The Report on China-Spain Joint Clinical Testing for Rapid COVID-19 Risk Screening by Eye-region Manifestations (preprint)

BackgroundThe worldwide surge in coronavirus cases has led to the COVID-19 testing demand surge. Rapid, accurate, and cost-effective COVID-19 screening tests working at a population level are in imperative demand globally. MethodsBased on the eye symptoms of COVID-19, we developed and tested a COVID-19 rapid prescreening model using the eye-region images captured in China and Spain with cellphone cameras. The convolutional neural networks (CNNs)-based model was trained on these eye images to complete binary classification task of identifying the COVID-19 cases. The performance was measured using area under receiver-operating-characteristic curve (AUC), sensitivity, specificity, accuracy, and F1. The application programming interface was open access. FindingsThe multicenter study included 2436 pictures corresponding to 657 subjects (155 COVID-19 infection, 23{middle dot}6%) in development dataset (train and validation) and 2138 pictures corresponding to 478 subjects (64 COVID-19 infections, 13{middle dot}4%) in test dataset. The image-level performance of COVID-19 prescreening model in the China-Spain multicenter study achieved an AUC of 0{middle dot}913 (95% CI, 0{middle dot}898-0{middle dot}927), with a sensitivity of 0{middle dot}695 (95% CI, 0{middle dot}643-0{middle dot}748), a specificity of 0{middle dot}904 (95% CI, 0{middle dot}891 -0{middle dot}919), an accuracy of 0{middle dot}875(0{middle dot}861-0{middle dot}889), and a F1 of 0{middle dot}611(0{middle dot}568-0{middle dot}655). InterpretationThe CNN-based model for COVID-19 rapid prescreening has reliable specificity and sensitivity. This system provides a low-cost, fully self-performed, non-invasive, real-time feedback solution for continuous surveillance and large-scale rapid prescreening for COVID-19. FundingThis project is supported by Aimomics (Shanghai) Intelligent

The Report on China-Spain Joint Clinical Testing for Rapid COVID-19 Risk Screening by Eye-region Manifestations (preprint)

Background: The worldwide surge in coronavirus cases has led to the COVID-19 testing demand surge. Rapid, accurate, and cost-effective COVID-19 screening tests working at a population level are in imperative demand globally. Methods: Based on the eye symptoms of COVID-19, we developed and tested a COVID-19 rapid prescreening model using the eye-region images captured in China and Spain with cellphone cameras. The convolutional neural networks (CNNs)-based model was trained on these eye images to complete binary classification task of identifying the COVID-19 cases. The performance was measured using area under receiver-operating-characteristic curve (AUC), sensitivity, specificity, accuracy, and F1. The application programming interface was open access. Findings: The multicenter study included 2436 pictures corresponding to 657 subjects (155 COVID-19 infection, 23.6%) in development dataset (train and validation) and 2138 pictures corresponding to 478 subjects (64 COVID-19 infections, 13.4%) in test dataset. The image-level performance of COVID-19 prescreening model in the China-Spain multicenter study achieved an AUC of 0.913 (95% CI, 0.898-0.927), with a sensitivity of 0.695 (95% CI, 0.643-0.748), a specificity of 0.904 (95% CI, 0.891 -0.919), an accuracy of 0.875(0.861-0.889), and a F1 of 0.611(0.568-0.655). Interpretation: The CNN-based model for COVID-19 rapid prescreening has reliable specificity and sensitivity. This system provides a low-cost, fully self-performed, non-invasive, real-time feedback solution for continuous surveillance and large-scale rapid prescreening for COVID-19. Funding: This project is supported by Aimomics (Shanghai) Intelligent

Rapid COVID-19 Risk Screening by Eye-region Manifestations (preprint)

