Summary Background Since the coronavirus disease 2019 outbreak began in the Chinese city of Wuhan on Dec 31, 2019, 68 imported cases and 175 locally acquired infections have been reported in Singapore. We aimed to investigate options for early intervention in Singapore should local containment (eg, preventing disease spread through contact tracing efforts) be unsuccessful. Methods We adapted an influenza epidemic simulation model to estimate the likelihood of human-to-human transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a simulated Singaporean population. Using this model, we estimated the cumulative number of SARS-CoV-2 infections at 80 days, after detection of 100 cases of community transmission, under three infectivity scenarios (basic reproduction number [R0] of 1·5, 2·0, or 2·5) and assuming 7·5% of infections are asymptomatic. We first ran the model assuming no intervention was in place (baseline scenario), and then assessed the effect of four intervention scenarios compared with a baseline scenario on the size and progression of the outbreak for each R0 value. These scenarios included isolation measures for infected individuals and quarantining of family members (hereafter referred to as quarantine); quarantine plus school closure; quarantine plus workplace distancing; and quarantine, school closure, and workplace distancing (hereafter referred to as the combined intervention). We also did sensitivity analyses by altering the asymptomatic fraction of infections (22·7%, 30·0%, 40·0%, and 50·0%) to compare outbreak sizes under the same control measures. Findings For the baseline scenario, when R0 was 1·5, the median cumulative number of infections at day 80 was 279 000 (IQR 245 000–320 000), corresponding to 7·4% (IQR 6·5–8·5) of the resident population of Singapore. The median number of infections increased with higher infectivity: 727 000 cases (670 000–776 000) when R0 was 2·0, corresponding to 19·3% (17·8–20·6) of the Singaporean population, and 1 207 000 cases (1 164 000–1 249 000) when R0 was 2·5, corresponding to 32% (30·9–33·1) of the Singaporean population. Compared with the baseline scenario, the combined intervention was the most effective, reducing the estimated median number of infections by 99·3% (IQR 92·6–99·9) when R0 was 1·5, by 93·0% (81·5–99·7) when R0 was 2·0, and by 78·2% (59·0 −94·4) when R0 was 2·5. Assuming increasing asymptomatic fractions up to 50·0%, up to 277 000 infections were estimated to occur at day 80 with the combined intervention relative to 1800 for the baseline at R0 of 1·5. Interpretation Implementing the combined intervention of quarantining infected individuals and their family members, workplace distancing, and school closure once community transmission has been detected could substantially reduce the number of SARS-CoV-2 infections. We therefore recommend immediate deployment of this strategy if local secondary transmission is confirmed within Singapore. However, quarantine and workplace distancing should be prioritised over school closure because at this early stage, symptomatic children have higher withdrawal rates from school than do symptomatic adults from work. At higher asymptomatic proportions, intervention effectiveness might be substantially reduced requiring the need for effective case management and treatments, and preventive measures such as vaccines. Funding Singapore Ministry of Health, Singapore Population Health Improvement Centre.

Interventions to mitigate early spread of SARS-CoV-2 in Singapore: a modelling study

The advancement of digital biomarkers and the provision of remote healthcare has greatly progressed during the coronavirus-19 global pandemic. Combining voice/speech data with artificial intelligence and machine-based learning offers a novel solution to the growing demand for telemedicine. Voice biomarkers, obtained from the extraction of characteristic acoustic and linguistic features, are associated with a variety of diseases and even coronavirus disease-2019. In the current review we i) describe the basis upon which digital voice biomarkers could facilitate “telemedicine,” ii) discuss potential mechanisms that may explain the association between voice biomarkers and disease, iii) offer a novel classification system to conceptualize voice biomarkers depending upon different methods for recording and analyzing voice/speech samples, iv) outline evidence demonstrating an association between voice biomarkers and a number of disease states, and v) describe the process of developing a voice biomarker from recording and storing voice samples and extracting relevant acoustic and linguistic features to training and testing deep and machine based learning algorithms to detect disease. We further explore several important future considerations in this area of research, including the necessity for clinical trials and importance of safeguarding data and individual privacy. To this end, we searched Pubmed and Google Scholar to identify studies evaluating the relationship between voice/speech features and biomarkers and various diseases. Search terms included “digital biomarker,” “telemedicine,” “voice features,” “voice biomarker,” “speech features,” “speech biomarkers,” “acoustics,” “linguistics,” “cardiovascular disease,” “neurologic disease,” “psychiatric disease,” and “infectious disease.” The search was limited to studies published in English in peer-reviewed journals between 1980 and the present day. To identify potential studies not captured by our database search strategy, we also searched studies listed in the bibliography of relevant publications and reviews.

https://api.elsevier.com/content/article/pii/S0025619623001301

Guess What We Can Hear – Novel Voice Biomarkers for the Remote Detection of Disease

