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大大增加了感染SARS-CoV-2的几率 (10- 37倍）。然而，自我报告的嗅觉功能是一个不可靠的预测嗅觉损失。基于我们 经验开发嗅觉测试与个性化算法的无症状检测阿尔茨海默氏症 疾病，我们创造了一个自我管理的易于使用的“在家里”5分钟的客观气味测试，以揭示 嗅觉功能的改变对许多人来说是不知道的，并增加了感染SARS的风险- 二型冠状病毒我们的新气味测试包括一个物理气味卡包含果皮和嗅气味标签和一个网络- 基于应用。一次性气味卡降低了气味测试作为气味传播媒介的风险。 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Web- 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 通过从电子健康记录中提取临床SARS-CoV-2 RT PCR检测结果的COVID状态。的 嗅觉测试提供了更好的SARS-CoV-2感染曲线下面积（0.83 - 0.85）， 阿根廷症状患者（年龄19 - 87岁）比单独的症状跟踪（0.66）。我们正在扩大 气味测试从具有三种气味的一个气味卡到6个气味卡，每个气味卡具有3种不同的气味（总共18种气味）。 有六个不同版本的气味卡将提供纵向筛选每周几次， 提供数据以构建嗅觉功能变化的个性化阈值-每个人作为 他们自己的控制和监测，以减少他们的预期业绩的基础上，他们的个人 而不是基于人口标准。在这里，我们建议开发一个本地应用程序， 纵向COVID-19检测（目标1），收集无症状医护人员数据， 患者和大学生（目标2），并开发用于个性化纵向嗅觉测试的算法 阈值，区分嗅觉丧失与COVID相对于流感，并评估发生肺部疾病的风险。 COVID感染患者的疾病（目标3）。纵向COVID-19检测是可获得的，负担得起的， 易于扩展。通过COVID气味测试进行有效筛查将更好地告知学生和员工， 他们不应该报告学校或工作，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检测。

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.