It is still nontrivial to develop a new fast COVID-19 screening method with the easier access and lower cost, due to the technical and cost limitations of the current testing methods in the medical resource-poor districts. On the other hand, there are more and more ocular manifestations that have been reported in the COVID-19 patients as growing clinical evidence[1]. This inspired this project. We have conducted the joint clinical research since January 2021 at the ShiJiaZhuang City, Heibei province, China, which approved by the ethics committee of The fifth hospital of ShiJiaZhuang of Hebei Medical University. We undertake several blind tests of COVID-19 patients by Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Meantime as an important part of the ongoing globally COVID-19 eye test program by AIMOMICS since February 2020, we propose a new fast screening method of analyzing the eye-region images, captured by common CCD and CMOS cameras. This could reliably make a rapid risk screening of COVID-19 with the sustainable stable high performance in different countries and races. Our model for COVID-19 rapid prescreening have the merits of the lower cost, fully self-performed, non-invasive, importantly real-time, and thus enables the continuous health surveillance. We further implement it as the open accessible APIs, and provide public service to the world. Our pilot experiments show that our model is ready to be usable to all kinds of surveillance scenarios, such as infrared temperature measurement device at airports and stations, or directly pushing to the target people groups smartphones as a packaged application.

DABC-Net for robust pneumonia segmentation and prediction of COVID-19 progression on chest CT scans (preprint)

Currently, reliable, robust and ready-to-use CT-based tools for prediction of COVID-19 progression are still lacking. To address this problem, we present DABC-Net, a novel deep learning (DL) tool that combines a 2D U-net for intra-slice spatial information processing, and a recurrent LSTM network to leverage inter-slice context, for automatic volumetric segmentation of lung and pneumonia lesions. We evaluate DABC-Net on more than 10,000 radiologists-labeled CT slices from four different cohorts. Compared to state-of-the-art segmentation tools, DABC-Net is much faster, more robust, and able to estimate segmentation uncertainty. Based only on the first two CT scans within 3 days after admission from 656 longitudinal CT scans, the AUC of our DBAC-Net for disease progression prediction reaches 93%. We release our tool as a GUI for patient-specific prediction of pneumonia progression, to provide clinicians with additional assistance to triage patients at early days after the diagnosis and to optimize the assignment of limited medical resources, which is of particular importance in current critical COVID-19 pandemic.

M3Lung-Sys: A Deep Learning System for Multi-Class Lung Pneumonia Screening from CT Imaging (preprint)

To counter the outbreak of COVID-19, the accurate diagnosis of suspected cases plays a crucial role in timely quarantine, medical treatment, and preventing the spread of the pandemic. Considering the limited training cases and resources (e.g, time and budget), we propose a Multi-task Multi-slice Deep Learning System (M3Lung-Sys) for multi-class lung pneumonia screening from CT imaging, which only consists of two 2D CNN networks, i.e., slice- and patient-level classification networks. The former aims to seek the feature representations from abundant CT slices instead of limited CT volumes, and for the overall pneumonia screening, the latter one could recover the temporal information by feature refinement and aggregation between different slices. In addition to distinguish COVID-19 from Healthy, H1N1, and CAP cases, our M 3 Lung-Sys also be able to locate the areas of relevant lesions, without any pixel-level annotation. To further demonstrate the effectiveness of our model, we conduct extensive experiments on a chest CT imaging dataset with a total of 734 patients (251 healthy people, 245 COVID-19 patients, 105 H1N1 patients, and 133 CAP patients). The quantitative results with plenty of metrics indicate the superiority of our proposed model on both slice- and patient-level classification tasks. More importantly, the generated lesion location maps make our system interpretable and more valuable to clinicians.

A New Screening Method for COVID-19 based on Ocular Feature Recognition by Machine Learning Tools (preprint)

The Coronavirus disease 2019 (COVID-19) has affected several million people. With the outbreak of the epidemic, many researchers are devoting themselves to the COVID-19 screening system. The standard practices for rapid risk screening of COVID-19 are the CT imaging or RT-PCR (real-time polymerase chain reaction). However, these methods demand professional efforts of the acquisition of CT images and saliva samples, a certain amount of waiting time, and most importantly prohibitive examination fee in some countries. Recently, some literatures have shown that the COVID-19 patients usually accompanied by ocular manifestations consistent with the conjunctivitis, including conjunctival hyperemia, chemosis, epiphora, or increased secretions. After more than four months study, we found that the confirmed cases of COVID-19 present the consistent ocular pathological symbols; and we propose a new screening method of analyzing the eye-region images, captured by common CCD and CMOS cameras, could reliably make a rapid risk screening of COVID-19 with very high accuracy. We believe a system implementing such an algorithm should assist the triage management or the clinical diagnosis. To further evaluate our algorithm and approved by the Ethics Committee of Shanghai public health clinic center of Fudan University, we conduct a study of analyzing the eye-region images of 303 patients (104 COVID-19, 131 pulmonary, and 68 ocular patients), as well as 136 healthy people. Remarkably, our results of COVID-19 patients in testing set consistently present similar ocular pathological symbols; and very high testing results have been achieved in terms of sensitivity and specificity. We hope this study can be inspiring and helpful for encouraging more researches in this topic.

