Comparative sensitivity of different respiratory specimen types for molecular diagnosis and monitoring of SARS-CoV-2 shedding in COVID-19 patients

Yang, Yang; Yang, Minghui; Yuan, Jing; Wang, Fuxiang; Wang, Zhaoqin; Li, Jinxiu; Zhang, Mingxia; Xing, Li; Wei, Jinli; Peng, Ling; Wong, Gary; Zheng, Haixia; Wu, Weibo; Shen, Chenguang; Liao, Mingfeng; Feng, Kai; Li, Jianming; Yang, Qianting; Zhao, Juanjuan; Liu, Lei; Liu, Yingxia

The global pandemic of Coronavirus Disease 2019 (COVID-19) is now ongoing. Rapid and accurate detection of the causative virus SARS-CoV-2 is vital for the treatment and control of COVID-19. In this study, the comparative sensitivity of different respiratory specimens were retrospectively analyzed using 3552 clinical samples from 410 Guangdong CDC (Center for Disease Control and Prevention) confirmed COVID-19 patients. Except for BALF, the sputum possessed the highest positive rate (73.4%∼87.5%), followed by nasal swabs (53.1%∼85.3%) for both severe and mild cases during the first 14 days after illness onset (d.a.o). Viral RNA could be detected in all BALF from the severe group collected as early as 4 days after illness onset (d.a.o) and lasted up to 46 d.a.o., while none of BALF samples from mild group. Moreover, although viral RNA was negative in the upper respiratory samples, it was also positive in BALF samples in most cases from severe group during treatment. Despite of typical ground-glass opacity observed via computed tomographic (CT) scans, no viral RNA was detected in the first 3 or all upper respiratory tract specimens from some COVID-19 patients. In conclusion, sputum is most sensitive for routine laboratory diagnosis of COVID-19, followed by nasal swabs. Detection of viral RNAs in BLAF improves diagnostic accuracy in severe COVID-19 patients.