Detection and Stability of SARS-CoV-2 in Three Self-Collected Specimen Types: Flocked Midturbinate Swab (MTS) in Viral Transport Media, Foam MTS, and Saliva

Vic Veguilla, Ashley L. Fowlkes, Adam Bissonnette, Shawn Beitel, Manjusha Gaglani, Christina A. Porucznik, Melissa S. Stockwell, Harmony L. Tyner, Allison L. Naleway, Sarang K. Yoon, Alberto J. Caban-Martinez, Meredith G. Wesley, Jazmin Duque, Zuha Jeddy, Joseph B. Stanford, Michael Daugherty, Ashton Dixon, Jefferey L. Burgess, Marilyn Odean, Holly C. GroomAndrew L. Phillips, Natasha Schaefer-Solle, Peenaz Mistry, Melissa A. Rolfes, Mark Thompson, Fatimah S. Dawood, Jennifer Meece

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Respiratory specimen collection materials shortages hampers severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing. We compared specimen alternatives and evaluated SARS-CoV-2 RNA stability under simulated shipping conditions. We compared concordance of RT-PCR detection of SARS-CoV-2 from flocked midturbinate swabs (MTS) in viral transport media (VTM), foam MTS without VTM, and saliva. Specimens were collected between August 2020 and April 2021 from three prospective cohorts. We compared RT-PCR cycle quantification (Cq) for Spike (S), Nucleocapsid (N), and the Open Reading Frame 1ab (ORF) genes for flocked MTS and saliva specimens tested before and after exposure to a range of storage temperatures (4–30°C) and times (2, 3, and 7 days). Of 1,900 illnesses with $2 specimen types tested, 335 (18%) had SARS-CoV-2 detected in $1 specimen; 304 (91%) were concordant across specimen types. Among illnesses with SARS-CoV-2 detection, 97% (95% confidence interval [CI]: 94–98%) were positive on flocked MTS, 99% (95% CI: 97–100%) on saliva, and 89% (95% CI: 84–93%) on foam MTS. SARS-CoV-2 RNA was detected in flocked MTS and saliva stored up to 30°C for 7 days. All specimen types provided highly concordant SARS-CoV-2 results. These findings support a range of viable options for specimen types, collection, and transport methods that may facilitate SARS-CoV-2 testing during supply and personnel shortages. IMPORTANCE Findings from this analysis indicate that (1) self-collection of flocked and foam MTS and saliva samples is feasible in both adults and children, (2) foam MTS with VTM and saliva are both viable and reasonable alternatives to traditional flocked MTS in VTM for SARS-CoV-2 detection, and (3) these sample types may be stored and transported at ambient temperatures for up to 7 days without compromising sample quality. These findings support methods of sample collection for SARS-CoV-2 detection that may facilitate widespread community testing in the setting of supply and personnel shortages during the current pandemic.

Original languageEnglish (US)
JournalMicrobiology Spectrum
Issue number3
StatePublished - Jun 2022


  • COVID-19
  • RT-PCR
  • SARS-CoV-2
  • respiratory specimens
  • sensitivity

ASJC Scopus subject areas

  • Physiology
  • Ecology
  • Immunology and Microbiology(all)
  • Genetics
  • Microbiology (medical)
  • Cell Biology
  • Infectious Diseases


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