Authors: Clare Davenport et al.,

Highlight

When used with RT‐PCR, there is no evidence for a difference in sensitivity of self‐collected gargle or deep‐throat saliva samples compared to nasopharyngeal samples collected by healthcare workers when used with RT‐PCR. Use of these alternative, self‐collected sample types has the potential to reduce cost and discomfort and improve the safety of sampling by reducing risk of transmission from aerosol spread which occurs as a result of coughing and gagging during the nasopharyngeal or oropharyngeal sample collection procedure. This may, in turn, improve access to and uptake of testing. Other types of saliva, nasal, oral and oropharyngeal samples are, on average, less sensitive compared to healthcare worker‐collected nasopharyngeal samples, and it is unlikely that sensitivities of this magnitude would be acceptable for confirmation of SARS‐CoV‐2 infection with RT‐PCR.

When used with Ag‐RDTs, there is no evidence of a difference in sensitivity between nasal samples and healthcare worker‐collected nasopharyngeal samples for detecting SARS‐CoV‐2. The implications of this for self‐testing are unclear as evaluations did not report whether nasal samples were self‐collected or collected by healthcare workers. Further research is needed in asymptomatic individuals, children and in Ag‐RDTs, and to investigate the effect of operator expertise on accuracy.

Quality assessment of the evidence base underpinning these conclusions was restricted by poor reporting. There is a need for further high‐quality studies, adhering to reporting standards for test accuracy studies.