenz, Jean-Benoît Arlet, Christel Arnold-Day, Ana Aroca, Rakesh Arora, Lovkesh Arora, Elise Artaud-Macari, Diptesh Aryal, Motohiro Asaki, Angel Asensio, Elizabeth A. Ashley, Muhammad Ashraf, Muhammad Sheharyar Ashraf, Abir Ben Ashur, Franklin Asiedu-Bekoe, Namra Asif, Mohammad Asim, Grace Assi, Jean Baptiste Assie, Amirul Asyraf, Ahmed Atia, Minahel Atif, Asia Atif Abdelrhman Abdallahrs, Anika Atique, Moad Atlowly, AM Udara Lakshan Attanyake, Johann Auchabie, Hugues Aumaitre, Adrien Auvet, Sergey Avdeev, Abdelmalek Awad Ali Mohammed, Eyvind W. Axelsen, Ared Ayad, Ahmed Ayman Hassan Helmi, Laurène Azemar, Mohammed Azizeldin, Cecile Azoulay, Hakeem Babatunde, Benjamin Bach, Delphine Bachelet, Claudine Badr, Roar Bævre-Jensen, Nadia Baig, John Kenneth Baillie, J Kevin Baird, Zinah Aqeel Abdulzahra Bairmani, Erica Bak, Agamemnon Bakakos, Nazreen Abu Bakar, Hibah Bileid Bakeer, Ashraf Bakri, Andriy Bal, Mohanaprasanth Balakrishnan, Irene Bandoh, Firouzé Bani-Sadr, Renata Barbalho, Nicholas Yuri Barbosa, Wendy S. Barclay, Saef Umar Barnett, Michaela Barnikel, Helena Barrasa, Cleide Barrigoto, Marie Bartoli, Cheryl Bartone, Joaquín Baruch, Romain Basmaci, Muhammad Fadhli Hassin Basri, AbdAlkarim Batool, Denise Battaglini, Jules Bauer, Diego Fernando Bautista Rincon, Denisse Bazan Dow, Abigail Beane, John Beca, Alexandra Bedossa, Ker Hong Bee, Husna Begum, Albertus Beishuizen, Aleksandr Beljantsev, David Bellemare, Anna Beltrame, Beatriz Amorim Beltrão, Marine Beluze, Nicolas Benech, Lionel Eric Benjiman, Suzanne Bennett, Luís Bento, Jan-Erik Berdal, Lamis Berdeweel, Delphine Bergeaud, Hazel Bergin, José Luis Bernal Sobrino, Kikaire Bernard, Giulia Bertoli, Lorenzo Bertolino, Simon Bessis, Adam Betz, Sybille Bevilcaqua, Karine Bezulier, Amar Bhatt, Krishna Bhavsar, Isabella Bianchi, Claudia Bianco, Sandra Bichoka, Farah Nadiah Bidin, Felwa Bin Humaid, Mohd Nazlin Bin Kamarudin, Muhannud Binnawara, Zeno Bisoffi, Patrick Biston, Laurent Bitker, Mustapha Bittaye, Jonathan Bitton, Pablo Blanco-Schweizer, Aaron Blandino Ortiz, Catherine Blier, Frank Bloos, Mathieu Blot, Lucille Blumberg, Polina Bobkova, Filomena Boccia, Laetitia Bodenes, Debby Bogaert, Anne-Hélène Boivin, Ariel Bolanga, Isabela Bolaños, Pierre-Adrien Bolze, Patrizia Bonelli, Aurelius Bonifasius, Joseph Bonney, Diogo Borges, Raphaël Borie, Hans Martin Bosse, Elisabeth Botelho-Nevers, Lila Bouadma, Olivier Bouchaud, Sabelline Bouchez, Kévin Bouiller, Laurence Bouillet, Camile Bouisse, Latsaniphone Bountthasavong, Anne-Sophie Boureau, John Bourke, Maude Bouscambert, Aurore Bousquet, Marielle Boyer-Besseyre, Maria Boylan, Fernando Augusto Bozza, Axelle Braconnier, Timo Brandenburger, Filipa Brás Monteiro, Luca Brazzi, Patrick Breen, Dorothy Breen, David Brewster, Kathy Brickell, Christopher Brighting, Tessa Broadley, Helen Brotherton, Alex Browne, Nicolas Brozzi, Sonja Hjellegjerde Brunvoll, Marjolein Brusse-Keizer, Petra Bryda, Nina Buchtele, Polina Bugaeva, Marielle Buisson, Danilo Buonsenso, Erlina Burhan, Donald Buri, Aidan Burrell, Ingrid G. Bustos, Denis Butnaru, André Cabie, Susana Cabral, Joana Cabrita, Eder Caceres, Cyril Cadoz, Rui Caetano Garcês, Mia Callahan, Kate Calligy, Jose Andres Calvache, Caterina Caminiti, João Camões, Paul Campbell, Josie Campisi, Cecilia