A Compressed Sensing Approach to Pooled RT-PCR Testing for COVID-19 Detection

High capacity clinical SARS-CoV-2 molecular testing using combinatorial pooling

BACKGROUND

The SARS-CoV-2 pandemic led to unprecedented testing demands, causing major testing delays globally. One strategy used for increasing testing capacity was pooled-testing, using a two-stage technique first introduced during WWII. However, such traditional pooled testing was used in practice only when positivity rates were below 2%.

METHODS

Here we report the development, validation and clinical application of P-BEST - a single-stage pooled-testing strategy that was approved for clinical use in Israel.

RESULTS

P-BEST is clinically validated using 3636 side-by-side tests and is able to correctly detect all positive samples and accurately estimate their Ct value. Following regulatory approval by the Israeli Ministry of Health, P-BEST was used in 2021 to clinically test 837,138 samples using 270,095 PCR tests - a 3.1fold reduction in the number of tests. This period includes the Alpha and Delta waves, when positivity rates exceeded 10%, rendering traditional pooling non-practical. We also describe a tablet-based solution that allows performing manual single-stage pooling in settings where liquid dispensing robots are not available.

CONCLUSIONS

Our data provides a proof-of-concept for large-scale clinical implementation of single-stage pooled-testing for continuous surveillance of multiple pathogens with reduced test costs, and as an important tool for increasing testing efficiency during pandemic outbreaks.

Semi-quantitative group testing for efficient and accurate qPCR screening of pathogens with a wide range of loads

BACKGROUND

Pathogenic infections pose a significant threat to global health, affecting millions of people every year and presenting substantial challenges to healthcare systems worldwide. Efficient and timely testing plays a critical role in disease control and transmission prevention. Group testing is a well-established method for reducing the number of tests needed to screen large populations when the disease prevalence is low. However, it does not fully utilize the quantitative information provided by qPCR methods, nor is it able to accommodate a wide range of pathogen loads.

RESULTS

To address these issues, we introduce a novel adaptive semi-quantitative group testing (SQGT) scheme to efficiently screen populations via two-stage qPCR testing. The SQGT method quantizes cycle threshold (Ct) values into multiple bins, leveraging the information from the first stage of screening to improve the detection sensitivity. Dynamic Ct threshold adjustments mitigate dilution effects and enhance test accuracy. Comparisons with traditional binary outcome GT methods show that SQGT reduces the number of tests by 24% on the only complete real-world qPCR group testing dataset from Israel, while maintaining a negligible false negative rate.

CONCLUSION

In conclusion, our adaptive SQGT approach, utilizing qPCR data and dynamic threshold adjustments, offers a promising solution for efficient population screening. With a reduction in the number of tests and minimal false negatives, SQGT holds potential to enhance disease control and testing strategies on a global scale.

Statistical modeling and evaluation of the impact of multiplicity classification thresholds on the COVID-19 pool testing accuracy

Prior research on pool testing focus on developing testing methods with the main objective of reducing the total number of tests. However, pool testing can also be used to improve the accuracy of the testing process. The objective of this paper is to improve the accuracy of pool testing using the same number of tests as that of individual testing taking into consideration the probability of testing errors and pool multiplicity classification thresholds. Statistical models are developed to evaluate the impact of pool multiplicity classiffcation thresholds on pool testing accuracy using the receiver operating characteristic (ROC) curve and the area under the curve (AUC). The findings indicate that under certain conditions, pool testing multiplicity yields superior testing accuracy compared to individual testing without additional cost. The results reveal that selecting the multiplicity classification threshold is a critical factor in improving the pool testing accuracy and show that the lower the prevalence level the higher the gains in accuracy using multiplicity pool testing. The findings also indicate that performance can be improved using a batch size that is inversely proportional to the prevalence level. Furthermore, the results indicate that multiplicity pool testing not only improves the testing accuracy but also reduces the total cost of the testing process. Based on the findings, the manufacturer's test sensitivity has more significant impact on the accuracy of multiplicity pool testing compared to that of manufacturer's test specificity.

