Saliva is less sensitive than nasopharyngeal swabs for COVID-19 detection in the community setting

  1. David Becker
  2. Efren Sandoval
  3. Aakash Amin
  4. Peter De Hoff
  5. Amberly Diets
  6. Nicole Leonetti
  7. Yan Wei Lim
  8. Christie Elliott
  9. Louise Laurent
  10. Joseph Grzymski
  11. James Lu

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Abstract

The use of saliva collection for SARS-CoV-2 diagnostics in the ambulatory setting provides several advantages when compared to nasopharyngeal swabs (NPS), including ease of self-collection and reduced use of personal protective equipment (PPE). In addition saliva collection could be advantageous in advising if a convalescent patient is able to return to work after a period of self-quarantine. We investigated the utility of saliva collection in the community setting at Renown Health in a prospective Diagnostic Cohort of 88 patients and in a Convalescent Cohort of 24 patients. In the Diagnostic Cohort, we find that saliva collection has reduced sensitivity (~30% less) relative than NPS. And in our convalescent cohort of patients greater than 8 days and less than 21 days from first symptom, we find that saliva has ~ 50% sensitivity relative to NPS. Our results suggest that rigorous studies in the intended populations should be performed before large-scale screening using saliva as the test matrix is initiated.

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  1. ScreenIT

    SciScore for 10.1101/2020.05.11.20092338: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationFor the first 60 specimens, patients were randomized to either tube.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: Thank you for sharing your data.

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The limitations of this study include the lack of detailed clinical information about participating patients; we did not attempt to correlate clinical characteristics with test outcomes. Further investigation and confirmation of this study is warranted. We acknowledge that alternative saliva collection methods with different preservation solutions, different extraction chemistries, or use of a more sensitive COVID-19 assay may yield better results in mildly symptomatic patients in the community setting. We are hopeful that further studies of these variables will provide an alternative collection system for testing mildly symptomatic or convalescent patients in the community setting. Our results suggest that rigorous studies in the intended populations should be performed before large-scale screening using saliva as the test matrix is initiated.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.1101/2020.05.11.20092338 on medRxiv