Canepa, Mireia Cantero, Janice Caoili, Pauline Caraux-Paz, Sheila Cárcel, Sofia Cardoso, Nelson Cardoso, Filipa Cardoso, Filipe Cardoso, Simone Carelli, Francesca Carlacci, Nicolas Carlier, Thierry Carmoi, Gayle Carney, Inês Carqueja, Marie-Christine Carret, François Martin Carrier, Ida Carroll, Leonor Carvalho, Maire-Laure Casanova, Mariana Cascão, Siobhan Casey, José Casimiro, Bailey Cassandra, Silvia Castañeda, Nidyanara Castanheira, Guylaine Castor-Alexandre, Ivo Castro, Ana Catarino, François-Xavier Catherine, Roberta Cavalin, Giulio Giovanni Cavalli, Alexandros Cavayas, Adrian Ceccato, Masaneh Ceesay, Shelby Cerkovnik, Minerva Cervantes-Gonzalez, Muge Cevik, Anissa Chair, Catherine Chakveatze, Adrienne Chan, Meera Chand, Jean-Marc Chapplain, Charlotte Charpentier, Julie Chas, Muhammad Mobin Chaudry, Jonathan Samuel Chávez Iñiguez, Anjellica Chen, Yih-Sharng Chen, Léo Chenard, Matthew Pellan Cheng, Antoine Cheret, Alfredo Antonio Chetta, Thibault Chiarabini, Julian Chica, Suresh Kumar Chidambaram, Leong Chin Tho, Catherine Chirouze, Davide Chiumello, Hwa Jin Cho, Sung-Min Cho, Bernard Cholley, Danoy Chommanam, Marie-Charlotte Chopin, Ting Soo Chow, Nathaniel Christy, Hiu Jian Chua, Jonathan Chua, Jose Pedro Cidade, José Miguel Cisneros Herreros, Barbara Wanjiru Citarella, Anna Ciullo, Jennifer Clarke, Rolando Claure-Del Granado, Sara Clohisey, Cassidy Codan, Caitriona Cody, Jennifer Coles, Gwenhaël Colin, Michael Collins, Jennifer Connolly, Marie Connor, Anne Conrad, Elaine Conway, Graham S. Cooke, Hugues Cordel, Amanda Corley, Sabine Cornelis, Alexander Daniel Cornet, Arianne Joy Corpuz, Andrea Cortegiani, Grégory Corvaisier, Sandrine Couffin-Cadiergues, Roxane Courtois, Stéphanie Cousse, Juthap*rn Cowan, Rachel Cregan, Charles Crepy D’Orleans, Cosimo Cristella, Gloria Crowl, Jonathan Crump, Claudina Cruz, Juan Luis Cruz Bermúdez, Jaime Cruz Rojo, Marc Csete, Alberto Cucino, Ailbhe Cullen, Matthew Cummings, Gerard Curley, Elodie Curlier, Colleen Curran, Paula Custodio, Ana da Silva Filipe, Charlene Da Silveira, Al-Awwab Dabaliz, Andrew Dagens, John Arne Dahl, Darren Dahly, Umberto D’Alessandro, Peter Daley, Zaina Dalloul, Heidi Dalton, Jo Dalton, Seamus Daly, Juliana Damas, Joycelyn Dame, Federico D’Amico, Cammandji Damien, Hegazy Dana, Nick Daneman, Jorge Dantas, Frédérick D’Aragon, Menno de Jong, Gillian de Loughry, Diego de Mendoza, Etienne De Montmollin, Ra De Pablo, Ana Isabel de Pinho Oliveira, Rosanna De Rosa, Cristina De Rose, Thushan de Silva, Jillian Deacon, David Dean, Alexa Debard, Bianca DeBenedictis, Marie-Pierre Debray, Nathalie DeCastro, William Dechert, Romain Decours, Eve Defous, Isabelle Delacroix, Alexandre Delamou, Karen Delavigne, Nathalie M. Delfos, Andrea Dell’Amore, Christelle Delmas, Pierre Delobel, Corine Delsing, Elisa Demonchy, Emmanuelle Denis, Dominique Deplanque, Pieter Depuydt, Mehul Desai, Diane Descamps, Mathilde Desvallées, Santi Dewayanti, Pathik Dhangar, Souleymane Taran Diallo, Alpha Diallo, Sylvain Diamantis, Andrea Dias, André Dias, Priscila Diaz, Rodrigo Diaz, Juan Jose Diaz, Bakary K Dibba, Kévin Didier, Jean-Luc Diehl, Vincent Dinot, Fara Diop, Alphonsine Diouf, Yael Dishon, Cedric Djadda, Félix Djossou, Annemarie B. Docherty, Helen Doherty, Arjen M Dondorp, Christl