Testing is the cornerstone of a successful public health response to coronavirus disease 2019 (COVID-19). Nasopharyngeal swab nucleic acid amplification testing (NAAT) is the non-invasive criterion standard for diagnosis of coronavirus disease 2019 (COVID-19). However, it requires trained personnel, limiting its availability, and the technique cannot be easily or reliably performed in all populations (i.e., children and quarantined individuals). 

Consequently, alternative sampling sites are being explored to allow broader deployment of testing, increased access in remote regions, and testing among underserviced populations who may have limited access to highly qualified testing personnel. Saliva testing (NAAT) represents an attractive alternative, but its diagnostic performance is unclear. To date, the results of studies on the diagnostic performance of saliva NAAT are conflicting and other studies have relied on the assumption that the sensitivity and specificity of the nasopharyngeal swab is perfect, which is not the case.

In a recent study published on JAMA Network, a meta-analysis found that the diagnostic sensitivity for saliva NAAT is approximately 83.2% which is comparable to that reported for nasopharyngeal swab NAAT. Given the ease of sample procurement and increased patient comfort, testing centers should strongly consider adopting saliva as their first sample choice, especially in community mass screening programs. Wow! We certainly have come a long way but although we have a long way to go, isn’t this exciting news?

Stay the course, stay well, mask up, get vaccinated, and stay tuned!