Introduction: Testing for active SARS-CoV-2 infection is a fundamental tool in the public health measures taken to control the COVID-19 pandemic. Because of the overwhelming use of SARS-CoV-2 reverse transcription (RT)-PCR tests worldwide, the availability of test kits has become a major bottleneck and the need to increase testing throughput is rising. We aim to overcome these challenges by pooling samples together, and performing RNA extraction and RT-PCR in pools. Methods: We tested the efficiency and sensitivity of pooling strategies for RNA extraction and RT-PCR detection of SARS-CoV-2. We tested 184 samples both individually and in pools to estimate the effects of pooling. We further implemented Dorfman pooling with a pool size of eight samples in large-scale clinical tests. Results: We demonstrated pooling strategies that increase testing throughput while maintaining high sensitivity. A comparison of 184 samples tested individually and in pools of eight samples showed that test results were not significantly affected. Implementing the eight-sample Dorfman pooling to test 26 576 samples from asymptomatic individuals, we identified 31 (0.12%) SARS-CoV-2 positive samples, achieving a 7.3-fold increase in throughput. Discussion: Pooling approaches for SARS-CoV-2 testing allow a drastic increase in throughput while maintaining clinical sensitivity. We report the successful large-scale pooled screening of asymptomatic populations.
Bibliographical noteFunding Information:
Y. Drier is supported by an Alon Fellowship and the Concern Foundation/American Friends of the Hebrew University Young Professorship Award. The following people are members of the Hebrew University-Hadassah Medical School COVID-19 diagnosis team and have contributed to the development of the pooled testing pipeline: A. Klochendler, A. Eden, A. Klar, A. Geldman, A. Arbel, A. Peretz, B. Shalom, B.L. Ochana, D. Avrahami-Tzfati, D. Neiman, D. Steinberg, D. Ben Zvi, E. Shpigel, G. Atlan, H. Klein, H. Chekroun, H. Shani, I. Hazan, I. Ansari, I. Magenheim, J. Moss, J. Magenheim, L. Peretz, L. Feigin, M. Saraby, M. Sherman, M. Bentata, M. Avital, M. Kott, M. Peyser, M. Weitz, M. Shacham, M. Grunewald, N. Sasson, N. Wallis, N. Azazmeh, N. Tzarum, O. Fridlich, R. Sher, R. Condiotti, R. Refaeli, R. Ben Ami, R. Zaken-Gallili, R. Helman, S. Ofek, S. Tzaban, S. Piyanzin, S. Anzi, S. Dagan, S. Lilenthal, T. Sido, T. Licht, T. Friehmann, Y. Kaufman, A. Pery, A. Saada, A. Dekel, A. Yeffet, A. Shaag, A. Michael-Gayego, E. Shay, E. Arbib, H. Onallah, K. Ben-Meir, L. Levinzon, L. Cohen-Daniel, L. Natan, M. Hamdan, M. Rivkin, M. Shwieki, O. Vorontsov, R. Barsuk, R. Abramovitch, R. Gutorov, S. Sirhan, S. Abdeen, Y. Yachnin, Y. Daitch.
© 2020 European Society of Clinical Microbiology and Infectious Diseases
- Group testing
- Infectious diseases