COVID-19 Evidence Alerts
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Current best evidence for clinical care (more info)

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Diagnosis Altawalah H, AlHuraish F, Alkandari WA, et al. Saliva specimens for detection of severe acute respiratory syndrome coronavirus 2 in Kuwait: A cross-sectional study. J Clin Virol. 2020 Nov;132:104652. doi: 10.1016/j.jcv.2020.104652. Epub 2020 Oct 1.

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) and represents a global pandemic affecting more than 26 million people and has claimed >870,000 lives worldwide. Diagnostic tests for SARS-COV-2 infection commonly use nasopharyngeal swabs (NPS). As an alternative specimen, we investigated the potential use of the real-time reverse transcriptase PCR (RT-PCR) detection of SARS-COV-2 in saliva samples in large suspected-COVID-19 patients in Kuwait. NPS and saliva samples pairs were prospectively collected from 891 COVID-19 suspected patients in Kuwait and analyzed using TaqPath™ COVID-19 multiplex RT-PCR. Of the 891 patients, 38.61 % (344/891) were positive for SARS-CoV-2, 4.83 % (43/891) were equivocal, and 56.56 % (504/891) were negative with NPS by RT-PCR. For saliva, 34.23 % (305/891) were positive for SARS-CoV-2, 3.14 (28/891) were equivocal, and 62.63 % (558/891) were negative. From 344 confirmed cases for SARS-CoV-2 with NPS samples, 287 (83.43 %) (95 % CI, 79.14-86.99) were positive with saliva specimens. Moreover, the diagnostic sensitivity and specificity of RT-PCR for the diagnosis of COVID-19 in saliva were 83.43 % (95 % CI: 79.07-87.20) and 96.71 % (95 % CI: 94.85-98.04 %), respectively. An analysis of the agreement between the NPS and saliva specimens demonstrated 91.25 % observed agreement (? coefficient = 0.814, 95 % CI, 0.775-0.854). This study demonstrates that saliva can be a noninvasive specimen for detection of SARS-CoV-2 by RT-PCR.

Discipline / Specialty Area Score
Infectious Disease
Public Health
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Hospital Doctor/Hospitalists
Internal Medicine
Comments from MORE raters

Infectious Disease rater

This study compared the yield of RT PCR on nasopharyngeal versus saliva samples of 891 persons suspected to have covid-19. Sensitivity was 83.43% and specificity 96.71%. Saliva samples would be a far more convenient method to test for covid-19. The relatively low sensitivity remains a concern.

Infectious Disease rater

Although there was 91.25% agreement overall between NP swab and saliva rapid PCR, amongst those positive for COVID-19 by NP swab, only 83.43 % were positive by saliva testing.

Internal Medicine rater

This study brought more evidence that saliva-based testing is a promising alternative sampling for SARS-CoV-2 detection by RT-PCR and could simplify and accelerate COVID-19 diagnosis.