Artificial intelligence enabled COVID-19 detection: techniques, challenges and use cases

Deep Learning and Machine Learning are becoming more and more popular as their algorithms get progressively better, and their use is expected to have the large effect on improving the health care system. Also, the pandemic was a chance to show how adding AI to healthcare infrastructure could help, since infrastructures around the world are overworked and falling apart. These new technologies can be used to fight COVID-19 because they are flexible and can be changed. Based on these facts, we looked at how the ML and DL-based models can be used to deal with the COVID-19 pandemic problem and what the pros and cons of each are. This paper gives a full look at the different ways to find COVID-19. We looked at the COVID-19 issues in a systematic way and then rated the methods and techniques for finding it based on their availability, ease of use, accuracy, and cost. We have also shown in pictures how well each of the detection techniques works. We did a comparison of different detection models based on the above factors. This helps researchers understand the different methods and the pros and cons of using them as the basis for their research. In the last part, we talk about the open challenges and research questions that come with putting these techniques together with other detection methods.

Effective matrix designs for COVID-19 group testing

BACKGROUND

Grouping samples with low prevalence of positives into pools and testing these pools can achieve considerable savings in testing resources compared with individual testing in the context of COVID-19. We review published pooling matrices, which encode the assignment of samples into pools and describe decoding algorithms, which decode individual samples from pools. Based on the findings we propose new one-round pooling designs with high compression that can efficiently be decoded by combinatorial algorithms. This expands the admissible parameter space for the construction of pooling matrices compared to current methods.

RESULTS

By arranging samples in a grid and using polynomials to construct pools, we develop direct formulas for an Algorithm (Polynomial Pools (PP)) to generate assignments of samples into pools. Designs from PP guarantee to correctly decode all samples with up to a specified number of positive samples. PP includes recent combinatorial methods for COVID-19, and enables new constructions that can result in more effective designs.

CONCLUSION

For low prevalences of COVID-19, group tests can save resources when compared to individual testing. Constructions from the recent literature on combinatorial methods have gaps with respect to the designs that are available. We develop a method (PP), which generalizes previous constructions and enables new designs that can be advantageous in various situations.

Use of compressed sensing to expedite high-throughput diagnostic testing for COVID-19 and beyond

The rapid spread of SARS-CoV-2 has placed a significant burden on public health systems to provide swift and accurate diagnostic testing highlighting the critical need for innovative testing approaches for future pandemics. In this study, we present a novel sample pooling procedure based on compressed sensing theory to accurately identify virally infected patients at high prevalence rates utilizing an innovative viral RNA extraction process to minimize sample dilution. At prevalence rates ranging from 0-14.3%, the number of tests required to identify the infection status of all patients was reduced by 69.26% as compared to conventional testing in primary human SARS-CoV-2 nasopharyngeal swabs and a coronavirus model system. Our method provided quantification of individual sample viral load within a pool as well as a binary positive-negative result. Additionally, our modified pooling and RNA extraction process minimized sample dilution which remained constant as pool sizes increased. Compressed sensing can be adapted to a wide variety of diagnostic testing applications to increase throughput for routine laboratory testing as well as a means to increase testing capacity to combat future pandemics.

Deep learning-based approach for detecting COVID-19 in chest X-rays

Today, 2019 Coronavirus (COVID-19) infections are a major health concern worldwide. Therefore, detecting COVID-19 in X-ray images is crucial for diagnosis, evaluation, and treatment. Furthermore, expressing diagnostic uncertainty in a report is a challenging duty but unavoidable task for radiologists. This study proposes a novel CNN (Convolutional Neural Network) model for automatic COVID-19 identification utilizing chest X-ray images. The proposed CNN model is designed to be a reliable diagnostic tool for two-class categorization (COVID and Normal). In addition to the proposed model, different architectures, including the pre-trained MobileNetv2 and ResNet50 models, are evaluated for this COVID-19 dataset (13,824 X-ray images) and our suggested model is compared to these existing COVID-19 detection algorithms in terms of accuracy. Experimental results show that our proposed model identifies patients with COVID-19 disease with 96.71 percent accuracy, 91.89 percent F1-score. Our proposed approach CNN’s experimental results show that it outperforms the most advanced algorithms currently available. This model can assist clinicians in making informed judgments on how to diagnose COVID-19, as well as make test kits more accessible.

Evaluation of efficiency and sensitivity of 1D and 2D sample pooling strategies for SARS-CoV-2 RT-qPCR screening purposes

To increase the throughput, lower the cost, and save scarce test reagents, laboratories can pool patient samples before SARS-CoV-2 RT-qPCR testing. While different sample pooling methods have been proposed and effectively implemented in some laboratories, no systematic and large-scale evaluations exist using real-life quantitative data gathered throughout the different epidemiological stages. Here, we use anonymous data from 9673 positive cases to model, simulate and compare 1D and 2D pooling strategies. We show that the optimal choice of pooling method and pool size is an intricate decision with a testing population-dependent efficiency-sensitivity trade-off and present an online tool to provide the reader with custom real-time 1D pooling strategy recommendations.

