Evolution of Specimen Self-Collection in the COVID-19 Era: Implications for Population Health Management of Infectious Disease

Abstract

Laboratory testing is an important component in the diagnosis of respiratory tract infections such as with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, specimen collection not only risks exposure of health care workers and other patients to infection, but also necessitates use of personal protective equipment that may be in short supply during periods of heightened disease activity. Self-collection of nasal or oropharyngeal swabs offers an alternative to address these drawbacks. Although studies in the past decade have demonstrated the utility of this approach for respiratory infections, it has not been widely adopted in routine clinical practice. The rapid spread of coronavirus disease 2019 (COVID-19), caused by SARS-CoV-2, has focused attention on the need for safe, convenient, timely, and scalable methods for collecting upper respiratory specimens for testing. The goals of this article are to highlight the literature regarding self-collected nasal or oropharyngeal specimens for respiratory pathogen testing; discuss the role of self-collection in helping prevent the spread of the COVID-19 disease from infected patients and facilitating a shift toward “virtual” medicine or telemedicine; and describe the current and future state of self-collection for infectious agents, and the impacts these approaches can have on population health management and disease diagnosis and prevention.

Evaluation of the Practicability of Biosynex Antigen Self-Test COVID-19 AG+ for the Detection of SARS-CoV-2 Nucleocapsid Protein from Self-Collected Nasal Mid-Turbinate Secretions in the General Public in France

“…Taken together, our observations highlight in adult profanes the usability of the BIOSYNEX Antigen Self-Test COVID-19 Ag+ using painless NMT self-sampling as a novel approach to assess SARS-CoV-2 infection by using Ag-RDT test and self-interpretation of the results in a supervised setting. The feasibility of nasal swabs self-collection in the community was previously emphasized for the diagnosis of respiratory virus infection, such as influenza A and B and other common respiratory viruses, including common coronaviruses [ 44 , 45 ], and these swabs appear to be both easy to perform [ 42 , 43 , 44 , 46 , 47 , 48 ] and well accepted [ 46 , 48 ]. Self-collection of nasal secretions for respiratory viruses offers potential significant benefits by reducing the requirement for personal protective equipment, limiting exposure of patients and staff to infection, increased convenience and access for patients and timeliness of a sample receipt [ 45 , 48 , 49 ].…”

“…The feasibility of nasal swabs self-collection in the community was previously emphasized for the diagnosis of respiratory virus infection, such as influenza A and B and other common respiratory viruses, including common coronaviruses [ 44 , 45 ], and these swabs appear to be both easy to perform [ 42 , 43 , 44 , 46 , 47 , 48 ] and well accepted [ 46 , 48 ]. Self-collection of nasal secretions for respiratory viruses offers potential significant benefits by reducing the requirement for personal protective equipment, limiting exposure of patients and staff to infection, increased convenience and access for patients and timeliness of a sample receipt [ 45 , 48 , 49 ]. In the present series, the handling of the test itself did not pose any particular problem, as previously demonstrated for other self-tests with similar cassettes [ 28 , 29 , 30 , 50 ].…”

“…Previous studies to date have looked at the performance of unobserved as well as supervised self-collected specimens for molecular detection of SARS-CoV-2 [ 45 , 71 , 72 , 73 , 74 , 75 , 76 , 77 ]. Thus, Tu and colleagues compared SARS-CoV-2 detection using a variety of swab types self-collected (under health care professional observation) by 530 symptomatic child and adult outpatients (or their parents or guardians), with nasopharyngeal swabs collected by health care professionals as the comparator gold standard [ 72 ].…”

“…McCulloch and colleagues have shown that unsupervised home mid-nasal swab collection was comparable to clinician-collected nasopharyngeal swab collection for molecular detection of SARS-CoV-2 in symptomatic patients, particularly those with higher viral loads [71]. The high analytical performance of self-collected samples, including NMT samples, for the molecular detection of common respiratory viruses was similarly reported [44][45][46][47][48]78]. A meta-analysis of nine studies comparing self-sampling and health care worker sampling for influenza testing reported a pooled sensitivity of 87% and specificity of 99% for self-collection [79].…”

Adolescents may accurately self-collect pharyngeal and rectal clinical specimens for the detection of Chlamydia trachomatis and Neisseria gonorrhoeae infection

“…The COVID-19 pandemic disrupted in-person clinic-based testing. As physicians switch from in-person visits to virtual visits, self-collected specimens are a promising alternative to clinician-collected specimens [ 1 ].…”