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Register a new userAC-DC: Amplification Curve Diagnostics for Covid-19 Group Testing
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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.
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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.
We analyze risk factors correlated with the initial transmission growth rate of the recent COVID-19 pandemic in different countries. The number of cases follows in its early stages an almost exponential expansion; we chose as a starting point in each country the first day $d_i$ with 30 cases and we fitted for 12 days, capturing thus the early exponential growth. We looked then for linear correlations of the exponents $alpha$ with other variables, for a sample of 126 countries. We find a positive correlation, {it i.e. faster spread of COVID-19}, with high confidence level with the following variables, with respective $p$-value: low Temperature ($4cdot10^{-7}$), high ratio of old vs.~working-age people ($3cdot10^{-6}$), life expectancy ($8cdot10^{-6}$), number of international tourists ($1cdot10^{-5}$), earlier epidemic starting date $d_i$ ($2cdot10^{-5}$), high level of physical contact in greeting habits ($6 cdot 10^{-5}$), lung cancer prevalence ($6 cdot 10^{-5}$), obesity in males ($1 cdot 10^{-4}$), share of population in urban areas ($2cdot10^{-4}$), cancer prevalence ($3 cdot 10^{-4}$), alcohol consumption ($0.0019$), daily smoking prevalence ($0.0036$), UV index ($0.004$, 73 countries). We also find a correlation with low Vitamin D levels ($0.002-0.006$, smaller sample, $sim 50$ countries, to be confirmed on a larger sample). There is highly significant correlation also with blood types: positive correlation with types RH- ($3cdot10^{-5}$) and A+ ($3cdot10^{-3}$), negative correlation with B+ ($2cdot10^{-4}$). Several of the above variables are intercorrelated and likely to have common interpretations. We performed a Principal Component Analysis, in order to find their significant independent linear combinations. We also analyzed a possible bias: countries with low GDP-per capita might have less testing and we discuss correlation with the above variables.
After emerging in China in late 2019, the novel Severe acute respiratory syndrome-like coronavirus 2 (SARS-CoV-2) spread worldwide and as of early 2021, continues to significantly impact most countries. Only a small number of coronaviruses are known to infect humans, and only two are associated with the severe outcomes associated with SARS-CoV-2: Severe acute respiratory syndrome-related coronavirus, a closely related species of SARS-CoV-2 that emerged in 2002, and Middle East respiratory syndrome-related coronavirus, which emerged in 2012. Both of these previous epidemics were controlled fairly rapidly through public health measures, and no vaccines or robust therapeutic interventions were identified. However, previous insights into the immune response to coronaviruses gained during the outbreaks of severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS) have proved beneficial to identifying approaches to the treatment and prophylaxis of novel coronavirus disease 2019 (COVID-19). A number of potential therapeutics against SARS-CoV-2 and the resultant COVID-19 illness were rapidly identified, leading to a large number of clinical trials investigating a variety of possible therapeutic approaches being initiated early on in the pandemic. As a result, a small number of therapeutics have already been authorized by regulatory agencies such as the Food and Drug Administration (FDA) in the United States, and many other therapeutics remain under investigation. Here, we describe a range of approaches for the treatment of COVID-19, along with their proposed mechanisms of action and the current status of clinical investigation into each candidate. The status of these investigations will continue to evolve, and this review will be updated as progress is made.
The COVID-19 pandemic, caused by the coronavirus SARS-CoV-2, has led to a wide range of non-pharmaceutical interventions being implemented around the world to curb transmission. However, the economic and social costs of some of these measures, especially lockdowns, has been high. An alternative and widely discussed public health strategy for the COVID-19 pandemic would have been to shield those most vulnerable to COVID-19, while allowing infection to spread among lower risk individuals with the aim of reaching herd immunity. Here we retrospectively explore the effectiveness of this strategy, showing that even under the unrealistic assumption of perfect shielding, hospitals would have been rapidly overwhelmed with many avoidable deaths among lower risk individuals. Crucially, even a small (20%) reduction in the effectiveness of shielding would have likely led to a large increase (>150%) in the number of deaths compared to perfect shielding. Our findings demonstrate that shielding the vulnerable while allowing infections to spread among the wider population would not have been a viable public health strategy for COVID-19, and is unlikely to be effective for future pandemics.
Group testing allows saving chemical reagents, analysis time, and costs, by testing pools of samples instead of individual samples. We introduce a class of group testing protocols with small dilution, suited to operate even at high prevalence ($5%-10%$), and maximizing the fraction of samples classified positive/negative within the first round of tests. Precisely, if the tested group has exactly one positive sample then the protocols identify it without further individual tests. The protocols also detect the presence of two or more positives in the group, in which case a second round could be applied to identify the positive individuals. With a prevalence of $5%$ and maximum dilution 6, with 100 tests we classify 242 individuals, $92%$ of them in one round and $8%$ requiring a second individual test. In comparison, the Dorfmans scheme can test 229 individuals with 100 tests, with a second round for $18.5%$ of the individuals.
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