Abstract
Efficient, wide-scale testing for SARS-CoV-2 is crucial for monitoring the incidence of the infection in the community. The gold standard for COVID-19 diagnosis is the molecular analysis of epithelial secretions from the upper respiratory system captured by nasopharyngeal (NP) or oropharyngeal swabs. Given the ease of collection, saliva has been proposed as a possible substitute to support testing at the population level. Here, we used a novel saliva collection device designed to favour the safe and correct acquisition of the sample, as well as the processivity of the downstream molecular analysis. We tested 1003 nasopharyngeal swabs and paired saliva samples self-collected by individuals recruited at a public drive-through testing facility. An overall moderate concordance (68%) between the two tests was found, with evidence that neither system can diagnose the infection in 100% of the cases. While the two methods performed equally well in symptomatic individuals, their discordance was mainly restricted to samples from convalescent subjects. The saliva test was at least as effective as NP swabs in asymptomatic individuals recruited for contact tracing. Our study describes a testing strategy of self-collected saliva samples, which is reliable for wide-scale COVID-19 screening in the community and is particularly effective for contact tracing.
Highlights
Some individuals were tested because they presented with respiratory symptoms, others had already been diagnosed with COVID-19 and they were tested to confirm their recovery, others were tested for contact tracing and, a group of healthcare operators was undergoing regular, routine screening (Table 1)
Standard 13 mm × 80 mm tubes already widely used for saliva collection device was first designed
Standard 13 mm × 80 mm tubes already widely collecting nasopharyngeal swabs were equipped with an insert functioning as a straw for used for collecting nasopharyngeal swabs were equipped with an insert functioning as a the deposition of saliva (Figure 1a)
Summary
SARS-CoV-2, the coronavirus causing COVID-19, has spread in all continents since the end of 2019, quickly becoming pandemic. The infection causes a respiratory syndrome which can be lethal, especially in individuals affected by other pathologies and in the elderly population. The widespread diffusion of the virus exposed the healthcare systems worldwide to an unprecedented pressure, quickly overpowering hospitals and healthcare professionals. In order to control the spread of the virus, to protect the individuals most at risk and to preserve the functionality of the healthcare system, the capability to promptly track the presence of SARS-CoV-2 in the community remains critical [1]
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