Saliva is more sensitive for SARS-CoV-2 detection than nasopharyngeal swabs
Saliva is more sensitive for SARS-CoV-2 detection in COVID-19 patients than nasopharyngeal swabs


  
        
      , John Fournier, Arnau Casanovas-Massana, Melissa Campbell, Maria Tokuyama, Pavithra Vijayakumar, Bertie Geng, M. Catherine Muenker, Adam J. Moore, Chantal B.F. Vogels, Mary E. Petrone, Isabel M. Ott, Peiwen Lu, Arvind Venkataraman, Alice Lu-Culligan, Jonathan Klein, Rebecca Earnest, Michael Simonov, Rupak Datta, Ryan Handoko, Nida Naushad, Lorenzo R. Sewanan, Jordan Valdez, Elizabeth B. White, Sarah Lapidus, Chaney C. Kalinich, Xiaodong Jiang, Daniel J. Kim, Eriko Kudo, Melissa Linehan, Tianyang Mao, Miyu Moriyama, Ji Eun Oh, Annsea Park, Julio Silva, Eric Song, Takehiro Takahashi, Manabu Taura, Orr-El Weizman, Patrick Wong, Yexin Yang, Santos Bermejo, Camila Odio, Saad B. Omer, Charles S. Dela Cruz, Shelli Farhadian, Richard A. Martinello, Akiko Iwasaki, Nathan D. Grubaugh, Albert I. Ko
  
      doi: https://doi.org/10.1101/2020.04.16.20067835 
  
  
  


AbstractRapid and accurate SARS-CoV-2 diagnostic testing is essential for controlling the ongoing COVID-19 pandemic. The current gold standard for COVID-19 diagnosis is real-time RT-PCR detection of SARS-CoV-2 from nasopharyngeal swabs. Low sensitivity, exposure risks to healthcare workers, and global shortages of swabs and personal protective equipment, however, necessitate the validation of new diagnostic approaches. Saliva is a promising candidate for SARS-CoV-2 diagnostics because (1) collection is minimally invasive and can reliably be self-administered and (2) saliva has exhibited comparable sensitivity to nasopharyngeal swabs in detection of other respiratory pathogens, including endemic human coronaviruses, in previous studies. To validate the use of saliva for SARS-CoV-2 detection, we tested nasopharyngeal and saliva samples from confirmed COVID-19 patients and self-collected samples from healthcare workers on COVID-19 wards. When we compared SARS-CoV-2 detection from patient-matched nasopharyngeal and saliva samples, we found that saliva yielded greater detection sensitivity and consistency throughout the course of infection. Furthermore, we report less variability in self-sample collection of saliva. Taken together, our findings demonstrate that saliva is a viable and more sensitive alternative to nasopharyngeal swabs and could enable at-home self-administered sample collection for accurate large-scale SARS-CoV-2 testing.Competing Interest StatementThe authors have declared no competing interest.Funding StatementFunding sources had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding authors had full access to all data in the study and had final responsibility for the decision to submit for publication.Author DeclarationsAll relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.YesAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesFootnotes↵# Joint senior authorsData AvailabilityAll data generated and/or analysed during the current study are available from the corresponding author on reasonable request.
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