The next wave of virus detection: A good kid

On some level, Carol Glaser thinks, the idea is almost too obvious to work. For decades, localities and governments around the world have used dogs to sniff out illegal drugs, explosives, landmines, and missing people—even disease. Why not the COVID?

After all, with so many 300 million olfactory receptors, a dog’s ability to scent or smell something is “about a hundred thousand times ours,” Glaser told me recently. “There’s an analogy I see: You can take a teaspoon of something and put it in water the size of 20 Olympic swimming pools, and a dog will detect it.”

This makes for a great theory: dogs as a kind of frontline detective agency in COVID. But Glaser is not just a theorist.

As medical officer for the Center for Laboratory Sciences of the California Department of Public Health (CDPH), Glaser was able to marshal resources and funds (through CDC Foundation) to test the path of the idea. Although it is still early, the results are promising enough that they could change the tide that the US will get in the face of outbreaks of many viruses, not just Covid, in the coming years.

And while the first tests were conducted in schools, Glaser and those who work with him are now moving the process to the place where it can have the greatest impact: skilled nursing facilities in California, home home to some of the worst states in the state. infection and mortality rates during the first two years of the coronavirus.

“There is a huge demand in our nursing homes,” Glaser said. “Nursing homes and other skilled facilities continue to experience epidemics all the time—and, of course, they are the most vulnerable populations. We’re making a big shift in nursing homes— care.”

Cats comfort the residents, and are therefore welcome. They work fast, needing only seconds to smell a person. And several COMMANDING LEAD laboratoryBUILT study THERE SHOW that medical detection dogs can accurately identify samples from people infected with COVID, suggesting they could serve a valuable, mobile screening role in the future.

In short, they are good dogs.

The beginning of the project, the details of which recently appeared in a research letter published in JAMA Pediatrics, is CDPH’s experience with the antigen test in its public school system. Although that program eventually received strong buy-in, Glaser said the regulatory requirements required extensive training of school personnel, distracting teachers and administrators from their core duties, “and the kids got a little sick from the swabs.”

Enter the dogs. Glaser is already familiar with reports that dogs are being tested to detect COVID at airports in the Finland, Saudi Arabia, and the United Arab Emiratesas well as others sports facilities. He reached Carol Edwards, executive director of the Northern California-based Early Alert Canines (EAC), which for more than 20 years has been training “sugar alert” dogs to warn insulin-dependent diabetics when they are about to experience a significant change in blood sugar levels .

Glaser wanted to know if Edwards could train dogs for detecting Covid. “I said, ‘Yes. Let’s do it,’ and then I panicked,” Edwards said with a laugh. “But it’s the same scent training that diabetes alert dogs do. It’s just one thing to take COVID samples and train the dogs on that.”

The science involved is very straightforward. As a result of metabolic processes, infected people with COVID releases volatile organic compounds (VOCs). These gas molecules can have a unique smell, which the dogs – in this case, yellow labs named Rizzo and Scarlett – are CAUSES on recognition of after rigorous training. “That’s what dogs actually smell,” said Edwards, who co-authored the JAMA study. “They don’t smell the virus itself.”

CDPH’s Glaser sets about taking worn socks from people infected with COVID, the better to preserve the VOCs collected there as a result of sweat formation. Edwards, of the EAC, then taught the dogs to put socks on the tire to detect the smell on which he was trained. Rizzo and Scarlet to distinguish compounds associated with Covid from other odors, reward them with Cheerios or a small liver treat each time they do — the same general regimen the dogs go through while learning— turn them on to sniff for any particular smell or substance.

This is certainly not new technology. In addition to the aforementioned uses, “dogs have been found to detect melanoma cells and other types of tumors such as lung, ovarian, bladder, and large intestine,” said Molly McAllister, chief medical officer of Mars Veterinary Health, a worldwide network of more than 2,500 veterinary hospitals and clinics. “They can be used to identify patients with malariaand was also found to be able to detect hypoglycemia, future seizures, and narcoleptic episodes.”

In a controlled lab setting, the results for Rizzo and Scarlett were excellent, with dogs “they get it like 98%, 99% of the time. They found the positive socks and ignored everything else,” Glaser said. In a pilot program in live school settings with more than 3,500 screenings last year, overall accuracy numbers fell to 90% with the dogs correctly identifying 85 infections and rejecting 3,411 infections. They did not accurately signal infection in 383 cases and less than 18 infections, giving a sensitivity of 83% and specificity of 90%.

Glaser suspects a decline in performance the field is due in part to a relatively chaotic environment, including things like wind, noise, and many others. smells of participants, including a burrito in a child’s backpack. Further study is needed to learn more about the causes and whether it can be reduced as the dogs become more familiar with their surroundings.

The process is decidedly old-school.We have the kids line up outside for us, and the dogs walk around and sniff their ankles,” Edwards said. “When they meet the VOCs they sit down. For them, it’s just a smell. They will receive attention.” All children and study staff also underwent a rapid antigen test for comparison purposes.

The advantages over swab testing are many, including saving time (dogs can sniff you are hundreds of subjects in one hour), convenience, and the potential to reduce by 80% the number of swab test kits because the swabs will only be used as a follow-up for those reported infected dogs. And while dogs need to be trained, fed, and kept, they may be the cheapest front-line defense against the virus yet considered.

There’s another consideration—and it’s especially compelling when applied to a skilled nursing setting: Residents enjoy interaction. The dogs have been in 10 to 12 nursing homes in Northern California so far, some times, and they are warmly embraced, just like they are in schools. “There are some people who are literally trying to follow dogs around on video, and they want pictures,” Glaser said. He and Edwards are considering adding a third, social dog “to come in after the other dogs have done their work,” just to cover and play with to help streamline the process..

It seems like a nice development because it is – but the business at hand is serious. “I think it’s the tip of the iceberg,” Edwards said. “We go to skilled nursing homes now because that’s where the outbreaks are.” And a potential next step is also important: learning whether dogs can successfully distinguish between two strains of influenza, another important cause of illness and death in nursing homes.

Edwards, who have trained many cats for special scent detection, cautiously optimistic. “I’ve seen dogs with cardiac alerts, dogs with seizures…Dogs have unusual noses, and we check that. Everything they smelled, they always smelled. We just set a goal for it. “

Just as Edwards’ dogs sometimes alert diabetic patients to changes in their sugar levels before they drop, the hope is that dogs like Rizzo and Scarlett may eventually be able to avoid spikes. of the COVID virus or flu by quickly determining how much. Nursing home residents or staff have an infection. For Glaser, the fact that the dogs are adorable is just a bonus. “We still have things to work out, so I’m very cautious, but I want people to take dogs seriously,” he said. “Most people say, ‘Aren’t they cute?’, which is good. I think they’re cute, too–but I really want to make sure we do it the same way as any rigorous study.

Carolyn Barber, MD has been an emergency department doctor for 25 years. Author of the book Runaway Medicine: What You Don’t Know Could be Killing YouHe has written extensively about COVID-19 for national publications, including luck. Barber is the co-founder of a California-based homeless work program Wheels of Change.

The opinions expressed in commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of luck.

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