A. Donnelly, Sean Donohue, Yoann Donohue, Peter Doran, Céline Dorival, Eric D’Ortenzio, Yash Doshi, Phouvieng Douangdala, James Joshua Douglas, Nathalie Dournon, Thomas Drake, Aoife Driscoll, Amiel A. Dror, Murray Dryden, Ibrahim Kwaku Duah, Claudio Duarte Fonseca, Vincent Dubee, François Dubos, Audrey Dubot-Pérès, Alexandre Ducancelle, Toni Duculan, Susanne Dudman, Abhijit Duggal, Paul Dunand, Jake Dunning, Mathilde Duplaix, Emanuele Durante-Mangoni, Lucian Durham III, Bertrand Dussol, Xavier Duval, Anne Margarita Dyrhol-Riise, Sim Choon Ean, Marco Echeverria-Villalobos, Giorgio Economopoulos, Michael Edelstein, Siobhan Egan, Linn Margrete Eggesbø, Khadeja Ehzaz, Carla Eira, Mohammed El Sanharawi, Marwan El Sayed, Mohammed Elabid, Mohamed Bashir Elagili, Mohammad Elbahnasawy, Sohail Elboshra, Brigitte Elharrar, Natalie Elkheir, Jacobien Ellerbroek, Merete Ellingjord-Dale, Hamida ELMagrahi, Rami Elmorsi, Mohammad Muatasm Elmubark, Lauren Eloundou, Philippine Eloy, Abelrahman Elsayed, Basma Elshaikhy, Tarek Elshazly, Wafa Elsokni, Aml Ahmed Eltayeb, Iqbal Elyazar, Zarief Kamel Emad, Hussein Embarek, Isabelle Enderle, Tomoyuki Endo, Gervais Eneli, Chan Chee Eng, Ilka Engelmann, Vincent Enouf, Olivier Epaulard, Haneen Esaadi, Mariano Esperatti, Hélène Esperou, Catarina Espírito Santo, Marina Esposito-Farese, Rachel Essaka, Lorinda Essuman, João Estevão, Manuel Etienne, Hiba Et-taghy, Rachael Evans, Anna Greti Everding, Mirjam Evers, Marc Fabre, Isabelle Fabre, Ismaila Fadera, Asgad Osman Abdalla Fadlalla, Amna Faheem, Mohamed Fahim Elalfy, Arabella Fahy, Hamza Faida, Cameron J. Fairfield, Komal Fareed, Pedro Faria, Ahmed Farooq, Hanan Fateena, Mohamed Fathi, Salem Fatima, Arie Zainul Fatoni, Karine Faure, Raphaël Favory, Mohamed Fayed, Niamh Feely, Marília Andreia Fernandes, Jorge Fernandes, François-Xavier Ferrand, Joana Ferrão, Carlo Ferrari, Mário Ferraz, Sílvia Ferreira, Bernardo Ferreira, Benigno Ferreira, Isabel Ferreira, Nicolas Ferriere, Céline Ficko, Claudia Figueiredo-Mello, Thomas Flament, Tom Fletcher, Aline-Marie Florence, Letizia Lucia Florio, Brigid Flynn, Deirdre Flynn, Federica Fogliazza, Jean Foley, Victor Fomin, Tatiana Fonseca, Patricia Fontela, Karen Forrest, Simon Forsyth, Denise Foster, Giuseppe Foti, Berline Fotso, Mohamed Fouad Abdrabo, Erwan Fourn, Robert A. Fowler, Marianne Fraher, Diego Franch-Llasat, Christophe Fraser, John F. Fraser, Marcela Vieira Freire, Ana Freitas Ribeiro, Caren Friedrich, Ricardo Fritz, Stéphanie Fry, Nora Fuentes, Masahiro f*ckuda, Argin G, Valérie Gaborieau, Rostane Gaci, Massimo Gagliardi, Jean-Charles Gagnard, Nathalie Gagné, Amandine Gagneux-Brunon, Abdou Gai, Sérgio Gaião, Linda Gail Skeie, Adham Mohamed Galal Mohamed Ramadan, Phil Gallagher, Elena Gallego Curto, Carrol Gamble, Aysylu Gamirova, Yasmin Gani, Arthur Garan, Rebekha Garcia, Noelia García Barrio, Julia Garcia-Diaz, Esteban Garcia-Gallo, Navya Garimella, Federica Garofalo, Denis Garot, Valérie Garrait, Basanta Gauli, Anatoliy Gavrylov, Alexandre Gaymard, Johannes Gebauer, Eva Geraud, Louis Gerbaud Morlaes, Nuno Germano, Ahmed Noman Ghaleb, Abdulrahman Ghaleb, Malak Ghemmeid, Praveen Kumar Ghisulal, Jade Ghosn, Marco Giani, Carlo Giaquinto, Tristan Gigante, Guillermo Giordano, Michelle Girvan, Valérie