Saliva—Friend and Foe in the COVID-19 Outbreak

Han, Pingping; Ivanovski, Sašo

doi:10.3390/diagnostics10050290

Cited by 92 publications

(92 citation statements)

References 73 publications

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“…As a proof of this, the Food and Drug Administration (FDA) recently approved the Emergency Use Authorization of several saliva-based tests, such as those proposed by Rutgers’ RUCDR Infinite Biologics and Yale School of Public Health. This stance is consistent with the finding that salivary droplets represent the main source of human-to-human transmission of SARS-CoV-2 infection ( Han and Ivanovski 2020 ). The use of saliva as a diagnostic specimen offers numerous advantages: it is easily self-collected by the patient with almost no discomfort, it does not require specialized health care personnel for its management, and it reduces the risks for the operator.…”

Section: Introductionsupporting

confidence: 92%

Diagnostic Salivary Tests for SARS-CoV-2

et al. 2020

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The diagnosis of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection relies on the detection of viral RNA by real-time reverse transcription polymerase chain reaction (rRT-PCR) performed with respiratory specimens, especially nasopharyngeal swabs. However, this procedure requires specialized medical personnel, centralized laboratory facilities, and time to provide results (from several hours up to 1 d). In addition, there is a non-negligible risk of viral transmission for the operator who performs the procedure. For these reasons, several studies have suggested the use of other body fluids, including saliva, for the detection of SARS-CoV-2. The use of saliva as a diagnostic specimen has numerous advantages: it is easily self-collected by the patient with almost no discomfort, it does not require specialized health care personnel for its management, and it reduces the risks for the operator. In the past few months, several scientific papers, media, and companies have announced the development of new salivary tests to detect SARS-CoV-2 infection. Posterior oropharyngeal saliva should be distinguished from oral saliva, since the former is a part of respiratory secretions, while the latter is produced by the salivary glands, which are outside the respiratory tract. Saliva can be analyzed through standard (rRT-PCR) or rapid molecular biology tests (direct rRT-PCR without extraction), although, in a hospital setting, these procedures may be performed only in addition to nasopharyngeal swabs to minimize the incidence of false-negative results. Conversely, the promising role of saliva in the diagnosis of SARS-CoV-2 infection is highlighted by the emergence of point-of-care technologies and, most important, point-of-need devices. Indeed, these devices can be directly used in workplaces, airports, schools, cinemas, and shopping centers. An example is the recently described Rapid Salivary Test, an antigen test based on the lateral flow assay, which detects the presence of the virus by identifying the spike protein in the saliva within a few minutes.

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Section: Introductionsupporting

confidence: 92%

Diagnostic Salivary Tests for SARS-CoV-2

et al. 2020

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“…As a diagnostic tool, such testing has the additional advantage of making assessments directly from an oral fluid that may be a culprit in transmission of SARS-CoV-2. 10 Unfortunately, only a handful of studies have examined the viral load dynamics over time for saliva and NP swab samples. 40,41 While these studies support the notion that SARS-CoV-2 tends to be at its highest level in saliva during the first week of infection, more information is needed on this important topic.…”

Section: Discussionmentioning

confidence: 99%

“…When considering various sample collection possibilities, saliva is attractive due to the known detection of SARS-CoV-2 through oral shedding, and the potential for rapid and easy self-collection, [9][10][11] thus minimizing the need for direct healthcare provider-patient contact and consequent conservation of PPE. In addition, a number of recent reports have detailed the detection of SARS-CoV-2 in saliva through the workflow in Figure 1B, including a report showing higher viral loads in saliva when compared to matched NP swabs from the same patients.…”

mentioning

confidence: 99%

“…In addition, a number of recent reports have detailed the detection of SARS-CoV-2 in saliva through the workflow in Figure 1B, including a report showing higher viral loads in saliva when compared to matched NP swabs from the same patients. 12 Importantly, saliva (expelled in aerosols and droplets) may be a significant factor in personto-person transmission of SARS-CoV-2, 10 and it has been suggested that NP swab tests remain positive long after patients are infectious (potentially due to detection of inactive virus or remnants of viral RNA in the NP cavity), 13 whereas SARS-CoV-2 viral loads in saliva are highest during the first week of infection, when a person is most infectious. These data suggest that viral loads in saliva may be a good reflection of the transmission potential of patients infected SARS-CoV-2.…”

mentioning

confidence: 99%

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Saliva-Based Molecular Testing for SARS-CoV-2 that Bypasses RNA Extraction

