ARMS for Coronavirus

Acute Respiratory Mortality Surveillance (ARMS) for Coronavirus Infection (COVID-19)

SARS-CoV-2 virus particles show in purple.

(Image from Credit: NIAID-RML/de Wit/Fischer)

Background: The World Health Organization has expressed concern about how countries with inadequate death reporting would be able to detect and respond to the spread of COVID-19. Most deaths in large parts of Africa and South Asia still occur at home, without medical attention, and hence the diagnosis is unknown…

Rationale: Enhanced mortality surveillance is essential in many countries to be able to detect and respond to the spread of COVID-19 (and other infections). In the absence of routine medical certification of hospital deaths, we have developed and implemented at national levels, verbal autopsy-based methods, including the Indian Million Death Study. Our experienced team will build on these lessons and ongoing research in China, India, Sierra Leone, and Ethiopia.

Three specific research hypotheses:

  1. An “Acute Respiratory Mortality Surveillance” (ARMS) module can be added quickly to the WHO verbal autopsy instrument and “validated” using hospital-based severe cases and deaths. Combining dual physician coding with machine learning and local epidemiological data, ARMS will be able to distinguish COVID-19 from other causes of respiratory deaths.
  2. Early deployment of ARMS in China, Hong Kong, India, Sierra Leone and Ethiopia among a few hundred adult deaths will help establish the baseline distributions of acute respiratory deaths, against which the spread of COVID-19 (or indeed other pathogens) can be measured.
  3. Effective knowledge translation of an open source, widely available ARMS module will improve the global response to COVID-19, particularly in the lowest income countries lacking mortality statistics and laboratory diagnostic capabilities, and help to improve mortality assessments for possible subsequent COVID-19 waves in later 2020/2021.

Impact: We will carefully assemble and validate measurement of acute respiratory deaths through ARMS, a globally relevant technology. This will make a vital contribution to the global response to the COVID-19 outbreak by strengthening surveillance in many countries lacking complete medical certification of death. The mortality and epidemiological information, paired with widespread access to the ARMS tool, will enhance local and global collaboration to mitigate any possible unchecked spread of COVID-19.


Under ARMS, CGHR will collect and develop materials that will be available to the public. These materials can be accessed though our Google Drive Similarly, as CGHR develops programming code for ARMS, it will be available through our GitHub repository.