Gissot, Jesse Gitaka, Gezy Giwangkancana, Daniel Glikman, Petr Glybochko, Eric Gnall, Geraldine Goco, François Goehringer, Siri Goepel, Jean-Christophe Goffard, Jin Yi Goh, Brigitta Golács, Jonathan Golob, Rui Gomes, Kyle Gomez, Joan Gómez-Junyent, Marie Gominet, Alicia Gonzalez, Patricia Gordon, Yanay Gorelik, Isabelle Gorenne, Laure Goubert, Cécile Goujard, Tiphaine Goulenok, Margarite Grable, Jeronimo Graf, Edward Wilson Grandin, Pascal Granier, Giacomo Grasselli, Lorenzo Grazioli, Christopher A. Green, Courtney Greene, William Greenhalf, Segolène Greffe, Domenico Luca Grieco, Matthew Griffee, Fiona Griffiths, Ioana Grigoras, Albert Groenendijk, Fassou Mathias Grovogui, Heidi Gruner, Yusing Gu, Fabio Guarracino, Jérémie Guedj, Martin Guego, Anne-Marie Guerguerian, Daniela Guerreiro, Romain Guery, Anne Guillaumot, Laurent Guilleminault, Maisa Guimarães de Castro, Thomas Guimard, Marieke Haalboom, Daniel Haber, Ali Hachemi, Abdurrahman Haddud, Nadir Hadri, Wael Hafez, Fakhir Raza Haidri, Fatima Mhd Rida Hajij, Sheeba Hakak, Matthew Hall, Adam Hall, Sophie Halpin, Shaher Hamdan, Abdelhafeez Hamdi, Jawad Hameed, Ansley Hamer, Raph L. Hamers, Rebecca Hamidfar, Bato Hammarström, Naomi Hammond, Terese Hammond, Matly Hanan, Rashan Haniffa, Hayley Hardwick, Samuel Bernard Ekow Harrison, Ewen M. Harrison, Janet Harrison, Alan Hartman, Sulieman Hasan, Mohd Shahnaz Hasan, Mohammad Ali Nabil Hasan, Madiha Hashmi, Junaid Hashmi, Amoni Hassan, Ebtisam Hassanin, Claire Hastie, Muhammad Hayat, Ailbhe Hayes, Leanne Hays, Jan Heerman, Lars Heggelund, Ahmed Helmi, Ross Hendry, Martina Hennessy, Aquiles Rodrigo Henriquez-Trujillo, Maxime Hentzien, Diana Hernandez, Daniel Herr, Andrew Hershey, Astarini Hidayah, Eibhlin Higgins, Samuel Hinton, Hiroaki Hiraiwa, Haider Hirkani, Hikombo Hitoto, Antonia Ho, Yi Bin Ho, Alexandre Hoctin, Isabelle Hoffmann, Wei Han Hoh, Oscar Hoiting, Rebecca Holt, Jan Cato Holter, Peter Horby, Juan Pablo Horcajada, Koji Hoshino, Kota Hoshino, Ikram Houas, Mabrouka Houderi, Catherine L. Hough, Stuart Houltham, Jimmy Ming-Yang Hsu, Jean-Sébastien Hulot, Stella Huo, Abby Hurd, Iqbal Hussain, Mahmood Hussein, Aliae Mohamed Hussein, Fatima Ibrahim, Bashir Ibran, Samreen Ijaz, M. Arfan Ikram, Carlos Cañada Illana, Patrick Imbert, Muhammad Imran Ansari, Rana Imran Sikander, Hugo Inácio, Carmen Infante Dominguez, Yun Sii Ing, Elias Iosifidis, Mariachiara Ippolito, Vera Irawany, Sarah Isgett, Tiago Isidoro, Nadiah Ismail, Margaux Isnard, Mette Stausland Istre, Junji Itai, Asami Ito, Daniel Ivulich, Danielle Jaafar, Salma Jaafoura, Hamza Jaber, Julien Jabot, Clare Jackson, Abubacarr Jagne, Victoria Janes, Waasila Jassat, Stéphane Jaureguiberry, Jeffrey Javidfar, Denise Jaworsky, Florence Jego, Anilawati Mat Jelani, Synne Jenum, Edwin Jesudason, Ruth Jimbo-Sotomayor, Ong Yiaw Joe, Ruth Noemí Jorge García, Silje Bakken Jørgensen, Mark Joseph, Cédric Joseph, Swosti Joshi, Mercé Jourdain, Philippe Jouvet, Hanna Jung, Anna Jung, Dafsah Juzar, Ouifiya Kafif, Florentia Kaguelidou, Neerusha Kaisbain, Thavamany Kaleesvran, Sabrina Kali, Alina Kalicinska, Karl Trygve Kalleberg, Smaragdi Kalomoiri, Muhammad Aisar Ayadi Kamaluddin, Armand Saloun Kamano, Zul Amali Che Kamaruddin, Nadiah Kamarudin, Darshana Hewa Kandamby, Kong Yeow