Longitudinal At Home Smell Testing to Detect Infection by SARS-CoV-2

摘要： 自我报告突然失去嗅觉或味觉会大大增加感染SARS-CoV-2的几率 (10-37倍)。然而，嗅觉功能的自我报告并不能可靠地预测嗅觉丧失。基于我们的 开发带有个性化算法的嗅觉测试以检测阿尔茨海默氏症的经验 疾病，我们创建了一个自我管理的易于使用的5分钟客观气味测试，在家中揭开 嗅觉功能的改变是许多人不知道的，并增加了感染SARS的风险- CoV-2。我们的新嗅觉测试包括一张包含脱皮和嗅觉气味标签的物理嗅觉卡片和一张网络- 基于应用程序。一次性气味卡片降低了气味测试作为传播疾病媒介的风险 传播给其他患者、研究人员和卫生保健工作者。每个参与者都访问网络- 基于他们自己的智能手机、平板电脑或电脑上的应用程序。在我们的试点研究中，我们验证了每个参与者的 通过从电子健康档案中提取临床SARS-CoV-2 RT-PCR检测结果来了解COVID状况。这个 嗅觉测试为美国和美国的SARS-CoV-2感染提供了更好的曲线下面积(0.83-0.85) 阿根廷有症状的患者(19-87岁)比单纯的症状跟踪(0.66)要好。我们正在扩展 气味测试从一张有三种气味的气味卡到六张有三种不同气味的气味卡(总共18种气味)。 拥有六种不同版本的嗅觉卡片，每周可以进行几次纵向筛查 提供数据以构建嗅觉功能变化的个性化阈值-每个人担任 他们自己根据个人情况控制和监控预期绩效的降低 而不是以人口标准为基础。在这里，我们建议开发一个本机应用程序来进行 纵向冠状病毒气味测试(目标1)，收集无症状、有症状的医护人员的数据 患者和大学生(目标2)，并为个性化的纵向气味测试开发算法 阈值，区分与流感相关的COVID和气味丧失，并评估发展为肺部疾病的风险 COVID感染患者的疾病(目标3)。纵向COVID气味测试方便、经济，而且 易于扩展。使用COVID气味测试进行有效的筛查将更好地告知学生和员工 他们不应该到学校或工作单位报到，并寻求医疗保健专业人员和分子的评估 在疾病的早期，通常是无症状的阶段进行测试。

Abstract: Self-report of sudden loss of smell or taste substantially increases the odds of being infected with SARS-CoV-2 (10 – 37-fold). However, self-report of smell function is an unreliable predictor of smell loss. Based on our experience developing smell tests with personalized algorithms for asymptomatic detection of Alzheimer's disease, we created a self-administered easy to use “at home” 5-minute objective smell test to uncover alterations in smell function unbeknownst to many individuals, and confer increased risk of infection by SARS- CoV-2. Our new smell test consists of a physical smell card containing peel and sniff odor labels and a web- based application. The disposable smell card reduces the risk that the smell test serves as a vector of transmission to other patients, research staff, and to health care workers. Each participant accesses the web- based app on their own smartphone, tablet, or computer. In our pilot studies, we validated each participant's COVID status by extracting results of clinical SARS-CoV-2 RT PCR assays from electronic health records. The smell test provides better area under the curve for SARS-CoV-2 infection (0.83 – 0.85) in both US and Argentinian symptomatic patients (ages 19 - 87) than symptom tracking alone (0.66). We are expanding the smell test from one smell card with three odors to 6 smell cards, each with 3 different odors (18 odors total). Having six different versions of the smell card will afford longitudinal screening several times per week and provide data to construct personalized thresholds for changes in olfactory function - each person serving as their own control and monitoring for diminishment of their expected performance based on their personal trajectory rather than being based on population norms. Here we propose to develop a native app to conduct longitudinal COVID Smell Test (Aim 1), collect data on asymptomatic health care workers, symptomatic patients, and undergraduates (Aim 2) and develop algorithms for the longitudinal smell test for personalized thresholds, differentiate smell loss from COVID relative to influenza, and assess risk of developing pulmonary disease in COVID infected patients (Aim 3). The Longitudinal COVID Smell Test is accessible, affordable, and readily scalable. Effective screening with the COVID smell test will better inform students and employees if they should not report to school or work, and seek an evaluation by a healthcare professional and molecular testing at an early, often asymptomatic, stage of the disease.