Methods We conducted a novel, city-wide home-based cross-sectional study in the Seattle Metropolitan area, utilizing rapid delivery systems for self-collection of a nasal swab and return to the laboratory for respiratory pathogen testing. All participation took place electronically, including recruitment, consent, and data collection. Within 24 hours of participants self-reporting respiratory symptoms, a nasal swab kit was delivered via a courier service. Demographic and illness characteristics were reported at the time of sample collection; one week later, recovery and behavioral information were collected.

Results From October 11, 2019 to January 25, 2020, 1,440 individuals enrolled and received a swab kit; 1,176 (85%) completed the illness questionnaire and returned their nasal swab, and 1,092 (93%) completed the follow-up survey. Among the 1,176 participants, 24% tested positive for influenza, and 41% tested positive for any respiratory pathogen. 746 of 1,092 participants (68%, p<0.0001) had not sought clinical care at follow-up. After adjusting for redeliveries, the average delivery time to Seattle participants was 2.5 hours (N=1,124), with 69% of those meeting the 2-hour delivery target.

Conclusion The majority of participants completed all study procedures, and a high proportion tested positive for a respiratory pathogen. A significant proportion of participants were non-healthcare-seeking, representing the subset not captured by traditional surveillance networks. In epidemic settings, home-based surveillance is a feasible and important method for community-level respiratory pathogen monitoring.