LOCAL EPIDEMIC INFORMATION

Thank you very much for your willingness to participate in this survey. Your information is a valuable source to develop our predictive model of the Global Early Warning System on Covid-19.

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* 1. Do you agree to participate in this survey?

Yes

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* 2. What is your address?

Address

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

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* 3. What is your age category?

Under 15

From 15 to under 25

From 25 to under 35

From 35 to under 45

From 45 to under 55

From 55 to under 65

From 65

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* 4. What is your gender?

Male

Female

Other

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* 5. What is your highest educational attainment?

High school completion or under

Associate and/or bachelor's degree

Master’s or higher degree

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* 6. How many people are you living with?

Other (please specify)

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* 7. How many people did you meet yesterday? (Except those you are living with)

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* 8. Please check the option that mostly describes your situation

	Not at all	Rare	Sometimes	Frequently	Very frequent/Always
1. To what extent, are you experiencing respiratory illness such as dry cough, shortness of breath, high fever?	1. To what extent, are you experiencing respiratory illness such as dry cough, shortness of breath, high fever? Not at all	1. To what extent, are you experiencing respiratory illness such as dry cough, shortness of breath, high fever? Rare	1. To what extent, are you experiencing respiratory illness such as dry cough, shortness of breath, high fever? Sometimes	1. To what extent, are you experiencing respiratory illness such as dry cough, shortness of breath, high fever? Frequently	1. To what extent, are you experiencing respiratory illness such as dry cough, shortness of breath, high fever? Very frequent/Always
2. How often do your family members have symptoms of respiratory disease?	2. How often do your family members have symptoms of respiratory disease? Not at all	2. How often do your family members have symptoms of respiratory disease? Rare	2. How often do your family members have symptoms of respiratory disease? Sometimes	2. How often do your family members have symptoms of respiratory disease? Frequently	2. How often do your family members have symptoms of respiratory disease? Very frequent/Always
3. How often do you see any neighbors or people living nearby who have respiratory symptoms?	3. How often do you see any neighbors or people living nearby who have respiratory symptoms? Not at all	3. How often do you see any neighbors or people living nearby who have respiratory symptoms? Rare	3. How often do you see any neighbors or people living nearby who have respiratory symptoms? Sometimes	3. How often do you see any neighbors or people living nearby who have respiratory symptoms? Frequently	3. How often do you see any neighbors or people living nearby who have respiratory symptoms? Very frequent/Always
4. How often do you know people living around you (or yourself) come back or meet people from China or South Korea last 7 days?	4. How often do you know people living around you (or yourself) come back or meet people from China or South Korea last 7 days? Not at all	4. How often do you know people living around you (or yourself) come back or meet people from China or South Korea last 7 days? Rare	4. How often do you know people living around you (or yourself) come back or meet people from China or South Korea last 7 days? Sometimes	4. How often do you know people living around you (or yourself) come back or meet people from China or South Korea last 7 days? Frequently	4. How often do you know people living around you (or yourself) come back or meet people from China or South Korea last 7 days? Very frequent/Always
5. How often do you know people living around you, (or yourself) come back or meet people from Singapore, Japan, Thailand, Taiwan, Hong Kong, Iran, Italy, Australia, or the United States last 7 days?	5. How often do you know people living around you, (or yourself) come back or meet people from Singapore, Japan, Thailand, Taiwan, Hong Kong, Iran, Italy, Australia, or the United States last 7 days? Not at all	5. How often do you know people living around you, (or yourself) come back or meet people from Singapore, Japan, Thailand, Taiwan, Hong Kong, Iran, Italy, Australia, or the United States last 7 days? Rare	5. How often do you know people living around you, (or yourself) come back or meet people from Singapore, Japan, Thailand, Taiwan, Hong Kong, Iran, Italy, Australia, or the United States last 7 days? Sometimes	5. How often do you know people living around you, (or yourself) come back or meet people from Singapore, Japan, Thailand, Taiwan, Hong Kong, Iran, Italy, Australia, or the United States last 7 days? Frequently	5. How often do you know people living around you, (or yourself) come back or meet people from Singapore, Japan, Thailand, Taiwan, Hong Kong, Iran, Italy, Australia, or the United States last 7 days? Very frequent/Always