A New Screening Method for COVID-19 based on Ocular Feature Recognition by Machine Learning Tools (preprint)

The Coronavirus disease 2019 (COVID-19) has affected several million people. With the outbreak of the epidemic, many researchers are devoting themselves to the COVID-19 screening system. The standard practices for rapid risk screening of COVID-19 are the CT imaging or RT-PCR (real-time polymerase chain reaction). However, these methods demand professional efforts of the acquisition of CT images and saliva samples, a certain amount of waiting time, and most importantly prohibitive examination fee in some countries. Recently, some literatures have shown that the COVID-19 patients usually accompanied by ocular manifestations consistent with the conjunctivitis, including conjunctival hyperemia, chemosis, epiphora, or increased secretions. After more than four months study, we found that the confirmed cases of COVID-19 present the consistent ocular pathological symbols; and we propose a new screening method of analyzing the eye-region images, captured by common CCD and CMOS cameras, could reliably make a rapid risk screening of COVID-19 with very high accuracy. We believe a system implementing such an algorithm should assist the triage management or the clinical diagnosis. To further evaluate our algorithm and approved by the Ethics Committee of Shanghai public health clinic center of Fudan University, we conduct a study of analyzing the eye-region images of 303 patients (104 COVID-19, 131 pulmonary, and 68 ocular patients), as well as 136 healthy people. Remarkably, our results of COVID-19 patients in testing set consistently present similar ocular pathological symbols; and very high testing results have been achieved in terms of sensitivity and specificity. We hope this study can be inspiring and helpful for encouraging more researches in this topic.

Clinical characteristics and prognostic factors of 148 COVID-19 cases in a secondary epidemic area (preprint)

Background: COVID-19 has rapidly spread worldwide; however, the prognostic factors of COVID-19 have not been well described. Based on the prospective medical records in a secondary epidemic area, we examined the epidemiological, clinical characteristics, and explored the prognostic factors of COVID-19 patients. Methods: This retrospective, multi-center cohort study included consecutive cases with laboratory-confirmed COVID-19 from January 22 to February 22, 2020 in Wenzhou, China. All cases were followed up to discharge, death, or up to March 16, 2020. Demographic, clinical, laboratory, treatment, and prognosis data were extracted with standardized form, and compared between severe and non-severe cases. Logistic regression and Cox regression were used to explore the factors associated with ICU admission and hospital stay, respectively. Results: The epidemic curve showed that the duration of the whole epidemic in this secondary epidemic area was relatively short. Of the 148 included cases, 29 were severe cases. The median age was 52 years (range, 10–93 years), 62.2% were male, and 60.8% were overweight or obese. Fever (81.8%) and cough (61.5%) were the most common symptoms. Importantly, 25.0% had no clear contact history. The median length of hospital stay was 20 days (95%CI: 19–21), and 5.4% of patients were admitted to ICU, and one patient died. Compared with the non-severe cases, the severe patients were older, had a longer hospital stay, and had higher proportions of smoking, laboratory abnormalities, and ICU risk. Elevated alanine aminotransferase was independently associated with ICU admission; however, type of antiviral drugs had no significant association with duration of hospital stay. Older age, faster respiratory rate, smoking, and comorbidity tended to have higher risk of ICU admission and longer duration of hospital stay. Conclusions: The second-generation cases had atypical symptoms, and one quarter of cases had no clear contact history with cases, indicating the importance of strict preventive and control measures. Abnormal liver function, faster respiratory rate and smoking may be associated with worse prognosis of COVID-19; however, there was no convincing evidence for an association between antiviral therapy and length of hospital stay.