Acceptability of OP/Na swabbing for SARS-CoV-2: a prospective observational cohort surveillance study in Western Australian schools

Abstract

ObjectivesWhen the COVID-19 pandemic was declared, Governments responded with lockdown and isolation measures to combat viral spread, including the closure of many schools. More than a year later, widespread screening for SARS-CoV-2 is critical to allow schools and other institutions to remain open. Here, we describe the acceptability of a minimally invasive COVID-19 screening protocol trialled by the Western Australian Government to mitigate the risks of and boost public confidence in schools remaining open. To minimise discomfort, and optimise recruitment and tolerability in unaccompanied children, a combined throat and nasal (OP/Na) swab was chosen over the nasopharyngeal swab commonly used, despite slightly reduced test performance.Design, setting and participantsTrialling of OP/Na swabbing took place as part of a prospective observational cohort surveillance study in 79 schools across Western Australia. Swabs were collected from 5903 asymptomatic students and 1036 asymptomatic staff in 40 schools monthly between June and September 2020.Outcome measuresPCR testing was performed with a two-step diagnostic and independent confirmatory PCR for any diagnostic PCR positives. Concurrent surveys, collected online through the REDCap platform, evaluated participant experiences of in-school swabbing.Results13 988 swabs were collected from students and staff. There were zero positive test results for SARS-CoV-2, including no false positives. Participants reported high acceptability: 71% of students reported no or minimal discomfort and most were willing to be reswabbed (4% refusal rate).ConclusionsOP/Na swabbing is acceptable and repeatable in schoolchildren as young as 4 years old and may combat noncompliance rates by significantly increasing the acceptability of testing. This kind of minimally-invasive testing will be key to the success of ongoing, voluntary mass screening as society adjusts to a new ‘normal’ in the face of COVID-19.Trial registration numberAustralian New Zealand Clinical Trials Registry—ACTRN12620000922976.

Extreme differences in SARS-CoV-2 viral loads among respiratory specimen types during presumed pre-infectious and infectious periods

“…Testing with combination specimen types (e.g., sampling from both the throat and anterior nares) was inferred to yield significantly improved clinical sensitivity to detect both infected ( Fig S6, S7 ) and presumed infectious individuals ( Fig 6-7 ) than any single specimen type, regardless of whether the combination specimen type was assumed to have the maximum or the average viral load of constituent specimen types ( Fig S7 ). Combination swabs have high acceptability(77), and are already common in many regions of the world. In the U.K., the National Health Service website even states that PCR tests that rely only on nasal swabbing will be “less accurate” than those with a combined nose and tonsil swab(78, 79).…”

Nasal swab is a good alternative sample for detecting SARS-CoV-2 with rapid antigen test: A meta-analysis

“…In addition to eliminating the drawbacks of nasopharyngeal swabs in terms of causing discomfort and possibly even damage to the patient [ 56 ], nasal swabs offered the option of home testing. Questionnaires were conducted in several studies, resulting that nearly all patients reported no pain in the anterior nasal collection, and it was easy to understand how to perform self-testing and interpret the test results [ 3 , 4 , 6 , 47 , 53 , 57 ]. Previous experience with HIV self-testing demonstrated that self-testers could perform HIV rapid diagnostic tests with reliability and accuracy [ 58 ].…”

Serum HCoV-spike specific antibodies do not protect against subsequent SARS-CoV-2 infection in children and adolescents

“…Although PCR swabs from the nose and throat were the gold standard during the pandemic, this type of swab was uncomfortable which may impact of the quality of these swabs in younger age groups. 34 Saliva PCR testing may prove to be more acceptable to young children and therefore be of use in monitoring incidence. 35 , 36 , 37 , 38 , 39 …”