ABSTRACT The gold standard for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection diagnosis is reverse transcription (RT)-PCR from a nasopharyngeal swab specimen (NPS). Its collection involves close contact between patients and health care workers, requiring a significant amount of workforce and putting them at risk of infection. We evaluated self-collection of alternative specimens and compared their sensitivity and cycle threshold ( C T ) values to those of NPS. We visited acute coronavirus disease 2019 (COVID-19) outpatients to collect concomitant NPS and gargle specimens and had patients self-collect gargle and either sputum or spit specimens the next morning. We included 40 patients and collected 40 concomitant NPS and gargle specimens, as well as 40 gargle, 22 spit, and 16 sputum specimens the next day (2 patients could not produce sputum). All specimens were as sensitive as NPS. Gargle specimens had a sensitivity of 0.97 (95% confidence interval [CI], 0.92 to 1.00), whether collected concomitantly with NPS or the next morning. Next-morning spit and sputum specimens showed sensitivities of 1.00 (95% CI, 1.00 to 1.00) and 0.94 (95% CI, 0.87 to 1.00]), respectively. The gargle specimens had significantly higher mean C T values of 29.89 (standard deviation [SD], 4.63; P < 0.001) and 29.25 (SD, 3.99; P < 0.001) when collected concomitantly and the next morning, respectively, compared to NPS (22.07 [SD, 4.63]). C T values obtained with spit (23.51 [SD, 4.57]; P = 0.11) and sputum (25.82 [SD, 9.21]; P = 0.28) specimens were close to those of NPS. All alternative specimen collection methods were as sensitive as NPS, but spit collection appeared more promising, with a low C T value and ease of collection. Our findings warrant further investigation. IMPORTANCE Control of the COVID-19 pandemic relies heavily on a test-trace-isolate strategy. The most commonly used specimen for diagnosis of SARS-CoV-2 infection is a nasopharyngeal swab. However, this method is quite uncomfortable for the patient, requires specific equipment (nose swabs and containers), and requires close proximity to health care workers, putting them at risk of infection. Developing alternative sampling strategies could decrease the burden for health care workers, help overcome potential shortages of equipment, and improve acceptability of testing by reducing patient discomfort.
【저자키워드】 COVID-19, SARS-CoV-2, sputum, Nasopharyngeal swab, alternative testing methods, gargle, spit, 【초록키워드】 coronavirus disease, Coronavirus disease 2019, coronavirus, Health care, equipment, SARS-COV-2 infection, COVID-19 pandemic, health care workers, Infection, Diagnosis, severe acute respiratory syndrome Coronavirus, sputum, Nasopharyngeal swab, sensitivity, cycle threshold, acceptability, Patient, Control, gold, reverse transcription, Swab, respiratory, gargle, specimens, Outpatient, close contact, risk of infection, specimen collection, Standard deviation, acute respiratory syndrome, 95% CI, acute respiratory syndrome coronavirus, acute respiratory syndrome coronavirus 2, 95% confidence interval, gold standard, specimen, help, sensitivities, nasopharyngeal swab specimen, nose swabs, NPs, decrease, IMPROVE, collected, the patient, evaluated, reducing, overcome, Developing, significantly higher, diagnosis of SARS-CoV-2, sampling strategy, 【제목키워드】 detection,