Real-world Evaluation of a Sample Pooling Strategy for Large-Scale Rapid COVID-19 Testing

Background: The worldwide outbreak of COVID-19 has become a public health crisis of unprecedented proportions. The fast spread of emerging variants increases the needs of rapid diagnostic and screening testing. Sample pooling efficiently expands the testing capacity under limited resources. Objectives: We evaluated the performance of sample pooling on the Point-of-Care (POC) Liat (R) and cobas (R) 6800 systems and provided real-world experiences for implementing these systems in large-scale screenings. Methods: Positive nasopharyngeal (NP) specimens with Ct values < 25, 25-30 or > 30 were tested individually and in pools to optimize the POC Liat (R) and cobas (R) 6800 systems, which were then implemented in community screenings. Results: The 5-sample pooling strategy did not affect the positive detection rates on Liat (R) or cobas (R) 6800 in samples with Ct values <25 or 25-30. However, in samples with low viral loads (Ct values >30), five-sample pooling has a higher positive detection rate on POC Liat (R) (20/20; 100%), compared to cobas (R) 6800 (9/20; 45%). Five-sample pooled on POC Liat (R) and two-sample pooled on cobas (R) 6800 appear to be appropriate for SARS-CoV-2 detection. By implementing the pooling strategies in two large-scale community screenings, 7,606 NP specimens was tested within 36 h; the average turn-around time was 4.8 h for cobas (R) 6800 and 1.3 h for POC Liat (R). Eight positive specimens (0.11%; 8/7,606) were identified, with Ct values ranging from 18.85 to 37.68. Conclusion: The performance of sample pooling on POC Liat (R) was demonstrated to be an effective, accurate, and economical approach for large-scale community screenings for COVID-19.