Rapid olfactory tools for telemedicine-friendly COVID-19 screening and surveillance

The COVID-19 pandemic is the most devastating infectious disease outbreak in a century, particularly inunderserved and minoritized communities. In 2020 alone, it will cost a million lives. It continues to wreakeconomic havoc worldwide. Therefore, it is critical to develop new tools that can mitigate the spread of SARS-CoV-2, the virus that causes COVID-19. Rapid screening tools can identify potentially infected individuals whocan then be isolated/quarantined from the uninfected and directed towards further testing and treatment.Unfortunately, definitive viral testing for SARS-CoV-2 has proven difficult to implement in many countries,including the US, due to technical, financial and governmental hurdles to universal access and timelyprocessing. Symptom-based screening offers a valuable, albeit imperfect, complement to viral testing that canhelp identify many individuals with the disease for isolation as well as treatment. A major challenge withsymptomatic testing is that COVID-19 is highly protean: the heterogeneity of symptoms means no singlesymptom or constellation of symptoms is definitive diagnostically. Still, there is growing evidence that suddenpartial or complete olfactory loss - even more than other symptoms such as fever or dry cough - is the singlebest predictor of COVID-19. In this proposal, we will develop and implement objective, self-administered smelltests for the purpose of identifying individuals with COVID-19 prior to, or in the absence of, viral testing, as wellas for use in population-level surveillance of COVID-19 spread. Several kinds of objective tests have beenused in clinical or laboratory settings to assess an individual's olfactory ability, including those that test theability to identify or discriminate odors as well as procedures to determine the lowest concentration anindividual can reliably perceive (i.e., odor detection threshold). Each approach has technical and logisticaladvantages and disadvantages, and each captures different aspects of olfactory dysfunction. RegardingCOVID-19, it is unknown what type of measure has the highest specificity or sensitivity. In Aim 1, we will use self-administered objective testing of odor identification and odor detection threshold in SARS-CoV-2-tested individuals to determine which olfactory measure is the best predictor of COVID-19. In Aim 2, we will use objective smell testing to assess whether population monitoring of olfactory loss in university, municipal orother community settings can serve as a sentinel of COVID-19 community spread. Together, our studies willprovide a rapid, remote-friendly, cost-effective, scalable, non-intrusive method to screen for COVID-19 at theindividual level and to assess prevalence in communities, especially those that have been traditionallyunderserved by the health care system and public health infrastructure.