Kang, Darakhshan Kanwal, Dyah Kanyawati, Valentina Kapustina, Mohamed Karghul, Pratap Karpayah, Todd Karsies, Christiana Kartsonaki, Daisuke Kasugai, Kevin Katz, Tatsuya Kawasaki, Christy Kay, Lamees Kayyali, Seán Keating, Pulak Kedia, Aoife Kelly, Niamh Kelly, Yvelynne Kelly, Sadie Kelly, Maeve Kelsey, Sommay Keomany, Maeve Kernan, Younes Kerroumi, Sharma Keshav, Evelyne Kestelyn, Shams Khail, Dina Osman Khair, Sarah Khaled, Imrana Khalid, Antoine Khalil, Quratul Ain Khan, Irfan Khan, Sushil Khanal, Abid Khatak, Krish Kherajani, Michelle E. Kho, Ryan Khoo, Denisa Khoo, Saye Khoo, Muhammad Nasir Khoso, Amin Khuwaja, Yuri Kida, Harrison Kihuga, Peter Kiiza, Beathe Kiland Granerud, Anders Benjamin Kildal, Jae Burm Kim, Antoine Kimmoun, Detlef Kindgen-Milles, Nobuya Kitamura, Stany Kivuruga, Eyrun Floerecke Kjetland, Paul Klenerman, Rob Klont, Gry Kloumann Bekken, Stephen R Knight, Robin Kobbe, Chamira Kodippily, Malte Kohns Vasconcelos, Sabin Koirala, Mamoru Komatsu, Franklina Korkor Abebrese, Volkan Korten, Stephanie Kouba, Karifa Kourouma, Mohamed Lamine Kourouma, Arsène Kpangon, Karolina Krawczyk, Ali Kredan, Sudhir Krishnan, Vinothini Krishnan, Oksana Kruglova, Anneli Krund, Pei Xuan Kuan, Ashok Kumar, Mukesh Kumar, Ganesh Kumar, Deepali Kumar, Dinesh Kuriakose, Ethan Kurtzman, Neurinda Permata Kusumastuti, Demetrios Kutsogiannis, Galyna Kutsyna, Ama Kwakyewaa Bedu-Addo, Sylvie Kwedi, Konstantinos Kyriakoulis, Marie Lachatre, Marie Lacoste, John G. 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Loschner, Paul Loubet, Bouchra Loufti, Guillame Louis, Silvia Lourenco, Lara Lovelace-Macon, Lee Lee Low, Marije Lowik, Jia Shyi Loy, Jean-Christophe Lucet, Carlos Lumbreras Bermejo, Carlos M. Luna, Olguta Lungu, Miles Lunn, Liem Luong, Nestor Luque, Dominique Luton, Nilar Lwin, Olavi Maasikas, Sarah MacDonald, Sara Machado, Moïse Machado, Gabriel Macheda, Juan Macias Sanchez, Jai Madhok, Guillermo Maestro de la Calle, Jacob Magara, Giuseppe Maglietta, Rachel Maguru, Mustafa Magzoub, Moataz Maher Emara, Mohammed Maher Hadhoud, Rafael Mahieu, Sophie Mahy, Ana Raquel Maia, Lars S. Maier, Oumou Maiga Ascofare, Mylène Maillet, Thomas Maitre, Nimisha Abdul Majeed, Maria Majori, Maximilian Malfertheiner, Nadia Malik, Dayana Malla, Paddy Mallon, Fernando Maltez, Denis Malvy, Patrizia Mammi, Victoria Manda, Jose M. Mandei, Laurent Mandelbrot, Frank Manetta, Julie Mankikian, Edmund Manning, Aldric Manuel, Veronika Maráczi, Ceila Maria Sant’Ana Malaque, Flávio Marino, Samuel Markowicz, Ana Marques, Catherine Marquis, Brian Marsh, Megan Marshal, John Marshall, Celina Turchi Martelli, Dori-Ann Martin, Emily Martin, Guillaume Martin-Blondel, Alessandra Martinelli, F. Eduardo Martinez, Ignacio Martin-Loeches, Martin Martinot, Alejandro Martín-Quiros, Ana Martins, Nuno Martins, João Martins, Caroline Martins Rego, Gennaro Martucci, Olga Martynenko, Eva Miranda Marwali, Marsilla Marzukie, Juan Fernado Masa Jimenez, David Maslove, Sabina Mason, Phillip Mason, Sobia Masood, Fatma Masoud, Moise Massoma, Palmer Masumbe, Mohd Basri Mat Nor, Moshe Matan, Sébastien Matata, Henrique Mateus Fernandes, Meghena Mathew, Christina Mathew, Girish Matjeti, Mathieu Mattei, Laurence Maulin, Juergen May, Jennifer May, Marcel Mayala, Javier Maynar, Mayfong Mayxay, Mohd Zulfakar Mazlan, Thierry Mazzoni, Placide Mbala, Lisa Mc Sweeney, Colin McArthur, Naina McCann, Peter McCanny, Aine McCarthy, Anne McCarthy, Colin McCloskey, Rachael McConnochie, Sherry McDermott, Sarah E. McDonald, Samuel McElwee, Natalie McEvoy, Allison McGeer, Kenneth A. 