6. How often do people in your area take preventive measures? (e.g. wearing a mask when coughing, washing hands, cleaning the environment)	6. How often do people in your area take preventive measures? (e.g. wearing a mask when coughing, washing hands, cleaning the environment) Not at all	6. How often do people in your area take preventive measures? (e.g. wearing a mask when coughing, washing hands, cleaning the environment) Rare	6. How often do people in your area take preventive measures? (e.g. wearing a mask when coughing, washing hands, cleaning the environment) Sometimes	6. How often do people in your area take preventive measures? (e.g. wearing a mask when coughing, washing hands, cleaning the environment) Frequently	6. How often do people in your area take preventive measures? (e.g. wearing a mask when coughing, washing hands, cleaning the environment) Very frequent/Always
7. In your opinion, to what extent do people in your area voluntarily report their suspected Covid-19 symptoms?	7. In your opinion, to what extent do people in your area voluntarily report their suspected Covid-19 symptoms? Not at all	7. In your opinion, to what extent do people in your area voluntarily report their suspected Covid-19 symptoms? Rare	7. In your opinion, to what extent do people in your area voluntarily report their suspected Covid-19 symptoms? Sometimes	7. In your opinion, to what extent do people in your area voluntarily report their suspected Covid-19 symptoms? Frequently	7. In your opinion, to what extent do people in your area voluntarily report their suspected Covid-19 symptoms? Very frequent/Always
8. At what level do your local officials carry out Covid-19 inspections and epidemic prevention?	8. At what level do your local officials carry out Covid-19 inspections and epidemic prevention? Not at all	8. At what level do your local officials carry out Covid-19 inspections and epidemic prevention? Rare	8. At what level do your local officials carry out Covid-19 inspections and epidemic prevention? Sometimes	8. At what level do your local officials carry out Covid-19 inspections and epidemic prevention? Frequently	8. At what level do your local officials carry out Covid-19 inspections and epidemic prevention? Very frequent/Always
9. How often do you meet people from other regions of the country or foreigners coming to your neighborhood?	9. How often do you meet people from other regions of the country or foreigners coming to your neighborhood? Not at all	9. How often do you meet people from other regions of the country or foreigners coming to your neighborhood? Rare	9. How often do you meet people from other regions of the country or foreigners coming to your neighborhood? Sometimes	9. How often do you meet people from other regions of the country or foreigners coming to your neighborhood? Frequently	9. How often do you meet people from other regions of the country or foreigners coming to your neighborhood? Very frequent/Always
10. How often can you buy or receive disease prevention materials (e.g. masks) in your area?	10. How often can you buy or receive disease prevention materials (e.g. masks) in your area? Not at all	10. How often can you buy or receive disease prevention materials (e.g. masks) in your area? Rare	10. How often can you buy or receive disease prevention materials (e.g. masks) in your area? Sometimes	10. How often can you buy or receive disease prevention materials (e.g. masks) in your area? Frequently	10. How often can you buy or receive disease prevention materials (e.g. masks) in your area? Very frequent/Always
11. How often have you experienced any difficulty in daily life since the first Covid-19 cases detected in your country?	11. How often have you experienced any difficulty in daily life since the first Covid-19 cases detected in your country? Not at all	11. How often have you experienced any difficulty in daily life since the first Covid-19 cases detected in your country? Rare	11. How often have you experienced any difficulty in daily life since the first Covid-19 cases detected in your country? Sometimes	11. How often have you experienced any difficulty in daily life since the first Covid-19 cases detected in your country? Frequently	11. How often have you experienced any difficulty in daily life since the first Covid-19 cases detected in your country? Very frequent/Always
12. How often have you perceived being at risk of being infected with Covid-19?	12. How often have you perceived being at risk of being infected with Covid-19? Not at all	12. How often have you perceived being at risk of being infected with Covid-19? Rare	12. How often have you perceived being at risk of being infected with Covid-19? Sometimes	12. How often have you perceived being at risk of being infected with Covid-19? Frequently	12. How often have you perceived being at risk of being infected with Covid-19? Very frequent/Always
13. How often have you had trouble sleeping in the last 7 days?	13. How often have you had trouble sleeping in the last 7 days? Not at all	13. How often have you had trouble sleeping in the last 7 days? Rare	13. How often have you had trouble sleeping in the last 7 days? Sometimes	13. How often have you had trouble sleeping in the last 7 days? Frequently	13. How often have you had trouble sleeping in the last 7 days? Very frequent/Always
14. How often have you felt restless or had difficulties concentrating in the last 7 days?	14. How often have you felt restless or had difficulties concentrating in the last 7 days? Not at all	14. How often have you felt restless or had difficulties concentrating in the last 7 days? Rare	14. How often have you felt restless or had difficulties concentrating in the last 7 days? Sometimes	14. How often have you felt restless or had difficulties concentrating in the last 7 days? Frequently	14. How often have you felt restless or had difficulties concentrating in the last 7 days? Very frequent/Always

