Saliva is more sensitive for SARS-CoV-2 detection in COVID-19 patients than nasopharyngeal swabs

Anne Louise Wyllie; John Fournier; Arnau Casanovas-Massana; Melissa Campbell; Maria Tokuyama; Pavithra Vijayakumar; Bertie Geng; M. Catherine Muenker; Adam J. Moore; Chantal B. F. Vogels; Mary E. Petrone; Isabel M. Ott; Peiwen Lu; Alice Lu-Culligan; Jonathan Klein; Arvind Venkataraman; Rebecca Earnest; Michael Simonov; Rupak Datta; Ryan Handoko; Nida Naushad; Lorenzo R. Sewanan; Jordan Valdez; Elizabeth B. White; Sarah Lapidus; Chaney C. Kalinich; Xiaodong Jiang; Daniel J. Kim; Eriko Kudo; Melissa Linehan; Tianyang Mao; Miyu Moriyama; Ji Eun Oh; Annsea Park; Julio Silva; Eric Song; Takehiro Takahashi; Manabu Taura; Orr-El Weizman; Patrick Wong; Yexin Yang; Santos Bermejo; Camila Odio; Saad B. Omer; Charles S. Dela Cruz; Shelli Farhadian; Richard A. Martinello; Akiko Iwasaki; Nathan D. Grubaugh; Albert I. Ko

Inpatients Nasopharyngeal and saliva samples were obtained every three days throughout their clinical course. Nasopharyngeal samples were taken by registered nurses using the BD universal viral transport (UVT) system. The flexible, mini-tip swab was passed through the patient's nostril until the posterior nasopharynx was reached, left in place for several seconds to absorb secretions then slowly removed while rotating. The swab was placed in the sterile viral transport media (total volume 3 mL) and sealed securely. Saliva samples were self-collected by the patient. Upon waking, patients were asked to avoid food, water and brushing of teeth until the sample was collected. Patients were asked to repeatedly spit into a sterile urine cup until roughly a third full of liquid (excluding bubbles), before securely closing it. All samples were stored at room temperature and transported to the research lab at the Yale School of Public Health within 5 hours of sample collection.