Nasopharyngeal (NP) swab samples for COVID-19 PCR testing can be uncomfortable, difficult to obtain, and require skilled healthcare personnel. We investigated alternative sampling techniques suitable for COVID-19 PCR testing that are less invasive and allow for self-collection. In a partnership between Fraser Health Authority, LifeLabs, and the British Columbia Centre for Disease Control Public Health Lab (BCCDC PHL), we compared these sampling techniques head-to-head against healthcare personnel-collected NP samples to see how they performed.
What Was the Study About?
We compared how well different types of patient samples detected SARS-CoV-2, the virus that causes COVID-19. We compared the following three sample types:
- Healthcare personnel-collected NP swab;
- Self-collected saline gargle (gargling saline solution or SG for short); and
- Self-collected throat-bilateral nares swabs (TN) obtained by swabbing the back of one’s throat and both nostrils.
All volunteers provided all three samples. They were provided instructions for self-collecting SG and TN samples. Sometimes, they had healthcare personnel looking over their shoulder, to ensure they were using the right technique. Other times, they were on their own, without supervision, to simulate how it would be if they were to do this at home.
What Did We Find?
In total, 311 people in the Fraser Health region of BC with COVID-19 symptoms participated. We found that in the first seven days after people started showing COVID-19 symptoms, self-collected TN swabs worked just as well as the ones collected by healthcare personnel from the NP area or the self-collected SG samples in detecting SARS-CoV-2. Surprisingly, whether or not healthcare personnel were there to supervise didn’t change the quality or performance of self-collected samples.
What Does This Mean?
The use of self-collected TN specimens as an alternative sample type introduces an accessible and less invasive way to test people who need a COVID-19 PCR. It also frees up healthcare staffing resources from performing COVID-19 NP swabbing.
In the case of Fraser Health Authority, LifeLabs, and the BCCDC PHL, it meant that testing sites could offer patients the option to pick up a self-collection kit, do the swabbing at home, and drop off the sample at the nearest collection site.
These kinds of innovative self-collection modalities may change the way we do testing. It could mean less reliance on scheduling in-person appointments and healthcare personnel personally performing all testing. For some tests and for some patient populations, it could mean simply picking up a test kit, self-collecting a sample, and dropping it off for testing at the laboratory. That could make it easier and more accessible to get lab testing done especially when access is a challenge. These types of flexible approaches may apply for other respiratory and infectious diseases testing, and thus help improve testing scale-up during a future outbreak or pandemic.
Dr. Aamir Bharmal is the Medical Director, Public Health Response at the British Columbia Centre for Disease Control and a Clinical Associate Professor at the University of British Columbia.
Mr. Eric Hempel is a project manager under the pandemic response and data & analytics portfolios at the Provincial Health Services Authority in British Columbia.
Dr. Linda Hoang is the interim Medical Co-Director for the British Columbia Centre for Disease Control Public Health Laboratory and a Clinical Professor at the University of British Columbia.
This research was published in the 2023 Annual Conference issue of JAMMI (8.s1).
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