SARS-CoV-2 Specimen Collection: Self-Collected Saliva as Admissible Alternative to Health Care Worker-Collected Nasopharyngeal Swabs

Reviewed by Clare Marlin, MS, RN; CIC Brain Innovation Center, Shirley Ryan AbilityLab

Multiple factors determine optimal sensitive respiratory virus detection including protocols of sample collection. While there is no universal standard for upper respiratory specimen collection, nasopharyngeal (NP) swabs are recognized as an important advancement in testing and are commonly used. The use of NP swabs or anterior nasal swabs (ANS), either collected by a health care worker or by the patient, are supported by the Centers for Disease Control and Prevention (CDC) and Infectious Diseases Society of America (IDSA) for coronavirus disease-19 (COVID-19) detection. Due to the ongoing COVID-19 pandemic, healthcare resource shortages including personnel, personal protective equipment (PPE), and laboratory supplies have led to the development and evaluation of alternate sensitive respiratory virus detection methods, such as self-collection of saliva.

In this prospective comparison of specimen types, approximately 350 adult patients at a drive-through testing center, who had COVID-19 suggestive symptoms, were instructed to swab both of their nostrils and pool saliva in their mouth before spitting into a tube. A health care worker also collected an NP swab from each patient. NP swabs and saliva were found to be clinically superior to ANS for identification of SARS-CoV-2 in the symptomatic patients within the comparison, which adds to the growing body of literature supporting saliva as admissible for specimen collection in COVID-19 symptomatic patients.


Hanson KE, Barker AP, Hillyard DR, Gilmore N, Barrett JW, Orlandi RR, Shakir SM. 2020. Self-collected anterior nasal and saliva specimens versus health care worker-collected nasopharyngeal swabs for the molecular detection of SARS-CoV-2. J Clin Microbiol 58:e01824-20.

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