Self-collected gargle specimen as a patient-friendly sample collection method for COVID-19 diagnosis in a population context

Abstract

Scaling up SARS-CoV-2 testing and tracing continues to be plagued with the limitation of the sample collection method, which requires trained healthcare workers to perform and causes discomfort to the patients. In response, we assessed the performance and user preference of gargle specimens for qRT-PCR-based detection of SARS-CoV-2 in Indonesia. Inpatients who had recently been diagnosed with COVID-19 and outpatients who were about to perform qRT-PCR testing were asked to provide nasopharyngeal and oropharyngeal (NPOP) swabs and self-collected gargle specimens. We demonstrated that self-collected gargle specimens can be an alternative specimen to detect SARS-CoV-2 and the viral RNA remained stable for 31 days at room temperature storage. The developed method was validated for use on multiple RNA extraction kits and commercially available COVID-19 RT-PCR kits. Our developed method achieved a sensitivity of 91.38% when compared to paired NPOP swab specimens (Ct < 35), with 97.10% of patients preferring the self-collected gargle method.

Performance of saline and water gargling for SARS-CoV-2 reverse transcriptase PCR testing: a systematic review and meta-analysis

“…After screening the titles and abstracts of the remaining articles, 45 full texts were screened (figure 1). On the basis of our selection criteria, 27 of those studies were excluded and 18 studies [28,29,35,36,[46][47][48][49][50][51][52][53][54][55][56][57][58][59] met our inclusion criteria (table 1). One study examined two study populations, of suspected infection and of confirmed cases, which were analysed separately [59].…”

“…On the basis of our selection criteria, 27 of those studies were excluded and 18 studies [28,29,35,36,[46][47][48][49][50][51][52][53][54][55][56][57][58][59] met our inclusion criteria (table 1). One study examined two study populations, of suspected infection and of confirmed cases, which were analysed separately [59]. Of these 19 study populations, seven assessed the diagnostic performance of gargle in populations with suspected infection [28,49,50,54,55,57,59], and 12 assessed the use of gargle for monitoring viral shedding in populations already confirmed to have SARS-CoV-2 infections, either as hospital inpatients or after being discharged (table 1) [29, 35, 36, 46-48, 51-53, 56, 58, 59].…”

“…One study examined two study populations, of suspected infection and of confirmed cases, which were analysed separately [59]. Of these 19 study populations, seven assessed the diagnostic performance of gargle in populations with suspected infection [28,49,50,54,55,57,59], and 12 assessed the use of gargle for monitoring viral shedding in populations already confirmed to have SARS-CoV-2 infections, either as hospital inpatients or after being discharged (table 1) [29, 35, 36, 46-48, 51-53, 56, 58, 59]. Regarding the study location, there were five studies from Canada [28,47,50,52,57], six from Germany [36,48,49,51,54,56] and with the rest (seven) from Finland [29], Turkey [55], China [46], Korea [58], Indonesia [59], Israel [53] and India [35].…”

“…Of these 19 study populations, seven assessed the diagnostic performance of gargle in populations with suspected infection [28,49,50,54,55,57,59], and 12 assessed the use of gargle for monitoring viral shedding in populations already confirmed to have SARS-CoV-2 infections, either as hospital inpatients or after being discharged (table 1) [29, 35, 36, 46-48, 51-53, 56, 58, 59]. Regarding the study location, there were five studies from Canada [28,47,50,52,57], six from Germany [36,48,49,51,54,56] and with the rest (seven) from Finland [29], Turkey [55], China [46], Korea [58], Indonesia [59], Israel [53] and India [35]. These studies spanned from 23 March 2020 to 19 July 2021, covering the period of different prevailing SARS-CoV-2 variants, from the ancestral strain, alpha variant, to its delta variant.…”

“…A total of 4444 individuals were included in the 18 eligible studies. Besides two that did not specify participants' age [50,56], all reviewed studies included an adult population, among which eight also included children aged below 18 years [28,36,47,48,52,54,57,59]. 12 studies [28,29,35,46,47,49,51,52,[54][55][56]58] used NPS and six studies [36,48,50,53,57,59] used ONPS, all collected by HCWs, as the reference gold standard.…”