Coronavirus Survivors Questionnaire
Please help everyone stay safe by sharing your stories of "How I Got Covid19". If you are a Coronavirus-19 survivor, you have the ANSWERS of how you got infected! an easy way to help our world with this battle, is to fill out the form now and let's save lives!
Note: The information in this study will be used only for research purposes and in ways that will not reveal who you are. We will sort the data to determine the highest risks. You will not be identified in any publication from this study. We and the World thank you for Sharing Your Lessons and Saving So Many Lives
Are you answering? You can do this survey anomalously if you don't want to disclose your name :)
Do you know how you/they got infected?
Yes - 100%
How did you get infected? Remember this survey is anonymous
Congested commute: flight, train, long bus trip
Large gathering: meetings, church, movies etc
Personal contact: social visits
Hospital: short-term or long-term stay
Touching an object: door handles, food, boxes, etc. (same like)
If congested commute, was it a
Short exposure like less than 5mins
Medium exposure 1-3 hours
Long exposure more than 3 hours
An airplane/train/ long bus trip /cruise ship
Taxi/short bus trip
Conference/church meeting/ stadium event
Shopping Mall/ school/ univeristy
If personal contact, was it because of?
a shared accommodation eg: spouse/ roommate
a one-time event like dinner for 2 or 3
a hug for a less than 10 seconds
a hug for a more than 10 seconds
from a taxi driver that handed you your bags?
the taxi did not have divider separating you?
the taxi drive handed your money?
someone coughed on me
a direct kiss
Doctors visit/check-up/day care
less than one week in hospital prior to infection
long term stay - Nursing Homes
Touching an object, door handle, food, boxes, etc. (same like)
Coffee or food drive-through
Groceries, postal-parcel/pizza delivery
Door handles/ handrail/ elevators buttons
Money or credit card
(Multiple Answers are ok) were you using any of these precautions when you got infected?
A face mask
Alcohol bases sanitizers to wash hands/surfaces
Using a face mask, what type?
Heavy duty respirator
Using alcohol bases sanitizers to wash hands/surfaces . What percentage?
70% Isopropyl or Ethyl
Below 70% Isopropyl or Ethyl Alcohol
Did you practise social distancing and hand washing. (Multiple Answers are ok)
less than 1 meter/3ft
more than 1 meter/3ft
washed hands 3X's a day
washed hands 20X's a day
Did you have any of the following symptoms? (Multiple Answers are ok)
Fever; high grade
Fever; low grade
Shortness of breath
Persistent pain or pressure in the chest
Unexplained loss of taste or smell
Bluish lips or face
Did you have any pre-existing medical conditions?
Did you have a hard time getting tested in a timely matter?
I was tested immediatley
I had to go back to my doctor or clinic a 2nd time
It was almost impossible to get tested
I never did get tested, my diagnosis was based on symptoms only.
How long were you symptomactic before your diagnosis?
Did you travel from December to present?
No travel history
How do you think you caught your infection?
Immediate Family (spouse and children)
Extended Family (grandparents, uncle, aunties, nephews and nieces)
Friends and other colleagues
Community: shopping, passenger sitting beside you etc
If community, please explain more details,
Did you have a mild or extreme case of Covid-19?
If you have recovered, how do you feel now?
Back to full health
Mild lung congestion (scarring)
Regular or tolerable pain
What advice do you have to prevent an infection?
What is your message to all the front-liners like Doctors and Nurses?
What country are you in?
Country NOT on List
United States - NY
United States - CA
United States - WA
Another Country not on the list above:
What is your age range?
16 - 30
31 - 50
51 - 70
What is your gender?
Thanks so much for all these great clues so we can all learn and be safer. You probably have saved lives :)
Yes, you give us permission to contct you for a follow-up or to offer you some support!
No, you want to stay anonymous ... np, we do really thank you for your help!
Name (Optional) Yes, you can do this survey anonymously, but we sure would appreciate your name in which we kept private
Email (Optional) but boy we love to ask you more questions or even an interview if you have critical information.
email@example.com your contact information will NEVER be shared with anyone and we will only message you if we have critical questions?
Should be Empty:
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