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Personal non-nasopharyngeal sampling in Covid-19: A new approach to hope

08 July 2020

Dr. Muhammad Torequl Islam :
The severe acute respiratory distress syndrome coronavirus 2 (SARS-CoV-2) is considered as an airborne virus which is known to transmit as a person-to-person mode through the cough, sneeze, droplet inhalation, and contact (e.g., oral, nasal, eye mucous membranes) from the infected person to the others. Health workers are at the forefront of the outbreak of this pandemic response as they are highly exposed to hazards that put them at risk of infection. Lack of personal protective equipment, exposure to infected patients, work overload, poor infection control, and preexisting medical conditions are the potential risk factors for novel coronavirus disease 2019 (Covid-19) among the health workers. On the other hand, current available mode of sample collection, i.e., from the oropharynx or nasopharynx by the health workers is creating an uncomfortable feeling to the suspected Covid-19 patients.
Generally, the health care workers collectswab samples from the suspected patients' oropharynx or nasopharynx according to testing guidelines for the SARS-CoV-2 worldwide. However, this procedure potentially increased the risk of transmission of this cytopathic virus to the health care workers, especially who are lacking sufficient personal protective equipment (PPE). It has been observed that it is easier and faster to obtain a tongue, nasal, or mid-turbinate sample over a nasopharyngeal sample, with less potential for the patient to sneeze, cough, or gag. Currently, non-nasopharyngeal samples have been validated for detection of this virus. Sample collection by the patient ownself reduces the overall risks related to exposure of the health care workers and preserves limited PPE.
The estimated sensitivities non-nasopharyngeal swabs, such as tongue, nasal, and mid-turbinate samples collected by the patients were 89.8, 94.0, and 96.2%, respectively. The viral load was found higher in the middle turbinate than in the nasopharynx and equivalent between the nose and the nasopharynx. It seems there is a possibility of the clinical usefulness of these kinds of non-nasopharyngeal swab samples collected by the patients as compared to the nasopharyngeal samples collected by health care workers for the diagnosis of Covid-19.
Adequate measures regarding the training and adoption of suitable techniques for sampling by patients can reduce PPE use and provide a more comfortable patient experience in the diagnosis of Covid-19 patients. Although, it is not a perfect standard diagnostic approach, but this can be implemented in the poorer countries like us to reduce the manpower, cost of PPE, the risk of viral transmission during sampling, super-spreading option, finally to ensure a comfortable patient experience. Additionally, patient collection of samples for SARS-CoV-2 testing from sites other than the nasopharynx may be a hopeful approach during the Covid-19 pandemic.
(Dr. Muhammad Torequl Islam is Assistant Professor, Department of Pharmacy, Life Science Faculty, Bangabandhu Sheikh Mujibur Rahman Science and Technology University. E-mail: [email protected])

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