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Robertson, Olivier Robineau, Anna Roca, Ferran Roche-Campo, Paola Rodari, Simão Rodeia, Julia Rodriguez Abreu, Bernhard Roessler, Claire Roger, Amanda Rojek, Roberto Roncon-Albuquerque Jr, Mélanie Roriz, Manuel Rosa-Calatrava, Michael Rose, Dorothea Rosenberger, Andrea Rossanese, Matteo Rossetti, Sandra Rossi, Patrick Rossignol, Carine Roy, Benoît Roze, Desy Rusmawatiningtyas, Clark D. Russell, Maeve Ryan, Steffi Ryckaert, Aleksander Rygh Holten, Isabela Saba, Luca Sacchelli, Sairah Sadaf, Musharaf Sadat, Valla Sahraei, Abdurraouf Said, Moumen Said Ellawi, Pranya Sakiyalak, Fodé Bangaly Sako, Moamen Salah, Ali Alaa Salah Eldin Mohamed Abbas, Nawal Salahuddin, Leonardo Salazar, Jodat Saleem, Mohammed Saleh Alyasiri, Talat Ahmed Abu Salem, Gabriele Sales, Charlotte Salmon Gandonniere, Hélène Salvator, Shaden Samardali, Dana Samardali, Yehia Samir Shaaban Aly Orabi, Olivier Sanchez, Emely Sanchez, Xavier Sánchez Choez, Kizy Sanchez de Oliveira, Angel Sanchez-Miralles, Zulfiqar Sandhu, Gyan Sandhu, Pierre-François Sandrine, Oana Săndulescu, Marlene Santos, Shirley Sarfo-Mensah, Bruno Sarmento Banheiro, Benjamine Sarton, Ankana Satya, Sree Satyapriya, Rumaisah Satyawati, Parthena Savvidou, Yen Tsen Saw, Islam Sayed, Justin Schaffer, Tjard Schermer, Arnaud Scherpereel, Marion Schneider, János Schnur, Michael Schwameis, Gary Schwartz, Janet T. Scott, Nicholas Sedillot, Tamara Seitz, Jaganathan Selvanayagam, Mageswari Selvarajoo, Malcolm G. Semple, Rasidah Bt Senian, Eric Senneville, Claudia Sepulveda, Tânia Sequeira, Filipa Sequeira, Ary Serpa Neto, Pablo Serrano Balazote, Ellen Shadowitz, Syamin Asyraf Shahidan, Hamza Shahla, Laila Shalabi, Haitam Shames, Anuraj Shankar, Shaikh Sharjeel, Pratima Sharma, Catherine A. Shaw, Victoria Shaw, Wejdan Ahmed Shawlan, Ahmed Shazly, John Robert Sheenan, Dr. Rajesh Mohan Shetty, Rohan Shetty, Nisreen Shiban, Mohiuddin Shiekh, Takuya Shiga, Nobuaki Shime, Naoki Shimizu, Hiroaki Shimizu, Keiki Shimizu, Sally Shrapnel, Shubha Kalyan Shrestha, Pramesh Sundar Shrestha, Hoi Ping Shum, Nassima Si Mohammed, Ng Yong Siang, Moses Siaw-Frimpong, Jeanne Sibiude, Bountoy Sibounheuang, Nidhal Siddig, Atif Siddiqui, Maqsood Ahmed Siddiqui, Louise Sigfrid, Fatoumata Sillah, Piret Sillaots, Catarina Silva, Maria Joao Silva, Rogério Silva, Benedict Sim Lim Heng, Wai Ching Sin, Dario Sinatti, Girish Sindhwani, Punam Singh, Mahendra Singh, Pompini Agustina Sitompul, Karisha Sivam, Vegard Skogen, Sue Smith, Benjamin Smood, Coilin Smyth, Dominic So, Tze Vee Soh, Lene Bergendal Solberg, Tom Solomon, Joshua Solomon, Emily Somers, Agnès Sommet, Tae Song, Rima Song, Myung Jin Song, Jack Song Chia, Arne Søraas, Albert Sotto, Edouard Soum, Marta Sousa, Ana Chora Sousa, Maria Sousa Uva, Vicente Souza-Dantas, Mamadou Saliou Sow, Alexandra Sperry, Elisabetta Spinuzza, Ekaterina Spiridonova, B. 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Figure 1. Data collection flow.

