Self-Administered COVID-19 Test Produces Results Comparable to Clinician-Administered Test

Researchers at Stanford University School of Medicine, CA, conducted a small, prognostic study to compare the diagnostic equivalence of patient-collected lower nasal swabs with that of the standard method of testing involving healthcare worker-collected oropharyngeal swabs. The results of this study, which were published in the Journal of the American Medical Association, showed that samples collected by patents who swabbed their own nasal passages yielded results for the COVID-19 virus that were as accurate as samples collected by the healthcare workers.

The study population consisted of outpatients at Stanford Health Care who had tested positive for COVID-19 (in March 2020 after receiving a reverse transcriptase-polymerase chain reaction test. Yvonne Maldonado, MD, and colleagues obtained remote consent from study participants and relayed testing instructions via written materials and video conference. After consent was obtained, participants were instructed to return to Stanford Health Care for drive-through specimen collection using 3 methods: patient-collected lower nasal swab, clinician-collected lower nasal swab, and clinician-collected oropharyngeal swab.

Of the 129 patients who had tested positive COVID-19 in March 2020, 30 participated in the study. Age ranges for participants was 19 to 40 years (N = 11), 41 to 60 years (N = 12), and 61 to 80 years (N = 7). The cohort consisted of approximately equal male/female representation (N = 16 and N = 14, respectively), with two-thirds (N = 20) of participants identifying as white.

Self-reported possible sources for exposure to the virus included travel (N = 5), close contact with a person with confirmed COVID-19 (N = 4), and close contact with a person with an influenza-like illness (N = 3). Eighteen patients did not know the source of their exposure.

The most frequently reported symptoms during the drive-through clinic visit were cough (N = 20), fever (N = 13), sore throat (N = 8), and shortness of breath (N = 7). More than half (N = 16) of patients had ≥1 documented comorbid conditions, including hypertension (N = 5), hyperlipidemia (N = 5), asthma (N = 3), and diabetes (N = 2). Five (17%) also tested positive for coinfection with another respiratory virus, including human parainfluenza virus (N = 2), rhinovirus (N = 1), and respiratory syncytial virus (N = 1).

The investigators reported that 11 (37%) patients had test results that were positive for COVID-19 infection across all 3 specimen-collection methods (ie, patient-administered nasal swab, clinician-administered nasal, and oropharyngeal swabs). Eighteen (60%) patients had test results that were negative for COVID-19 across all 3 specimen-collection methods. One patient had a positive test for the self-administered nasal swab but a negative test for both clinician-administered tests.

The sensitivity of the patient-collected specimens was 100% (95% confidence interval [CI], 72%-100%) and the specificity was 95% (95% CI, 74%-100%).

The investigators concluded that their findings support recent guidance suggesting that patient-collected lower nasal swabs are an acceptable specimen collection method for COVID-19 testing. They also noted that these results are only preliminary and are drawn from a small sample size, and that because of their limited generalizability, the findings need to be validated in other clinical settings.

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