Request edit access
Intra-family COVID-19 infection (or lack of it) survey
Aim of the study:
In the second wave (March 2021-till date), we hear many families where almost all members got affected. This contrasts with a standard definition of "Secondary Attack Rate" at home, which is roughly 30%. The objective is to see if data on the secondary attack rates in India can be gathered to reach meaningful conclusions and even differences relative to 1st wave can be characterized.

The survey is only about homes. Hostels, hospitals, workplaces or transit facilities should not be included.

This is a survey with the purely scientific goal to understand the vulnerabilities at home, and also to spread awareness on home quarantine, as well as to subsequently help plan better vaccine strategy. The survey is supposed to help provide awareness on how to be safe at home. The survey is NOT intended for politics and NOT intended for any misuse of private information.

Who should participate:
You should participate in this survey, only if YOUR family got affected or a family YOU know very well got affected. We do not want participants reporting 2nd hand stories they heard.

If you know TWO FAMILIES with 1 or more infections, we request your patience in filling two separate forms.

We feel that collecting data beyond the 1st question will add a lot of ambiguity to conclusions.

Survey Design:
The following survey is designed by Meher K Prakash, Jawaharlal Nehru Center for Advanced Scientific Research, Bangalore.

Privacy:
We ask for names and contact details for authenticity, and verifiability. No names, contact numbers will be shared to any one or be used by the person collecting it for any other purposes. All personal data will be maintained confidential. By removing contact details, and anonymzing the names with alphanumeric codes, the survey results will be made public.

For example, Prakash's friend who is 40 years old and lives in electronic city and phone number 1234567890 has got an infection and spread to 3 members in the family. This will be released in the format ABC123 from a city in Karnataka. (name, phone number, or address will be removed)

The statistical conclusions of the survey, however, will be made public.

Thanks very much for participating.

Sign in to Google to save your progress. Learn more
Your name (We need it for authenticity. It will not be made public or shared with anyone or used for any other purpose. Also mention the name of the contact if it is not about your family. Example: Prakash, reporting about XYZ) *
Your contact number. Without a valid phone number, the survey entry will be dropped (the number WILL NOT be made public, and WILL NOT be used for any other purpose. We may contact you if we have any further questions) *
Are you reporting about your family or your friend/relative's family *
Are you reporting about the 1st wave or 2nd wave *
Required
Size of the city of the affected family *
State of the affected family *
Size of the household (number of members living together) *
Approximate ages of all members in the family (should match the number of members above) Example: 53, 40, 33, 20 *
Approximate size of the house (to see if isolation is possible) *
Education level in the family (Families which had at least one person who was educated to Bachelors level or more; and families where the highest eduction is below Bachelor's level *
Age of the 1st person who tested positive or you believe had symptoms (example: 56) *
Was a home isolation possible? *
Number of people who got infected in the family within 2-3 weeks of the 1st infection. These persons either tested positive or had COVID-19-like symptoms. For example, if father brought infection home, and mother, child got infected, count it as 2 additional infections at home. Do not count the father who was the first infected. *
Ages of others who got infected in the family (example: 35, 55, 62) *
Was the primary contact likely to be a maid or driver or any househelp *
Was anyone among the infected vaccinated ? *
Unfortunately, was there a COVID-19 death or hospitalization in the family? Age of this person(s) *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. - Terms of Service - Privacy Policy

Does this form look suspicious? Report

Google Forms