News & Analysis Biotech Innovations CRISPR-Based COVID-19 Smartphone Predicting COVID-19 Outcomes any symptoms, to make sure resources are Test in Development in Emergency Department Patients appropriately allocated,” Fred Kwon, PhD, A simplified point-of-care assay that turns a A new artificial intelligence algorithm uses the study’s lead author, said in a statement. smartphone into a fluorescence micro- chest x-ray severity scores and clinical vari- The chest x-ray severity scores alone could scope could expand coronavirus disease ables collected during emergency depart- be useful. “We are working to incorporate 2019(COVID-19)testingcapability,research- ment (ED) visits to predict whether pa- this algorithm-generated severity score into ers reported in a study in Cell. tients with coronavirus disease 2019 the clinical workflow to inform treatment de- The assay, which uses clustered (COVID-19) will be intubated or will die. If fur- cisions and flag high-risk patients in the fu- regularly interspaced short palindromic ther validated in larger studies with addi- ture,” Kwon said. repeats (CRISPR) gene editing technol- tional patient populations, the proof-of- ogy, emits a fluo- concept model, described in Radiology: Phone Apps and Wearable Trackers rescent signal in Artificial Intelligence, could be used to ap- Modestly Improve Activity Viewpoint page 529 the presence of propriately triage ED patients before they Smartphone fitness applications and wear- the novel corona- become seriously ill with COVID-19. able activity trackers seem to have a small to virus’s RNA. A smartphone camera can moderate positive effect on physical activ- detect this signal directly, without amplifi- ity,a systematic review and meta-analysis of cation of the viral genome used in most randomized trials found. The improve- genetic tests. This means the test can ments, reported in the British Journal of quantify the amount of virus in the Sports Medicine, corresponded to an addi- sample—the quicker the signal is picked up, tional 1850 steps per day. the higher the viral load. The review is the first to focus on healthy In the study, the assay was able to adults using contemporary technology like detect RNA extracted from patients’ nasal fitness wristbands and smartwatches with swabs within 5 minutes. Samples with less automated and continuous self-monitoring virus could be detected within 30 min- Researchers at the Icahn School of and feedback, the authors said. The analy- utes. “Monitoring viral loads quantitatively Medicine at Mount Sinai in New York City sis included 28 studies that involved 7454 would allow estimation of infection stage trained and validated the algorithm using participants aged 18 to 65 years with no and help predict infectivity, recovery, and deidentified electronic health record data chronic health conditions, 28% of whom return from quarantine in real time,” the from patients with COVID-19 who were were women. The studies were published authors wrote. treated at 3 Mount Sinai Health System EDs between January 2007 and January 2020 “We plan on applying for [Emer- in the Brooklyn, Manhattan, and Queens and tested interventions that lasted an gency Use Authorization] in the next boroughs over 2 weeks last March. The average of 13 weeks. Most of the interven- few months,” researcher Melanie Ott, training and validation data comprised out- tions used a fitness tracker with or without MD, PhD, of the Gladstone Institute of comes, x-rays with radiologist-assigned an app. Virology at the University of California, severity scores, blood pressure readings, Apps and trackers with text message San Francisco, wrote in a January email. and blood work like creatinine, D-dimer, prompts and features allowing for person- A rollout in pharmacies and drop-in clinics and troponin levels from 338 patients aged alization were significantly more effective is planned first, with an at-home test 21 to 50 years. than those without these elements. Partici- potentially to follow later. The technique The algorithm learned how to assign se- pant retention in studies was also associ- targets different parts of the virus’ genome, verity scores to x-rays. The researchers then ated with effectiveness. which should make it less vulnerable to tested the model’s ability to predict out- “Given the wide and increasing reach false-negatives as the pathogen continues comes for 161 different patients with of smartphones, even modest improve- to mutate. COVID-19seenattheEDsthefollowingweek ments in physical activity can produce For now, the test still requires labora- in March. Two-thirds of this group were older large effects at the population level,” the tory equipment and RNA extraction. “In than 50 years. Overall, the approach pre- authors wrote. They suggested that clini- the future, our next assay will cut out the dicted intubations with 86% accuracy and cians could prescribe the use of smart- need for laboratory in a single-step assay,” deaths with 82% accuracy, but it per- phone apps or activity trackers to extend Ott wrote. The research team also includes formed better for younger patients. their benefits beyond the “‘worried well’ Jennifer Doudna, PhD, who shares a Nobel “The algorithm can help clinicians antici- early adopters.” − Jennifer Abbasi Prize in chemistry for developing CRISPR- pate acute worsening (decompensation) of Note: Source references are available through based gene editing. patients, even those who present without embedded hyperlinks in the article text online. iStock.com/Tempura 522 JAMA February 9, 2021 Volume 325, Number 6 (Reprinted) jama.com © 2021 American Medical Association. All rights reserved. Downloaded From: https://jamanetwork.com/ on 10/02/2021.