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 – 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 – 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 ].…”

User acceptability of saliva and gargle samples for identifying COVID-19 positive high-risk workers and household contacts

“…Of important note, the volume of saliva required for this study was greater than that which would be necessary in practice (0.5 – 1 ml), and reducing the volume required may further increase the acceptability of saliva testing. In addition, the large volumes of saline used in this study are likely unnecessary with most other groups using only 2.5 – 5mls [24] , [25] , [26] .…”

“…Pharyngeal gargle specimens have also been shown to be a useful sample type for detection of respiratory viruses including coronaviruses [ 7 , [18] , [19] , [20] ] and have shown comparability with NTS in the detection of SARS-CoV-2, although the available literature is more limited [21] , [22] , [23] , [24] , [25] , [26] .…”

Direct comparison of Altona-SARS-CoV-2 dual target RT-qPCR Assay with commercial LAMP Assay using throat washes in health care staff testing

“…Second, the method was rapidely available and independent of the most limited resource in the early phase of the pandemics besides PCR reagents, namely swabs. Meanwhile several studies have been published that also made use of throat washes or saliva, although these studies suggested to the community that this sampling procedure was entirely novel [14] , [15] , [16] , [17] , [18] .…”