Reliability of self-sampling for accurate assessment of respiratory virus viral and immunologic kinetics

Alpana Waghmare; Elizabeth M Krantz; Subhasish Baral; Emma Vasquez; Tillie Loeffelholz; E. Lisa Chung; Urvashi Pandey; Jane Kuypers; Elizabeth R Duke; Keith R Jerome; Alexander L Greninger; Daniel B Reeves; Florian Hladik; E Fabian Cardozo-Ojeda; Michael Boeckh; Joshua T Schiffer

A critical research priority is to develop rapid molecular tests that provide accurate diagnosis, 23 determine infectiousness and transmissibility, and allow for monitoring of viral load during 24 therapy 6 . For numerous viral infections, including influenza, viral load correlates with disease 25 severity and secondary household attack rate 7-9 . Early studies suggest that peak viral load 26 differentiates mild from severe COVID-19 10 .Furthermore, viral load monitoring during antiviral 27 therapy is a mainstay for various human infections including HIV, hepatitis B, cytomegalovirus 28 and hepatitis C infections [11] [12] [13] [14] [15] [16] [17] . Particularly for viruses such as SARS-CoV-2 for which severe 29 clinical outcomes occur in a minority of patients, viral load may serve as a useful surrogate 30 marker to design smaller, but still sufficiently powered treatment studies 4,10 . individuals. Currently licensed flocked swabs may not be optimal for patients with vulnerable 51 mucosal membranes and low platelet counts (e.g. following cytotoxic chemotherapy) because 52 they are associated with some discomfort and possible bleeding. Moreover, their general level 53 of discomfort may deter participants from collecting longitudinal samples. This may limit 54 widespread use for self-testing, especially as surveillance testing or for use in vulnerable 55 patients or children. Importantly, a reliable and comfortable home-based self-testing 56 methodology is needed to prevent potentially infected individuals from entering healthcare 57 facilities to be tested and transmitting virus to healthcare workers and other patients. Initial data 58 on foam swabs are promising, suggesting a broader role for home-based self-swabbing for 59 respiratory viral pandemics 24, 25 . 60 61 . CC-BY-ND 4.0 International license It is made available under a author/funder, who has granted medRxiv a license to display the preprint in perpetuity.