Rañoa

Holland

Alnaji

et al. 2020

Preprint

124

178

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Convenient, repeatable, large-scale molecular testing for SARS-CoV-2 would be a key weapon to help control the COVID-19 pandemic. Unfortunately, standard SARS-CoV-2 testing protocols are invasive and rely on numerous items that can be subject to supply chain bottlenecks, and as such are not suitable for frequent repeat testing. Specifically, personal protective equipment (PPE), nasopharyngeal (NP) swabs, the associated viral transport media (VTM), and kits for RNA isolation and purification have all been in short supply at various times during the COVID-19 pandemic. Moreover, SARS-CoV-2 is spread through droplets and aerosols transmitted through person-to-person contact, and thus saliva may be a relevant medium for diagnosing SARS-CoV-2 infection status. Here we describe a saliva-based testing method that bypasses the need for RNA isolation/purification. In experiments with inactivated SARS-CoV-2 virus spiked into saliva, this method has a limit of detection of 500-1000 viral particles per mL, rivalling the standard NP swab method, and initial studies also show excellent performance with 100 clinical samples. This saliva-based process is operationally simple, utilizes readily available materials, and can be easily implemented by existing testing sites, thus allowing for high-throughput, rapid, and repeat testing of large populations. Graphical Abstract3 BackgroundThe slow roll-out and inconsistent availability of diagnostic testing for SARS-CoV-2 has hobbled efforts to control the COVID-19 pandemic in many countries. Testing protocols based on the use of nasopharyngeal (NP) swabs as the collection agent, placed in a tube containing viral transport media (VTM), followed by RNA isolation/purification and subsequent analysis by RT-qPCR is currently the most common method ( Figure 1A). 1,2 While some variant of this process has been implemented worldwide, there are multiple challenges with this workflow. Sample collection using NP swabs requires healthcare workers wearing personal protective equipment (PPE) to collect samples, the swabs can be uncomfortable for the patients during collection, and the swabs and the associated VTM have been in short supply at many times and in most locations. In addition, RNA isolation/purification is another significant bottleneck, both in the time and labor required for this process, and in the availability of the equipment and reagents. All of these components also add to the cost of the testing process.There is emerging consensus that widespread, frequently repeated testing is necessary for a safer return to activities that are important for society. Given the data suggesting that SARS-CoV-2 can be spread by pre-symptomatic/asymptomatic carriers, 3-6 localized outbreaks could be dramatically reduced or prevented if individuals shedding SARS-CoV-2 could be readily identified and isolated. For example, imagine a testing bubble placed over a group that desires face-to-face interaction -employees of a company, members of a sports team, extended family networks, etc. If all members of...

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“…There has been a tremendous potential of using saliva as a potential diagnosing modality as this offers an edge over other diagnostic tools as the collection of saliva is relatively non-invasive and easy to collect. 28…”

Section: Current Diagnostic Modalities For Coronavirusmentioning

confidence: 99%

Saliva as a Diagnostic Tool for Detection of Coronavirus: A Review

Lal

Saleem

Ahmed

2020

J Islamabad Med Dental Coll

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We aimed in this literature review to demonstrate the association and potential of detecting novel coronavirus in saliva of patients and how its implication in future can aid in diagnosis as a non-invasive diagnostic modality. The specimen can be easily obtained and tested from suspected individuals. Review of available literature in PubMed, Google Scholar, EBSCO, and Semantic Scholar was carried out using keywords and combination of “Coronavirus”, “saliva” and “diagnosis”. Of 1846 articles found, 110 were screened and included in this literature review. Currently, nasopharyngeal swab is the standard diagnostic tool as it has been reported to be accurate and sensitive towards detection of coronavirus. Testing of saliva specimens is now being considered to aid rapid detection, because saliva collection and its testing are relatively simple, cheap, and safe for both patients as well as healthcare professionals. Further research on this will be beneficial to control and contain the virus.

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Saliva—Friend and Foe in the COVID-19 Outbreak

Cited by 92 publications

References 73 publications

Diagnostic Salivary Tests for SARS-CoV-2

Diagnostic Salivary Tests for SARS-CoV-2

Saliva-Based Molecular Testing for SARS-CoV-2 that Bypasses RNA Extraction

Saliva as a Diagnostic Tool for Detection of Coronavirus: A Review

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