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* 9. Have you experienced any of the following difficulties? (Please check all that apply)

Difficulty in accessing information to Covid-19

Difficulty in health check-ups and care in relation to Covid-19

Difficulty in accessing counseling and psychological supports for any concern related to Covid-19

You or any family member been prevented from getting medical care due to Covid-19

None of above

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* 10. Please check the option that best describes your health today.

	Not at all	Slight	Moderate	Severe	Unable/Extreme
1. To what extent do you have any problems with mobility (e.g. walking)	1. To what extent do you have any problems with mobility (e.g. walking) Not at all	1. To what extent do you have any problems with mobility (e.g. walking) Slight	1. To what extent do you have any problems with mobility (e.g. walking) Moderate	1. To what extent do you have any problems with mobility (e.g. walking) Severe	1. To what extent do you have any problems with mobility (e.g. walking) Unable/Extreme
2. To what extent, do you have any problems with self-care (e.g. dressing, taking shower…)	2. To what extent, do you have any problems with self-care (e.g. dressing, taking shower…) Not at all	2. To what extent, do you have any problems with self-care (e.g. dressing, taking shower…) Slight	2. To what extent, do you have any problems with self-care (e.g. dressing, taking shower…) Moderate	2. To what extent, do you have any problems with self-care (e.g. dressing, taking shower…) Severe	2. To what extent, do you have any problems with self-care (e.g. dressing, taking shower…) Unable/Extreme
3. To what extent do you have any problems with usual activities (e.g. work, reading, writing, housework)?	3. To what extent do you have any problems with usual activities (e.g. work, reading, writing, housework)? Not at all	3. To what extent do you have any problems with usual activities (e.g. work, reading, writing, housework)? Slight	3. To what extent do you have any problems with usual activities (e.g. work, reading, writing, housework)? Moderate	3. To what extent do you have any problems with usual activities (e.g. work, reading, writing, housework)? Severe	3. To what extent do you have any problems with usual activities (e.g. work, reading, writing, housework)? Unable/Extreme
4. To what extent do you have pain or discomfort?	4. To what extent do you have pain or discomfort? Not at all	4. To what extent do you have pain or discomfort? Slight	4. To what extent do you have pain or discomfort? Moderate	4. To what extent do you have pain or discomfort? Severe	4. To what extent do you have pain or discomfort? Unable/Extreme
5. To what extent do you have anxiety or depression	5. To what extent do you have anxiety or depression Not at all	5. To what extent do you have anxiety or depression Slight	5. To what extent do you have anxiety or depression Moderate	5. To what extent do you have anxiety or depression Severe	5. To what extent do you have anxiety or depression Unable/Extreme

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* 11. If 100 means the best health you can imagine and 0 means the worst health you can imagine. Please self-report your health today. (Please move the scroll bar to score or write the number in the blank box on the right side)

Move the scroll bar to score

100

Clear

i We adjusted the number you entered based on the slider’s scale.

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* 12. To what extent, do you think these following precautionary measures are needed in your place of residence?

