Pooled Testing Strategies for SARS-CoV-2 diagnosis: A comprehensive review

Abstract

SARS-CoV-2 has surged across the globe causing the ongoing COVID-19 pandemic. Systematic testing to facilitate index case isolation and contact tracing is needed for efficient containment of viral spread. The major bottleneck in leveraging testing capacity has been the lack of diagnostic resources. Pooled testing is a potential approach that could reduce cost and usage of test kits. This method involves pooling individual samples and testing them ‘ en bloc ’. Only if the pool tests positive, retesting of individual samples is performed. Upon reviewing recent articles on this strategy employed in various SARS-CoV-2 testing scenarios, we found substantial diversity emphasizing the requirement of a common protocol. In this article, we review various theoretically simulated and clinically validated pooled testing models and propose practical guidelines on applying this strategy for large scale screening. If implemented properly, the proposed approach could contribute to proper utilization of testing resources and flattening of infection curve.

Real-world Evaluation of a Sample Pooling Strategy for Large-Scale Rapid COVID-19 Testing

“…The difference in pooling methods may have various impacts on the detection sensitivity [16] . The VTM pooling method usually leads to a decrease in viral loads in the pooled samples due to sample dilution, which may increase the risk of false negatives [ 17 , 18 ].…”

Advances in molecular infectious diseases testing in the time of COVID-19

“…Sample pooling is another COVID-inspired strategy to expand test capacity [25] . The most common approach to pooling involves combining a defined number of patient samples, typically 3 to 5, into a single sample container and testing the mixed contents.…”

SARS-CoV-2 RT-qPCR testing of pooled saliva samples: a case study of 824 asymptomatic individuals and a questionnaire survey in Japan

“…Pooled testing, in which samples from multiple individuals are combined into a single test, havs been shown to be effective in multiple infectious disease screening settings, including for syphilis and HIV (30, 31). During the current COVID-19 pandemic, a pooled-sample testing approach has been reported to save both cost and time when implemented on larger scales (30, 32, 33).…”

“…Pooled testing, in which samples from multiple individuals are combined into a single test, havs been shown to be effective in multiple infectious disease screening settings, including for syphilis and HIV (30, 31). During the current COVID-19 pandemic, a pooled-sample testing approach has been reported to save both cost and time when implemented on larger scales (30, 32, 33). For pooled testing to be effective, certain baseline parameters should be considered: the prevalence or positivity rate within the community, sensitivity and specificity of the test, and the limits of detection.…”