Taken together, our findings suggest that an unusually high number of Google searches for pneumonia was recorded in the US before the COVID-19 outbreak, displaying a paradigmatic peak in the week between 16–22 December 2020. Although this abnormal increase cannot be directly attributed to searches carried out by individuals with SARS-CoV-2 infection, this phenomenon is supportive of the findings by Basavaraju et al., in that SARS-CoV-2 may have started to circulate in the US before January 2020. It is also interesting to note that a similar finding was recently reported by Lippi et al., who found an unexpected increase in Google searches for COVID-19 symptoms in Italy’s pre-pandemic period.
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