Group testing via hypergraph factorization applied to COVID-19

Large scale screening is a critical tool in the life sciences, but is often limited by reagents, samples, or cost. An important recent example is the challenge of achieving widespread COVID-19 testing in the face of substantial resource constraints. To tackle this challenge, screening methods must efficiently use testing resources. However, given the global nature of the pandemic, they must also be simple (to aid implementation) and flexible (to be tailored for each setting). Here we propose HYPER, a group testing method based on hypergraph factorization. We provide theoretical characterizations under a general statistical model, and carefully evaluate HYPER with alternatives proposed for COVID-19 under realistic simulations of epidemic spread and viral kinetics. We find that HYPER matches or outperforms the alternatives across a broad range of testing-constrained environments, while also being simpler and more flexible. We provide an online tool to aid lab implementation: http://hyper.covid19-analysis.org .

Extreme Compressed Sensing of Poisson Rates from Multiple Measurements

Compressed sensing (CS) is a signal processing technique that enables the efficient recovery of a sparse high-dimensional signal from low-dimensional measurements. In the multiple measurement vector (MMV) framework, a set of signals with the same support must be recovered from their corresponding measurements. Here, we present the first exploration of the MMV problem where signals are independently drawn from a sparse, multivariate Poisson distribution. We are primarily motivated by a suite of biosensing applications of microfluidics where analytes (such as whole cells or biomarkers) are captured in small volume partitions according to a Poisson distribution. We recover the sparse parameter vector of Poisson rates through maximum likelihood estimation with our novel Sparse Poisson Recovery (SPoRe) algorithm. SPoRe uses batch stochastic gradient ascent enabled by Monte Carlo approximations of otherwise intractable gradients. By uniquely leveraging the Poisson structure, SPoRe substantially outperforms a comprehensive set of existing and custom baseline CS algorithms. Notably, SPoRe can exhibit high performance even with one-dimensional measurements and high noise levels. This resource efficiency is not only unprecedented in the field of CS but is also particularly potent for applications in microfluidics in which the number of resolvable measurements per partition is often severely limited. We prove the identifiability property of the Poisson model under such lax conditions, analytically develop insights into system performance, and confirm these insights in simulated experiments. Our findings encourage a new approach to biosensing and are generalizable to other applications featuring spatial and temporal Poisson signals.

Optimization in the Context of COVID-19 Prediction and Control: A Literature Review

This paper presents an overview of some key results from a body of optimization studies that are specifically related to COVID-19, as reported in the literature during 2020-2021. As shown in this paper, optimization studies in the context of COVID-19 have been used for many aspects of the pandemic. From these studies, it is observed that since COVID-19 is a multifaceted problem, it cannot be studied from a single perspective or framework, and neither can the related optimization models. Four new and different frameworks are proposed that capture the essence of analyzing COVID-19 (or any pandemic for that matter) and the relevant optimization models. These are: (i) microscale vs. macroscale perspective; (ii) early stages vs. later stages perspective; (iii) aspects with direct vs. indirect relationship to COVID-19; and (iv) compartmentalized perspective. To limit the scope of the review, only optimization studies related to the prediction and control of COVID-19 are considered (public health focused), and which utilize formal optimization techniques or machine learning approaches. In this context and to the best of our knowledge, this survey paper is the first in the literature with a focus on the prediction and control related optimization studies. These studies include optimization of screening testing strategies, prediction, prevention and control, resource management, vaccination prioritization, and decision support tools. Upon reviewing the literature, this paper identifies current gaps and major challenges that hinder the closure of these gaps and provides some insights into future research directions.

Pooling Samples to Increase SARS-CoV-2 Testing

As SARS-CoV-2 continues to propagate around the world, it is becoming increasingly important to scale up testing. This is necessary both at the individual level, to inform diagnosis, treatment and contract tracing, as well as at the population level to inform policies to control spread of the infection. The gold-standard RT-qPCR test for the virus is relatively expensive and takes time, so combining multiple samples into “pools” that are tested together has emerged as a useful way to test many individuals with less than one test per person. Here, we describe the basic idea behind pooling of samples and different methods for reconstructing the result for each individual from the test of pooled samples. The methods range from simple pooling, where each pool is disjoint from the other, to more complex combinatorial pooling where each sample is split into multiple pools and each pool has a specified combination of samples. We describe efforts to validate these testing methods clinically and the potential advantages of the combinatorial pooling method named Tapestry Pooling that relies on compressed sensing techniques.