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      A Scalable, Easy-to-Deploy Protocol for Cas13-Based Detection of SARS-CoV-2 Genetic Material

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          Abstract

          The COVID-19 pandemic has created massive demand for widespread, distributed tools for detecting SARS-CoV-2 genetic material. The hurdles to scalable testing include reagent and instrument accessibility, availability of highly trained personnel, and large upfront investment.

          ABSTRACT

          The COVID-19 pandemic has created massive demand for widespread, distributed tools for detecting SARS-CoV-2 genetic material. The hurdles to scalable testing include reagent and instrument accessibility, availability of highly trained personnel, and large upfront investment. Here, we showcase an orthogonal pipeline we call CREST (Cas13-based, rugged, equitable, scalable testing) that addresses some of these hurdles. Specifically, CREST pairs commonplace and reliable biochemical methods (PCR) with low-cost instrumentation, without sacrificing detection sensitivity. By taking advantage of simple fluorescence visualizers, CREST allows a binary interpretation of results. CREST may provide a point-of-care solution to increase the distribution of COVID-19 surveillance.

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          Most cited references29

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          Virological assessment of hospitalized patients with COVID-2019

          Coronavirus disease 2019 (COVID-19) is an acute infection of the respiratory tract that emerged in late 20191,2. Initial outbreaks in China involved 13.8% of cases with severe courses, and 6.1% of cases with critical courses3. This severe presentation may result from the virus using a virus receptor that is expressed predominantly in the lung2,4; the same receptor tropism is thought to have determined the pathogenicity-but also aided in the control-of severe acute respiratory syndrome (SARS) in 20035. However, there are reports of cases of COVID-19 in which the patient shows mild upper respiratory tract symptoms, which suggests the potential for pre- or oligosymptomatic transmission6-8. There is an urgent need for information on virus replication, immunity and infectivity in specific sites of the body. Here we report a detailed virological analysis of nine cases of COVID-19 that provides proof of active virus replication in tissues of the upper respiratory tract. Pharyngeal virus shedding was very high during the first week of symptoms, with a peak at 7.11 × 108 RNA copies per throat swab on day 4. Infectious virus was readily isolated from samples derived from the throat or lung, but not from stool samples-in spite of high concentrations of virus RNA. Blood and urine samples never yielded virus. Active replication in the throat was confirmed by the presence of viral replicative RNA intermediates in the throat samples. We consistently detected sequence-distinct virus populations in throat and lung samples from one patient, proving independent replication. The shedding of viral RNA from sputum outlasted the end of symptoms. Seroconversion occurred after 7 days in 50% of patients (and by day 14 in all patients), but was not followed by a rapid decline in viral load. COVID-19 can present as a mild illness of the upper respiratory tract. The confirmation of active virus replication in the upper respiratory tract has implications for the containment of COVID-19.
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            Temporal dynamics in viral shedding and transmissibility of COVID-19

            We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infector-infectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. We estimated that 44% (95% confidence interval, 25-69%) of secondary cases were infected during the index cases' presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission.
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              Case-Fatality Rate and Characteristics of Patients Dying in Relation to COVID-19 in Italy

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                Author and article information

                Contributors
                Role: Editor
                Journal
                J Clin Microbiol
                J Clin Microbiol
                jcm
                jcm
                JCM
                Journal of Clinical Microbiology
                American Society for Microbiology (1752 N St., N.W., Washington, DC )
                0095-1137
                1098-660X
                21 January 2021
                19 March 2021
                April 2021
                19 March 2021
                : 59
                : 4
                : e02402-20
                Affiliations
                [a ]University of California, Santa Barbara, Department of Molecular, Cellular, and Developmental Biology, Santa Barbara, California, USA
                [b ]Neuroscience Research Institute, University of California, Santa Barbara, Santa Barbara, California, USA
                [c ]Center for BioEngineering, University of California, Santa Barbara, Santa Barbara, California, USA
                St. Jude Children's Research Hospital
                Author notes
                Address correspondence to Diego Acosta-Alvear, daa@ 123456lifesci.ucsb.edu , or Maxwell Z. Wilson, mzw@ 123456ucsb.edu .

                Jennifer N. Rauch and Eric Valois contributed equally to this work. Jennifer N. Rauch was the primary lead regarding data collection and so is listed first. Diego Acosta-Alvear and Maxwell Z. Wilson are co-senior authors.

                For a companion article on this topic, see https://doi.org/10.1128/JCM.02403-20.

                Citation Rauch JN, Valois E, Solley SC, Braig F, Lach RS, Audouard M, Ponce-Rojas JC, Costello MS, Baxter NJ, Kosik KS, Arias C, Acosta-Alvear D, Wilson MZ. 2021. A scalable, easy-to-deploy protocol for Cas13-based detection of SARS-CoV-2 genetic material. J Clin Microbiol 59:e02402-20. https://doi.org/10.1128/JCM.02402-20.

                Author information
                https://orcid.org/0000-0002-1139-8486
                https://orcid.org/0000-0003-0768-7004
                Article
                02402-20
                10.1128/JCM.02402-20
                8092748
                33478979
                fc40114f-0cdf-472b-821b-987478a152f3
                Copyright © 2021 Rauch et al.

                This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.

                This article is made available via the PMC Open Access Subset for unrestricted noncommercial re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                History
                : 16 September 2020
                : 2 December 2020
                : 10 January 2021
                Page count
                Figures: 5, Tables: 0, Equations: 0, References: 32, Pages: 8, Words: 4800
                Categories
                Virology
                Custom metadata
                April 2021

                Microbiology & Virology
                crispr,cas13,covid-19,point of care,sars-cov-2,testing
                Microbiology & Virology
                crispr, cas13, covid-19, point of care, sars-cov-2, testing

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