Figure 2. Map of data sources and volumes.

Figure 3. Heatmap of the ISARIC-WHO COVID-19 Case Report Form field group inclusion in institutional datasets. The inclusion proportion of each field group is visualised for 42 institutional datasets. Darker colours indicate a lower inclusion proportion.

Figure 4. Utilisation distance of data fields in the ISARIC-WHO COVID-19 Case Report From for all (N = 950,064) and severe (N = 256,529) patient data. Utilisation distance comprises the mean completion rate (x-axis) and inclusion rate (y-axis) among institutions. Colours are assigned to dots and backgrounds as visual cues, marking utilisation distances lower than 30 as dark green, those from 30 to 70 as yellow, and those greater than 70 as red. Colours in the severe patient plots are varied to indicate a decrease across this threshold from all patients to severe patients: light green for fields with utilisation distances that decreased to below 30 in severe patients and orange for fields with utilisation distances that decreased to below 70 in severe patients. Field labels are listed from the lowest to the highest utilisation distance within each collection time: (A) admission (left), (D) daily (centre), and (S) summary and (O) outcome (right). Next to each field name, the left circle applies to ‘All patients’, and the right circle applies to ‘Severe patients’.

Table 1. Site and patient distribution across 42 institutional datasets included in the ISARIC COVID-19 Data Platform.

	Hospitals	Countries	All Patients	Severe Patients *	Data Collection Start Date	Months of Data Collection
Total	1886	82	950,064	256,529		725.7
Range	1–627	1–44	30–494,547	0–122,754	24/01/2020–17/03/2021	1.0–38.0
Median	1	1	1014.5	107	17/02/2020	16.8
IQR	1.0–28.0	1.0–1.0	182.8–4485.5	22.5–1147.8		7.6–28.1

* Severe patients are a subset of ‘All patients’.

Table 2. Utilisation distance of data field groups in all and severe patient cohorts.

Collection Time	Field Group	All Patient Data			Severe Patient Data			Difference
Collection Time	Field Group	Utilisation Distance Mean (SD)	Completion % Mean (SD)	Inclusion % Mean (SD)	Utilisation Distance Mean (SD)	Completion % Mean (SD)	Inclusion % Mean (SD)	Utilisation Distance Delta (SD)
Outcome	Outcome status	8.0 (3.3)	89.8 (3.5)	95.2 (3.4)	3.7 (2.4)	95.7 (2.1)	97.5 (3.5)	4.3 (0.8)
Admission	Demographics	16.3 (14.0)	91.6 (8.2)	79.1 (18.7)	16.3 (14.0)	91.6 (8.2)	79.1 (18.7)	0.0 (0.0)
Admission	Comorbidities	22.9 (13.8)	79.0 (16.1)	77.9 (15.8)	22.9 (13.7)	83.2 (15.8)	74.1 (15.1)	0.0 (0.1)
Admission	Signs and symptoms	27.2 (14.4)	78.4 (10.7)	68.9 (18.6)	27.1 (13.3)	82.3 (7.5)	66.7 (18.6)	0.0 (1.1)
Admission	Vital signs	30.6 (10.8)	69.1 (13.5)	70.3 (9.3)	28.5 (11.4)	75.0 (14.5)	69.0 (10.0)	2.0 (−0.7)
Summary	Complications	41.8 (12.5)	65.5 (12.9)	52.8 (14.9)	37.5 (13.4)	78.1 (14.6)	52.4 (14.9)	4.3 (−0.9)
Admission	Pre-admission medication	47.3 (3.8)	70.5 (12.2)	40.5 (0.0)	46.5 (0.6)	79.8 (12.7)	38.1 (3.4)	0.8 (3.3)
Daily	Vitals and assessments	51.6 (12.3)	64.5 (23.0)	39.6 (13.9)	47.5 (11.3)	76.3 (18.3)	39.2 (14.2)	4.0 (1.0)
