Shady Hassan, Vocalis Health
MEDdesign

Returning to ‘Normal’: Non-Invasive Screening Via Vocal Analysis

By Shady Hassan, M.D.
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Shady Hassan, Vocalis Health

A return to normalcy requires us to address the limits of current testing approaches and broadly deploy reliable screening tools that facilitate early detection and encourage more focused testing of those at high-risk of spreading the coronavirus.

As the second and third waves of COVID-19 unfold, it has become abundantly clear that we need creative new solutions for pandemic management. Infection rates are rising while the economy is buckling under the limitations the pandemic and its management have caused. The economic hardships endured by businesses, universities and families, coupled with the fatigue experienced by people social distancing, wearing masks, and isolating at home, are combining to create an increasingly unsustainable situation.

One critical gap exacerbating the effects of COVID-19 is in the current processes of screening and testing suspected virus carriers. Standalone screening solutions, including temperature and symptom checking, are insufficient and can easily be “fooled” by a person taking an OTC fever-reducing medication like Tylenol. Existing testing solutions, including PCR and antigen testing, are resource-intensive and indiscriminately applied.

The implementation of a highly scalable and non-invasive screening tool can help fill the gap by better informing who requires more advanced testing.

With a non-invasive screening tool that goes beyond temperature and symptom checking, which themselves are not a reliable indication for asymptomatic patients, we can add a necessary layer of risk-assessment before sending people for a traditional PCR test. Narrowing down which patients are more likely to be COVID-19 positive can allow health systems to efficiently allocate limited resources, and furthermore, such screening tools can help us, as a society, to return to ‘normal’ activities—going to the office, getting together with friends, returning to university classes, traveling and more.

Existing Testing Methods

Currently, symptomatic people, or those who have known exposure, are using PCR or antigen testing to determine whether they have become infected with COVID-19. This approach to testing is highly ineffective in managing viral spread, because COVID-19 is notoriously inconsistent in its virulence, and many people who become infected either remain asymptomatic or only experience symptoms one–two weeks after infection. Additionally, it was found that infectiousness peaks on or before the onset of symptoms, during an “incubation period,” limiting the utility of available testing methods to address the spread of the virus.

Prior to testing, screening is a necessary tool for pandemic management. The two currently available methods for COVID-19 screening are temperature checks and symptom questionnaires, and both are extremely limited. Temperature elevations are only reported in approximately 55.5% of COVID-19 positive individuals. Symptom questionnaires are dependent upon the honesty of the symptom reporter and, like temperature checks, are limited by both the prevalence and timing of symptom onset. Neither screening approach is capable of detecting individuals who are COVID-19 positive but asymptomatic.

Due to the lack of reliability of our current screening tools, we have been relying heavily on PCR and antigen tests to fulfill the roles of both testing and screening for COVID-19, and while each of these tools has diagnostic benefits, neither are suitable to fulfill the screening role. PCR testing, while accurate, is invasive, expensive, not widely available, requires a heavy load of resources and personnel, and test results often take a few days to receive. Rapid antigen testing, as the name suggests, can produce faster results than a traditional PCR test but is less sensitive and effective only in symptomatic patients, which, given the infectiousness of asymptomatic patients, severely limits their utility as a screening tool. Ideally, both tests should be used solely as confirmatory diagnostic testing and not as screening tools.

For improved control and understanding of the virus, a screening method that can flag people at heightened risk for carrying the virus well before they start showing symptoms should be widely available.

Efficient Testing Solutions

Enabling a smooth return to normalcy requires that we address the limitations of current testing approaches and broadly deploy reliable screening tools that facilitate early detection and encourage more focused testing of those at high-risk of spreading the virus.

Ideally, these tools would be non-invasive, highly scalable, cost effective and able to assess the need for performing a diagnostic test, such as a PCR. This will help ensure that individuals who are most likely to be positive for COVID-19 are tested first, and that scarce and expensive testing resources are used efficiently.

Providing accessible tools at a low cost would most effectively bring the pandemic under control. By implementing an easy-to-use technological solution, health systems, businesses, governments, universities, airlines and other industries can begin a safe return to normal activity.

Voice Analysis as a COVID-19 Screening Tool

The ideal screening tool which meets all the necessary requirements of affordability, availability and accuracy, is vocal analysis. Vocal analysis has proven effective in detecting and monitoring patients with chronic obstructive pulmonary disease and other voice-affecting diseases, and this technology can be applied to COVID-19, given its impact on the respiratory system.

By identifying the typical characteristics of a COVID-positive patient—the vocal biomarkers—we can deploy a highly scalable screening solution to assess a person’s relative risk of being COVID-positive.

A voice-based screening process would simply require a patient to record their voice using their own smartphone, tablet or any other smart device, and harnessing AI and machine learning technology, analysis can immediately be performed, correlating the voice recording with those of COVID-19 infected individuals from a clinical trial database.

This screening process can add an extra layer of confirmation that an asymptomatic person is indeed not likely to be carrying the disease and help restore confidence in employees returning to work, passengers to planes, or shoppers to stores, providing reassurance that extra screening has been implemented. It can also detect potential infection, thus guiding and prioritizing PCR testing, or, simply recommending that a person remain at home, if they are asymptomatic.

Combining vocal analysis with symptom reporting further enhances the screening capabilities of both and can adds to our armamentarium of pandemic management options. Voice recordings are quick, non-invasive, and can be used every day for ongoing monitoring.

While no screening or diagnostic test has yet reached 100% accuracy, the more reliable screening measures we utilize in tandem, the more likely we are to identify asymptomatic COVID-19 positive individuals. When used in conjunction with other screening and testing tools, vocal analysis can enhance the efficacy of the pandemic response by increasing the efficiency of testing and helping to quickly identify COVID-19 infected individuals, thereby reducing viral transmission and helping us get back to work, school, and life.

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