Understanding testing options for school districts and benefits of saliva testing – September 2021
Link 1: This first link comes from the NJ.gov weekly Covid update email:
At the bottom of the page, the following paragraph is included to highlight testing:
“Vaccine and Testing Details”
“Workers are considered “fully vaccinated” for COVID-19 two weeks or more after they have received the second dose in a two-dose series or two weeks or more after they have received a single-dose vaccine. Vaccines must be currently authorized for emergency use or approved by the FDA or the WHO.
Both antigen and molecular tests are acceptable for weekly testing.”
Link 2: This link is a two-page document with information about “testing basics” Coronavirus Disease 2019 Testing Basics (fda.gov)
It’s important to distinguish between a test that uses a nasal swab and one that uses saliva. Please refer to page two which includes the following chart regarding the benefits of using a saliva test.
Link 3: A research report from a scientific journal associated with the National Institutes of Health: Comparison of SARS-CoV-2 detection in nasopharyngeal swab and saliva (nih.gov)
The journal entry starts with the following paragraph:
“ In this journal, Azzi et al. reported that saliva was a reliable tool to detect SARS-CoV-2.1 We prospectively compared the efficacy of PCR detection of SARS-CoV-2 between paired nasopharyngeal and saliva samples in 76 patients including ten coronavirus disease 2019 (COVID-19) patients. The overall concordance rate of the virus detection between the two samples reached as high as 97.4% (Table 1 ); we confirmed that saliva is a noninvasive and reliable alternative to nasopharyngeal swabs and facilitates widespread PCR testing in the face of shortages of swabs and protective equipment without posing a risk to healthcare workers.”
Link 4: An article from Yale News titled: “Saliva samples preferable to deep nasal swabs for testing Covid-19”.
Saliva samples preferable to deep nasal swabs for testing COVID-19 | YaleNews
Paragraph two is below:
“The study led by the Yale School of Public Health — and conducted at Yale New Haven Hospital with 44 inpatients and 98 health care workers — found that saliva samples taken from just inside the mouth provided greater detection sensitivity and consistency throughout the course of an infection than the broadly recommended nasopharyngeal (NP) approach. The study also concluded that there was less variability in results with the self-sample collection of saliva.”
Link 5: A research report published in The Lancet. The key to understanding the benefits of the use of saliva testing for pooled and individual samples is discussed in both the “Findings” section and the “Interpretations” section.
Findings
“From August 27, 2020 until January 13, 2021, 253,406 saliva specimens were self-collected from students, faculty and staff from 93 K-12 schools and 18 universities. Pool sizes of up to 24 samples were tested over a 20-week period. Pooled testing did not significantly alter the sensitivity of the molecular assay in terms of both qualitative (100% detection rate on both pooled and individual samples) and quantitative (comparable cycle threshold (Ct) values between pooled and individual samples) measures. The detection of SARS-CoV-2 in saliva was comparable to the nasopharyngeal swab. Pooling samples substantially reduced the costs associated with PCR testing and allowed schools to rapidly assess transmission and adjust prevention protocols as necessary. In one instance, in-school transmission of the virus was determined within the main office and led to review and revision of heating, ventilating and air-conditioning systems.”
Interpretation
“By establishing low-cost, weekly testing of students and faculty, pooled saliva analysis for the presence of SARS-CoV-2 enabled schools to determine whether transmission had occurred, make data-driven decisions, and adjust safety protocols. We provide strong evidence that pooled testing may be a fundamental component to the reopening of schools by minimizing the risk of in-school transmission among students and faculty.”
I know the state has mandated testing for those who chose not to get the vaccine for personal, medical, or religious reasons. But I wonder if an additional mitigation strategy might be to test all educators to stay ahead of potential outbreaks.
Link 6: A journal entry dated June 2021 published in Science News titled “Saliva can be more effective than nasopharyngeal swabs for Covid-19 testing, researchers find”
A few key takeaways include the conclusion that nasopharyngeal swabs pose challenges including exposure risk to healthcare workers and supply change constraints. Additionally, saliva samples are easier to collect with less risk to the health care provider.
The authors called the saliva test a “game changer” for Covid-19 testing because it allows for increased compliance from the population being tested in addition to decrease exposure risk to health care workers during the collection process.
Link 7: Journal entry in the National Library of Medicine titled “Saliva is a reliable tool to detect SARS-CoV-2.
Saliva is a reliable tool to detect SARS-CoV-2 – PubMed (nih.gov)
Link 8: Rutgers University has been successfully utilizing a home-based saliva test to screen certain students and employees for Covid-19 since May of 2020.
COVID-19 Testing – Universitywide COVID-19 Information (rutgers.edu)
The Rutgers testing program utilizes the Saliva PCR test to identify virus particles. Saliva is deposited into a test tube, similar to giving a specimen for the well-known commercial genetic testing companies. As compared with the nasopharyngeal swab method, this testing method reduces risk of transmission, reduces use of personal protective equipment, and can be done at home.
An example of what Hunterdon County is doing – testing available to all residents for free. https://www.hunterdoncares.org .
Passaic County – free testing for residents https://www.passaiccountynj.org/government/departments/health/at-home_covid-19_testing/index.php
Concerning free testing- Another link from the NJ Covid-19 Information Hub:
This past summer, it became clear that both vaccinated and unvaccinated individuals can spread the Covid-19 virus to others. How beneficial would it be if districts established a grant-funded testing system to help get ahead of any potential variant outbreaks?
Since most educators are vaccinated, testing only unvaccinated employees, unfortunately, misses the majority of potential virus transmitters. A testing system that includes in some capacity all educators and potentially students can help address and reduce the concerns.
Link 9: From “Rutgers Today” an article about how the salvia test developed at Rutgers was given FDA approval back in April 2020.
New Rutgers Saliva Test for Coronavirus Gets FDA Approval | Rutgers University
Again, a key component of the report is the simplicity of the saliva test and the benefit of less risk to the health care worker.
In the last year, there has been a lot more research that confirms the benefit of using a saliva test compared to a nasal swab. The saliva test has four main advantages.
- Easier to administer with less risk to the health care worker
- Less intrusive to the patient
- Lower cost
- Can easily be added to a district’s testing protocol
Additional links-
Letter from state to all districts:
NJDOH outline of screening testing overview:
https://www.nj.gov/health/cd/documents/topics/NCOV/K12_school_testing_packet.pdf
Epidemiology Laboratory Capacity (ELC) via the CDC document for reopening and testing.
https://www.cdc.gov/ncezid/dpei/pdf/guidance-elc-reopening-schools-508.pdf
NJCVC.org