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Sample Pooling as a Strategy to Detect Community Transmission of SARS-CoV-2

Educational Objective
To understand the need for robust diagnostic testing to differentiate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from other routine respiratory infections
1 Credit CME

The coronavirus disease 2019 (COVID-19) pandemic has revealed the global importance of robust diagnostic testing to differentiate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from other routine respiratory infections and guide appropriate clinical management. Given the limited testing capacity available in the United States early in the pandemic, individuals with a clinical syndrome consistent with COVID-19, but without travel or exposure history, were not tested.1 Therefore, it remains uncertain whether there may have been community circulation of SARS-CoV-2 prior to the identification of individuals with positive results through standard public health surveillance. Sample pooling, a strategy used for community monitoring of other infectious diseases such as trachoma, has not, to our knowledge, been deployed for the early comprehensive screening of SARS-CoV-2 in the United States.2

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Benjamin A. Pinsky, MD, PhD, Department of Pathology, Stanford University School of Medicine, 3375 Hillview, Room 2913, Palo Alto, CA 94304 (bpinsky@stanford.edu).

Published Online: April 6, 2020. doi:10.1001/jama.2020.5445

Author Contributions: Drs Hogan and Pinsky had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: All authors.

Acquisition, analysis, or interpretation of data: All authors.

Drafting of the manuscript: Hogan, Pinsky.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Hogan, Sahoo.

Administrative, technical, or material support: Pinsky.

Supervision: Pinsky.

Conflict of Interest Disclosures: None reported.

Additional Contributions: We thank ChunHong Huang, PhD, Department of Pathology, Stanford University, for her contribution in generating the data for this study, without compensation.

References
1.
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2.
Ray  KJ , Zhou  Z , Cevallos  V ,  et al.  Estimating community prevalence of ocular Chlamydia trachomatis infection using pooled polymerase chain reaction testing.   Ophthalmic Epidemiol. 2014;21(2):86-91. doi:10.3109/09286586.2014.884600PubMedGoogle ScholarCrossref
3.
Corman  VM , Landt  O , Kaiser  M ,  et al.  Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR.   Euro Surveill. 2020;25(3):1-8. doi:10.2807/1560-7917.ES.2020.25.3.2000045PubMedGoogle ScholarCrossref
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Centers for Disease Control and Prevention.  Evaluating and testing persons for coronavirus disease 2019 (COVID-19). Updated March 24, 2020. Accessed March 25 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html
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Santa Clara County Public Health.  Healthy Santa Clara County: novel coronavirus (COVID-19) data dashboard. Accessed March 25, 2020. https://www.sccgov.org/sites/phd/DiseaseInformation/novel-coronavirus/Pages/dashboard.aspx
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Lipsitch  M , Swerdlow  DL , Finelli  L .  Defining the epidemiology of COVID-19—studies needed.   N Engl J Med. 2020;382(13):1194-1196. Published online March 26, 2020. doi:10.1056/NEJMp2002125PubMedGoogle ScholarCrossref
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