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We propose `Tapestry, a novel approach to pooled testing with application to COVID-19 testing with quantitative Reverse Transcription Polymerase Chain Reaction (RT-PCR) that can result in shorter testing time and conservation of reagents and testing kits. Tapestry combines ideas from compressed sensing and combinatorial group testing with a novel noise model for RT-PCR used for generation of synthetic data. Unlike Boolean group testing algorithms, the input is a quantitative readout from each test and the output is a list of viral loads for each sample relative to the pool with the highest viral load. While other pooling techniques require a second confirmatory assay, Tapestry obtains individual sample-level results in a single round of testing, at clinically acceptable false positive or false negative rates. We also propose designs for pooling matrices that facilitate good prediction of the infected samples while remaining practically viable. When testing $n$ samples out of which $k ll n$ are infected, our method needs only $O(k log n)$ tests when using random binary pooling matrices, with high probability. However, we also use deterministic binary pooling matrices based on combinatorial design ideas of Kirkman Triple Systems to balance between good reconstruction properties and matrix sparsity for ease of pooling. In practice, we have observed the need for fewer tests with such matrices than with random pooling matrices. This makes Tapestry capable of very large savings at low prevalence rates, while simultaneously remaining viable even at prevalence rates as high as 9.5%. Empirically we find that single-round Tapestry pooling improves over two-round Dorfman pooling by almost a factor of 2 in the number of tests required. We validate Tapestry in simulations and wet lab experiments with oligomers in quantitative RT-PCR assays. Lastly, we describe use-case scenarios for deployment.
The first part of the paper presents a review of the gold-standard testing protocol for Covid-19, real-time, reverse transcriptase PCR, and its properties and associated measurement data such as amplification curves that can guide the development of appropriate and accurate adaptive group testing protocols. The second part of the paper is concerned with examining various off-the-shelf group testing methods for Covid-19 and identifying their strengths and weaknesses for the application at hand. The third part of the paper contains a collection of new analytical results for adaptive semiquantitative group testing with probabilistic and combinatorial priors, including performance bounds, algorithmic solutions, and noisy testing protocols. The probabilistic setting is of special importance as it is designed to be simple to implement by nonexperts and handle heavy hitters. The worst-case paradigm extends and improves upon prior work on semiquantitative group testing with and without specialized PCR noise models.
Pooled testing offers an efficient solution to the unprecedented testing demands of the COVID-19 pandemic, although with potentially lower sensitivity and increased costs to implementation in some settings. Assessments of this trade-off typically assume pooled specimens are independent and identically distributed. Yet, in the context of COVID-19, these assumptions are often violated: testing done on networks (housemates, spouses, co-workers) captures correlated individuals, while infection risk varies substantially across time, place and individuals. Neglecting dependencies and heterogeneity may bias established optimality grids and induce a sub-optimal implementation of the procedure. As a lesson learned from this pandemic, this paper highlights the necessity of integrating field sampling information with statistical modeling to efficiently optimize pooled testing. Using real data, we show that (a) greater gains can be achieved at low logistical cost by exploiting natural correlations (non-independence) between samples -- allowing improvements in sensitivity and efficiency of up to 30% and 90% respectively; and (b) these gains are robust despite substantial heterogeneity across pools (non-identical). Our modeling results complement and extend the observations of Barak et al (2021) who report an empirical sensitivity well beyond expectations. Finally, we provide an interactive tool for selecting an optimal pool size using contextual information
When testing for a disease such as COVID-19, the standard method is individual testing: we take a sample from each individual and test these samples separately. An alternative is pooled testing (or group testing), where samples are mixed together in different pools, and those pooled samples are tested. When the prevalence of the disease is low and the accuracy of the test is fairly high, pooled testing strategies can be more efficient than individual testing. In this chapter, we discuss the mathematics of pooled testing and its uses during pandemics, in particular the COVID-19 pandemic. We analyse some one- and two-stage pooling strategies under perfect and imperfect tests, and consider the practical issues in the application of such protocols.
In this paper we propose a novel SEIR stochastic epidemic model. A distinguishing feature of this new model is that it allows us to consider a set up under general latency and infectious period distributions. To some extent, queuing systems with infinitely many servers and a Markov chain with time-varying transition rate are the very technical underpinning of the paper. Although more general, the Markov chain is as tractable as previous models for exponentially distributed latency and infection periods. It is also significantly simpler and more tractable than semi-Markov models with a similar level of generality. Based on the notion of stochastic stability, we derive a sufficient condition for a shrinking epidemic in terms of the queuing systems occupation rate that drives the dynamics. Relying on this condition, we propose a class of ad-hoc stabilising mitigation strategies that seek to keep a balanced occupation rate after a prescribed mitigation-free period. We validate the approach in the light of recent data on the COVID-19 epidemic and assess the effect of different stabilising strategies. The results suggest that it is possible to curb the epidemic with various occupation rate levels, as long as the mitigation is not excessively procrastinated.
There have been more than 850,000 confirmed cases and over 48,000 deaths from the human coronavirus disease 2019 (COVID-19) pandemic, caused by novel severe acute respiratory syndrome coronavirus (SARS-CoV-2), in the United States alone. However, there are currently no proven effective medications against COVID-19. Drug repurposing offers a promising way for the development of prevention and treatment strategies for COVID-19. This study reports an integrative, network-based deep learning methodology to identify repurposable drugs for COVID-19 (termed CoV-KGE). Specifically, we built a comprehensive knowledge graph that includes 15 million edges across 39 types of relationships connecting drugs, diseases, genes, pathways, and expressions, from a large scientific corpus of 24 million PubMed publications. Using Amazon AWS computing resources, we identified 41 repurposable drugs (including indomethacin, toremifene and niclosamide) whose therapeutic association with COVID-19 were validated by transcriptomic and proteomic data in SARS-CoV-2 infected human cells and data from ongoing clinical trials. While this study, by no means recommends specific drugs, it demonstrates a powerful deep learning methodology to prioritize existing drugs for further investigation, which holds the potential of accelerating therapeutic development for COVID-19.