1. Increased SARS-CoV-2 Testing Capacity with Pooled Saliva Samples
- Author
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Doug E. Brackney, Albert I. Ko, Santos Bermejo, Arnau Casanovas-Massana, Anne L. Wyllie, Akiko Iwasaki, Anne E. Watkins, Shelli F. Farhadian, Nathan D. Grubaugh, Chantal B.F. Vogels, Rupak Datta, John Fournier, Daniel M. Weinberger, Eli P. Fenichel, Melissa Campbell, and Charles S. Dela Cruz
- Subjects
Microbiology (medical) ,Saliva ,Veterinary medicine ,2019-20 coronavirus outbreak ,Coronavirus disease 2019 (COVID-19) ,Epidemiology ,Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ,030231 tropical medicine ,lcsh:Medicine ,Increased SARS-Cov-2 Testing Capacity with Pooled Saliva Samples ,lcsh:Infectious and parasitic diseases ,2019 novel coronavirus disease ,03 medical and health sciences ,respiratory infections ,0302 clinical medicine ,diagnostics ,Medicine ,lcsh:RC109-216 ,viruses ,030212 general & internal medicine ,saliva ,business.industry ,SARS-CoV-2 ,screening ,lcsh:R ,Dispatch ,COVID-19 ,zoonoses ,Infectious Diseases ,coronavirus disease ,business ,Coronavirus Infections ,severe acute respiratory syndrome coronavirus 2 - Abstract
Expanding testing capabilities is integral to managing the further spread of SARS-CoV-2 and developing reopening strategies, particularly in regards to identifying and isolating asymptomatic and pre-symptomatic individuals. Central to meeting testing demands are specimens that can be easily and reliably collected and laboratory capacity to rapidly ramp up to scale. We and others have demonstrated that high and consistent levels of SARS-CoV-2 RNA can be detected in saliva from COVID-19 inpatients, outpatients, and asymptomatic individuals. As saliva collection is non-invasive, extending this strategy to test pooled saliva samples from multiple individuals could thus provide a simple method to expand testing capacity. However, hesitation towards pooled sample testing arises due to the dilution of positive samples, potentially shifting weakly positive samples below the detection limit for SARS-CoV-2 and thereby decreasing the sensitivity. Here, we investigated the potential of pooling saliva samples by 5, 10, and 20 samples prior to RNA extraction and RT-qPCR detection of SARS-CoV-2. Based on samples tested, we conservatively estimated a reduction of 7.41%, 11.11%, and 14.81% sensitivity, for each of the pool sizes, respectively. Using these estimates we modeled anticipated changes in RT-qPCR cycle threshold to show the practical impact of pooling on results of SARS-CoV-2 testing. In tested populations with greater than 3% prevalence, testing samples in pools of 5 requires the least overall number of tests. Below 1% however, pools of 10 or 20 are more beneficial and likely more supportive of ongoing surveillance strategies.
- Published
- 2021