Covid-19 Survivor’s 5 minute Experience Survey

In addition to supporting the ongoing work currently being carried out by various bodies of science on Covid-19, this cross-sectional survey aims to analyse the various lifestyle, environment, genetic makeup, health conditions and experience of Covid-19 survivors to determine if there is some pattern or common traits shared by these persons which could have contributed to their ability to overcome the virus.


This survey is completely anonymous. We will only ask for a contact email address at the end if you are happy for us to contact you to understand a bit more about your experience.


Thank you for your time.

Mandatory questions underlined with red color need to be answered

Overall Experience

We want to understand a little more about your experience, this will enable us analyse the effect, other factors that may have contributed towards your recovery
Were you diagnosed of Covid-19, by a Government approved Health Institution?

Yes

No
Were you admitted in a hospital or a centre or did you self-isolate at home?

Self-Isolated

Hospital Admission

All of the above

Not Applicable
What symptoms did you experience during this period?

Fever

Cough

Shortness of breath or difficulty breathing

Chills

Muscle pain

Headache

Sore throat

New loss of taste or smell

Other
If other, please specify ...

On a scale of 1 to 10 (1 being least severe and 10 being most severe), how would you rate the severity of the symptoms you had?

1

2

3

4

5

6

7

8

9

10
How long were you in quarantine or isolation after testing positive (before recovery) ?

Less than 7 days

Less than 14 days

Less than 21 days

Less than 28 days

More than 1 month
Do you live alone?

Yes

No
If you answered No to the question above, was anyone else infected? (This question is key as we are noticing that within a household, only one person can contract the virus and other persons do not show any symptoms)

Yes

No

Don't Know
Do you think you know where you would have contracted this virus?

Workplace

Household

Commuting to work

Travelling

Don't Know

Other
If other, please specify ...

What medication or therapy do you consider to have contributed to your recovery?

Antibiotics

Hydroxychloroquine

Supplements

Other

Don't Know
If other, please specify ...

What would you describe as the most contributing factor to your survival or recovery

How would you describe your experience at the hospital or if you self-isolated, can you describe how your environment helped?

If you have shared your story on some other social media platforms, please provide a link to it ...

Medical History

We want to understand if there are patterns that exist across the population based on their health and medical history
What is your blood group?

A

B

AB

O

Don't Know
What is your Genotype?

AA

AS

AC

SS

SC

CC

Don't Know
Before you were diagnosed of Covid-19, did you have any pre-existing medical condition?

Yes

No

Prefer not to Say
If you had a pre-existing medical condition, what was it?

Would you consider yourself as one who observes a regular routine or keep a healthy lifestyle, such as exercise?

Yes

No

Prefer not to Say
Do you / have you ever smoked?

Yes

No

Prefer not to Say
Do you regularly take alcohol?

Yes

No

Prefer not to Say
Before you were diagnosed of Covid-19, have you been on a long term medication?

Yes

No

Recommendations

Are there some lessons learnt you wish to share with the public which you think could be beneficial?
Would you like us to contact you should we want to learn more about your experience?

Yes

No
If you want us to contact you, please provide your email in the box below

Are there any other lessons learnt you will like to share with users?

General Information

We want to understand the composition and charactertistcs of the population
How would you describe your occupation?

Please select your country

Please select your age group

Under 12 years

12-17 years

18-24 years

25-34 years

35-44 years

45-54 years

55-64 years

65-74 years

75 years or older
Please select your Ethnicity?

English / Welsh / Scottish / Northern Irish / British

Irish

Gypsy or Irish Traveller

Any other White background

White and Black Caribbean

White and Black African

White and Asian

Any other Mixed / Multiple ethnic background

Indian

Pakistani

Bangladeshi

Chinese

Any other Asian background

African

Caribbean

Any other Black / African / Caribbean background

Arab

Any other ethnic group
Please select your gender?

Male

Female

Prefer not to Say

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