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45 changes: 43 additions & 2 deletions docs/api/covidcast-signals/chng.md
Original file line number Diff line number Diff line change
Expand Up @@ -26,6 +26,8 @@ commercial purposes.
| --- | --- |
| `smoothed_outpatient_covid` | Estimated percentage of outpatient doctor visits with confirmed COVID-19, based on Change Healthcare claims data that has been de-identified in accordance with HIPAA privacy regulations, smoothed in time using a Gaussian linear smoother |
| `smoothed_adj_outpatient_covid` | Same, but with systematic day-of-week effects removed; see [details below](#day-of-week-adjustment) |
| `smoothed_outpatient_cli` | Estimated percentage of outpatient doctor visits primarily about COVID-related symptoms, based on Change Healthcare claims data that has been de-identified in accordance with HIPAA privacy regulations, smoothed in time using a Gaussian linear smoother |
| `smoothed_adj_outpatient_cli` | Same, but with systematic day-of-week effects removed; see [details below](#day-of-week-adjustment) |

## Table of contents
{: .no_toc .text-delta}
Expand Down Expand Up @@ -64,15 +66,36 @@ not necessarily indicative of a true increase of COVID-19 in a location.

## Qualifying Conditions

We receive data on the following two categories of counts:
We receive data on the following six categories of counts:

- Denominator: Daily count of all unique outpatient visits.
- Covid: Daily count of all unique visits with primary ICD-10 code in any of:
{U07.1, B97.21, or B97.29}.
- COVID-like: Daily count of all unique outpatient visits with primary ICD-10 code
of any of: {U07.1, U07.2, B97.29, J12.81, Z03.818, B34.2, J12.89}.
- Flu-like: Daily count of all unique outpatient visits with primary ICD-10 code
of any of: {J22, B34.9}. The occurrence of these codes in an area is
correlated with that area's historical influenza activity, but are
diagnostic codes not specific to influenza and can appear in COVID-19 cases.
- Mixed: Daily count of all unique outpatient visits with primary ICD-10 code of
any of: {Z20.828, J12.9}. The occurance of these codes in an area is
correlated to a blend of that area's COVID-19 confirmed case counts and
influenza behavior, and are not diagnostic codes specific to either disease.
- Flu: Daily count of all unique outpatient visits with primary ICD-10 code of
any of: {J09\*, J10\*, J11\*}. The asterisk `*` indicates inclusion of all
subcodes. This set of codes are assigned to influenza viruses.

For the COVID signal, we consider only the *Denominator* and *Covid* counts.

For the CLI signal, if a patient has multiple visits on the same date (and hence
multiple primary ICD-10 codes), then we will only count one of and in descending
order: *Flu*, *COVID-like*, *Flu-like*, *Mixed*. This ordering tries to account for
the most definitive confirmation, e.g. the codes assigned to *Flu* are only used
for confirmed influenza cases, which are unrelated to the COVID-19 coronavirus.

## Estimation

### COVID-Like Illness
### COVID Illness

For a fixed location $$i$$ and time $$t$$, let $$Y_{it}$$
denote the Covid counts and let $$N_{it}$$ be the
Expand All @@ -83,6 +106,20 @@ $$
\hat p_{it} = 100 \cdot \frac{Y_{it}}{N_{it}}
$$

### COVID-Like Illness

For a fixed location $$i$$ and time $$t$$, let $$Y_{it}^{\text{Covid-like}}$$,
$$Y_{it}^{\text{Flu-like}}$$, $$Y_{it}^{\text{Mixed}}$$, $$Y_{it}^{\text{Flu}}$$
denote the correspondingly named ICD-filtered counts and let $$N_{it}$$ be the
total count of visits (the *Denominator*). Our estimate of the CLI percentage is
given by

$$
\hat p_{it} = 100 \cdot \frac{Y_{it}^{\text{Covid-like}} +
\left((Y_{it}^{\text{Flu-like}} + Y_{it}^{\text{Mixed}}) -
Y_{it}^{\text{Flu}}\right)}{N_{it}}
$$

### Day-of-Week Adjustment

The fraction of visits due to COVID-19 is dependent on the day of the week. On
Expand Down Expand Up @@ -131,6 +168,10 @@ $$\dot{Y}_{it} = Y_{it} / \alpha_{wd(t)}.$$
We then use these adjusted counts to estimate the COVID-19 percentage as described
above.

For the CLI indicator, we apply the same method to the numerator $$Y_{it} =
Y_{it}^{\text{Covid-like}} + \left((Y_{it}^{\text{Flu-like}} +
Y_{it}^{\text{Mixed}}) - Y_{it}^{\text{Flu}}\right).$$

### Backwards Padding

To help with the reporting delay, we perform the following simple
Expand Down