	Not necessary	Slightly necessary	Moderately necessary	Necessary	Extremely necessary
1. Kindergarten, Primary, Secondary and High school closures	1. Kindergarten, Primary, Secondary and High school closures Not necessary	1. Kindergarten, Primary, Secondary and High school closures Slightly necessary	1. Kindergarten, Primary, Secondary and High school closures Moderately necessary	1. Kindergarten, Primary, Secondary and High school closures Necessary	1. Kindergarten, Primary, Secondary and High school closures Extremely necessary
2. College and University closures	2. College and University closures Not necessary	2. College and University closures Slightly necessary	2. College and University closures Moderately necessary	2. College and University closures Necessary	2. College and University closures Extremely necessary
3. Forbidding crowding together (such as holding events or festivals)	3. Forbidding crowding together (such as holding events or festivals) Not necessary	3. Forbidding crowding together (such as holding events or festivals) Slightly necessary	3. Forbidding crowding together (such as holding events or festivals) Moderately necessary	3. Forbidding crowding together (such as holding events or festivals) Necessary	3. Forbidding crowding together (such as holding events or festivals) Extremely necessary
4. Temperature checks in all public places	4. Temperature checks in all public places Not necessary	4. Temperature checks in all public places Slightly necessary	4. Temperature checks in all public places Moderately necessary	4. Temperature checks in all public places Necessary	4. Temperature checks in all public places Extremely necessary
5. Check your own temperature cat home, then report the result to a nearby health care officer	5. Check your own temperature cat home, then report the result to a nearby health care officer Not necessary	5. Check your own temperature cat home, then report the result to a nearby health care officer Slightly necessary	5. Check your own temperature cat home, then report the result to a nearby health care officer Moderately necessary	5. Check your own temperature cat home, then report the result to a nearby health care officer Necessary	5. Check your own temperature cat home, then report the result to a nearby health care officer Extremely necessary
6. Strictly control of temporary residence registration and trace people coming back from Covid-19 hot spots	6. Strictly control of temporary residence registration and trace people coming back from Covid-19 hot spots Not necessary	6. Strictly control of temporary residence registration and trace people coming back from Covid-19 hot spots Slightly necessary	6. Strictly control of temporary residence registration and trace people coming back from Covid-19 hot spots Moderately necessary	6. Strictly control of temporary residence registration and trace people coming back from Covid-19 hot spots Necessary	6. Strictly control of temporary residence registration and trace people coming back from Covid-19 hot spots Extremely necessary
7. Encourage people with symptoms related to Covid-19 to self-quarantine at home	7. Encourage people with symptoms related to Covid-19 to self-quarantine at home Not necessary	7. Encourage people with symptoms related to Covid-19 to self-quarantine at home Slightly necessary	7. Encourage people with symptoms related to Covid-19 to self-quarantine at home Moderately necessary	7. Encourage people with symptoms related to Covid-19 to self-quarantine at home Necessary	7. Encourage people with symptoms related to Covid-19 to self-quarantine at home Extremely necessary

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* 13. Are you willing to support the Global Early Warning System on Covid-19? (Please check all that apply)

Sharing related information and experiences

Support means, tools or other necessary materials

Giving financial support for research and training health care professionals

Other (Please specify)

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* 14. How have your monthly household earnings been affected by COVID-19?

Increased

Declined

Unchanged

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* 15. Please estimate the changes in your monthly household earnings.

Unchanged (0%)

Under 10%

From 10% to under 20%

From 20% to under 30%

From 30% to under 40%

From 40% to under 50%

From 50% to under 60%

From 60% to under 70%

From 70% to under 80%

From 80% to under 90%

From 90% to 100%

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* 16. How have your monthly household spendings been affected by Covid-19?

Increased

Declined

Unchanged

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* 17. Please estimate changes in your monthly household spendings

Unchanged (0%)

Under 10%

From 10% to under 20%

From 20% to under 30%

From 30% to under 40%

From 40% to under 50%

From 50% to under 60%

From 60% to under 70%

From 70% to under 80%

From 80% to under 90%

From 90% to 100%

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* 18. How do you mainly obtain health information related to Covid-19? (Please check all that apply)

Social media

Internet

Television

Radio

Newspaper

Friends or family

Other (Please specify)

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* 19. To what extent do you trust the media to provide you with accurate information about the Covid-19? Please assign from 0 to 10 with 0 means not at all and 10 means completely trust

Not at all
0

So-so
5

Completely trust
10

Not at all
0

So-so
5

Completely trust
10