The COVID-19 pandemic has resulted in enormous costs to our society. Besides finding medicines to treat those infected by the virus, it is important to find effective and efficient strategies to prevent the spreading of the disease. One key factor to prevent transmission is to identify COVID-19 biomarkers that can be used to develop an efficient, accurate, noninvasive, and self-administered screening procedure. Several COVID-19 variants cause significant respiratory symptoms, and thus a voice signal may be a potential biomarker for COVID-19 infection.This study investigated the effectiveness of different phonemes and a range of voice features in differentiating people infected by COVID-19 with respiratory tract symptoms.This cross-sectional, longitudinal study recorded six phonemes (i.e., /a/, /e/, /i/, /o/, /u/, and /m/) from 40 COVID-19 patients and 48 healthy subjects for 22 days. The signal features were obtained for the recordings, which were statistically analyzed and classified using Support Vector Machine (SVM).The statistical analysis and SVM classification show that the voice features related to the vocal tract filtering (e.g., MFCC, VTL, and formants) and the stability of the respiratory muscles and lung volume (Intensity-SD) were the most sensitive to voice change due to COVID-19. The result also shows that the features extracted from the vowel /i/ during the first 3 days after admittance to the hospital were the most effective. The SVM classification accuracy with 18 ranked features extracted from /i/ was 93.5% (with F1 score of 94.3%).A measurable difference exists between the voices of people with COVID-19 and healthy people, and the phoneme /i/ shows the most pronounced difference. This supports the potential for using computerized voice analysis to detect the disease and consider it a biomarker. 

Voice Features of Sustained Phoneme as COVID-19 Biomarker

Background: The integration of edge computing into smart healthcare systems requires the development of computationally efficient models and methodologies for monitoring and detecting patients’ healthcare statuses. In this context, mobile devices, such as smartphones, are increasingly employed for the purpose of aiding diagnosis, treatment, and monitoring. Notably, smartphones are widely pervasive and readily accessible to a significant portion of the population. These devices empower individuals to conveniently record and submit voice samples, thereby potentially facilitating the early detection of vocal irregularities or changes. This research focuses on the creation of diverse machine learning frameworks based on vocal samples captured by smartphones to distinguish between pathological and healthy voices. Methods: The investigation leverages the publicly available VOICED dataset, comprising 58 healthy voice samples and 150 samples from voices exhibiting pathological conditions, and machine learning techniques for the classification of healthy and diseased patients through the employment of Mel-frequency cepstral coefficients. Results: Through cross-validated two-class classification, the fine k-nearest neighbor exhibited the highest performance, achieving an accuracy rate of 98.3% in identifying healthy and pathological voices. Conclusions: This study holds promise for enabling smartphones to effectively identify vocal disorders, offering a multitude of advantages for both individuals and healthcare systems, encompassing heightened accessibility, early detection, and continuous monitoring. 

Assessment of Voice Disorders Using Machine Learning and Vocal Analysis of Voice Samples Recorded through Smartphones

Background: The COVID-19 pandemic has resulted in enormous costs to our society. Besides finding medicines to treat those infected by the virus, it is important to find effective and efficient strategies to prevent the spreading of the disease. One key factor to prevent transmission is to identify COVID-19 biomarkers that can be used to develop an efficient, accurate, noninvasive, and self-administered screening procedure. Several COVID-19 variants cause significant respiratory symptoms, and thus a voice signal may be a potential biomarker for COVID-19 infection. Aim: This study investigated the effectiveness of different phonemes and a range of voice features in differentiating people infected by COVID-19 with respiratory tract symptoms. Method: This cross-sectional, longitudinal study recorded six phonemes (i.e., /a/, /e/, /i/, /o/, /u/, and /m/) from 40 COVID-19 patients and 48 healthy subjects for 22 days. The signal features were obtained for the recordings, which were statistically analyzed and classified using Support Vector Machine (SVM). Results: The statistical analysis and SVM classification show that the voice features related to the vocal tract filtering (e.g., MFCC, VTL, and formants) and the stability of the respiratory muscles and lung volume (Intensity-SD) were the most sensitive to voice change due to COVID-19. The result also shows that the features extracted from the vowel /i/ during the first 3 days after admittance to the hospital were the most effective. The SVM classification accuracy with 18 ranked features extracted from /i/ was 93.5% (with F1 score of 94.3%). Conclusion: A measurable difference exists between the voices of people with COVID-19 and healthy people, and the phoneme /i/ shows the most pronounced difference. This supports the potential for using computerized voice analysis to detect the disease and consider it a biomarker.

Non-invasive Vocal Biomarker is Associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection.

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Non-invasive Vocal Biomarker is Associated with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection.