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

Maor, Elad; Tsur, Nir; Barkai, Galia; Meister, Ido; Makmel, Shmuel; Friedman, Eli; Aronovich, Daniel; Mevorach, Dana; Lerman, Amir; Zimlichman, Eyal; Bachar, Gideon

Objective To investigate the association of voice analysis with SARS-CoV-2 infection. Patients and methods A vocal biomarker, a unitless scalar with a value between 0-1, was developed based on 434 voice samples. The biomarker training was followed by a prospective, multi-center, observational study. All subjects were tested for SARS-CoV-2, had their voice recorded to a smartphone application and gave their informed consent to participate in the study. The association of SARS-CoV-2 infection with the vocal biomarker was evaluated. Results Final study population included 80 subjects with a median age of 29 [23-36], of whom 68% were men. Forty patients were positive for SARS-CoV-2. Infected patients were 12 times more likely to report at least one symptom (odds ratio 11.8, p<.001). The vocal biomarker was significantly higher among infected patients (0.11 [0.06-0.17] vs. 0.19 [0.12-0.3], p=.001). The area under the receiver operating characteristic curve (AUC) evaluating the association of the vocal biomarker with SARS-CoV-2 status was 72%. With a biomarker threshold of 0.115, the results translated to a sensitivity and specificity of 85% [95% CI: 70-94%] and 53% [95% CI: 36-69%], respectively. When added to a self-reported symptom classifier, the AUC significantly improved from 0.775 to 0.85. Conclusion Voice analysis is associated with SARS-CoV-2 status and holds the potential to improve the accuracy of self-reported symptom-based screening tools. This pilot study suggests a possible role for vocal biomarkers in screening for SARS-CoV-2 infected subjects.