Final Summary Report< Breath Omics for the COVID-19: Virus Detection and AI Diagnosis >

1.　Abstract
　　　・SARS-CoV-2 was detected in the exhaled breath condensate (EBC) obtained from COVID-19 patients via PCR and proteome analyses.
　　　・Higher amounts of virus were released in the EBC during vocally breathing, compared to the regularly breathing of COVID-19 patients.
　　　・EBC was useful not only for COVID-19 diagnosis but also for biomarker development allowing a precise assessment of disease severity and prognosis.
2.　Results
　　A)　Purpose
　　　・Detection SARS-CoV-2 in EBC obtained from COVID-19 patients of mild and moderate severity.
　　　・Impacts of different breathing conditions (e.g. with no voice, small voice, singing voice and loud voice) on viral recovery in EBC.
　　　・Exploration of biomarkers for estimating host defense activity and disease severity by newly developed breath omics technology.
　　B)　Method
　　　・PCR analysis for SARS-CoV-2 was conducted with EBC obtained from COVID-19 patients of mild or moderate severity.
　　　・Breath omics was performed for COVID-19 to see the metabolic and inflammatory responses with the EBC recovered from COVID-19 patients.
　　C)　Outcome
　　　・A larger number of virus was detected in the vocally breathing than in regular deeply breathing, suggesting the vocalization is a high risk condition to spread the virus to the surrounding environment that will be thereby accelerating the coronavirus pandemic.
　　　・The PCR analyses of breath aerosols non-invasively obtained was found to be highly useful to identify the spreaders of the coronavirus, and therefore extremely effective to prevent the airborne infection and COVID-19 epidemic.
　　　・The EBC levels of newly identified metabolites are significantly elevated in the patients suffering from pneumonia.
　　　・There is a particular breath metabolite that will be a useful biomarker for diagnosis of disease progression.
　　D)　Consideration
　　　・Optimize analytical methods to improve diagnostic accuracy and sensitivity for false negative cases.
　　　・Exploration of biomarkers for estimating host defense activity and disease severity by newly developed breath omics technology.
　　　・Acquire biomarkers for diagnosis of pneumonia and cytokine storm and prediction of prognosis.
　　　・Increase clinical case number for EBC analysis and integrate the EBC profiles with clinical information and genome information to establish AI diagnostics based on the breath omics.

■　SARS-CoV-2 was detected in the exhaled breath condensate (EBC) obtained from COVID-19 patients via PCR and proteome analyses.
■　Higher amounts of virus were released in the EBC during vocally breathing, compared to the regularly breathing of COVID-19 patients.
■　EBC was useful not only for COVID-19 diagnosis but also for biomarker development allowing a precise assessment of disease severity and prognosis.
【Goals and Achievements】
・Detection SARS-CoV-2 in exhaled breath condensates (EBC) obtained from COVID-19 patients of mild and moderate severity
・Impacts of different breathing conditions (e.g. with no voice, small voice, singing voice and loud voice) on the recovery of viral particles in EBC
・Exploration of biomarkers for estimating host defense activity and disease severity by newly developed breath omics technology

The exhaled virus was detected in COVID-19 patients and was examined to see the difference between regular breathing and vocalization.

PCR analysis for SARS-CoV-2 was conducted with EBC obtained from COVID-19 patients of mild or moderate severity.

【Results】
・A preliminary qualitative analysis showed that all 6 breath PCR-positive cases coincided with positive reactions under vocalization.
・Further quantitative study showed that much more virus was exhaled by vocalization, and a particular case blasted out a huge amount of virus, which is estimated as much as thousands of virus only in one time breath.

【Conclusions】
・A larger number of virus was detected in the vocally breathing than in regular deeply breathing, suggesting the vocalization is a high risk condition to spread the virus to the surrounding environment that will be thereby accelerating the coronavirus pandemic.
・The PCR analyses of breath aerosols non-invasively obtained was found to be highly useful to identify the spreaders of the coronavirus, and therefore extremely effective to prevent the airborne infection and COVID-19 epidemic.

【Background】
We discovered so far a series of new metabolites that can be a good biomarker for inflammatory response in the lungs. Breath omics was performed for COVID-19 to see the metabolic and inflammatory responses with the EBC recovered from COVID-19 patients. This new omics technology developed herein is found to be potentially applicable for the anti-COVID strategy to finally eradicate the pandemic worldwide.

【Interpretation】
・The EBC levels of newly identified metabolites are significantly elevated in the patients suffering from pneumonia.
・There is a particular breath metabolite that will be a useful biomarker for diagnosis of disease progression.

・Optimize analytical methods to improve diagnostic accuracy and sensitivity for false negative cases.

・Exploration of biomarkers for estimating host defense activity and disease severity by newly developed breath omics technology.

・Acquire biomarkers for diagnosis of pneumonia and cytokine storm and prediction of prognosis.

・Increase clinical case number for EBC analysis and integrate the EBC profiles with clinical information and genome information to establish AI diagnostics based on the breath omics.