Summary	Diagnostics	52.8 (25.0)	54.0 (24.8)	42.3 (28.2)	52.0 (24.1)	59.1 (24.9)	40.1 (26.4)	0.8 (0.9)
Daily	Interventions	53.1 (14.3)	59.1 (24.5)	39.0 (9.2)	45.3 (8.0)	82.5 (11.4)	39.1 (9.7)	7.8 (6.4)
Summary	Interventions	55.0 (21.5)	61.2 (28.2)	35.5 (23.1)	52.5 (21.6)	67.6 (26.9)	35.8 (23.9)	2.5 (−0.2)
Admission	Lab tests	56.5 (12.0)	37.0 (15.1)	51.1 (9.8)	52.7 (12.6)	44.9 (16.9)	50.4 (9.4)	3.8 (−0.6)
Daily	Lab tests	58.4 (9.1)	39.3 (12.2)	44.3 (7.4)	52.1 (9.7)	52.6 (13.9)	44.1 (7.3)	6.3 (−0.6)
Outcome	Outcome health	78.8 (38.6)	19.9 (37.2)	22.6 (40.5)	78.3 (39.2)	20.5 (37.6)	23.1 (41.2)	0.5 (−0.6)
All	All	43.9 (21.0)	61.6 (24.3)	53.3 (22.4)	41.0 (19.9)	70.2 (22.7)	52.4 (22.0)	3.0 (1.2)

The mean proportion of datasets that included the field and completed the field is expressed in %. The mean utilisation distance expresses the mean distance from 100% inclusion and 100% completion of all fields in a given group. Delta is the mean field group utilisation distance in all patients minus the mean field group utilisation distance in severe patients.

Table 3. Examples of utilisation distance of individual fields in all and severe patient cohorts.

Collection Time	Field Group	Field	Utilisation Distance, All Patients (x, y)	Utilisation Distance, Severe Patients (x, y)	Delta
Admission	Demographics	Sex	1.7 (99.9, 97.6)	1.7 (99.9, 97.6)	0
Daily	Vitals and assessments	O₂ saturation	42.3 (71.2, 47.6)	38.7 (84.1, 47.6)	3.6
Outcome	Outcome status	Outcome	5.7 (92.3, 97.6)	2.0 (97.2, 100)	3.7
Admission	Lab tests	INR	58.5 (30.8, 54.8)	54.6 (39.2, 52.4)	3.8
Summary	Complications	Bacteraemia	32.4 (71.4, 64.3)	27.3 (85.3, 64.3)	5.0
Daily	Lab tests	Troponin	73.4 (18.4, 35.7)	67.8 (28.8, 35.7)	5.6
Summary	Complications	ARDS	30.3 (68.0, 71.4)	24.0 (81.6, 71.4)	6.3
Daily	Lab tests	ALT	52.1 (45.9, 50.0)	45.8 (58.8, 50.0)	6.3
Daily	Vitals and assessments	Glasgow coma score	51.9 (48.5, 47.6)	45.2 (63.5, 47.6)	6.8
Daily	Lab tests	PT	70.7 (21.4, 38.1)	63.3 (35.4, 38.1)	7.5
Daily	Lab tests	Lactate	63.7 (28.5, 45.2)	55.0 (44.8, 45.2)	8.7
Daily	Vitals and assessments	PaO₂ sample type	64.9 (34.4, 35.7)	56.0 (53.6, 35.7)	8.9
Summary	Interventions	High-flow nasal cannula duration	81.1 (26.6, 11.9)	71.5 (50.3, 11.9)	9.5
Summary	Interventions	Non-invasive vent duration	74.3 (10.3, 45.2)	63.7 (28.5, 45.2)	10.6
Daily	Interventions	Dopamine	64.9 (34.5, 35.7)	45.5 (97.1, 35.7)	19.4
Daily	Interventions	ECLS/ECMO type	90.9 (2.1, 16.7)	60.9 (78.2, 16.7)	30.0

Fields listed are a random sample. Delta is the utilisation distance in all patients minus the utilisation distance in severe patients. Utilisation distance is a function of the mean field completion (x) and field inclusion (y). Utilisation colour groups in severe patients: light green indicates fields with utilisation distances that decreased to below 30 in severe patients; orange indicates fields with utilisation distances that decreased to below 70 in severe patients; dark green indicates fields with utilisation distances lower than 30 in all patients and severe patients; yellow indicates those from 30 to 70; and red indicates those greater than 70.

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