COVID-19 and saliva testing

There is research being done on the valid use of saliva as a diagnostic measure for SARS-CoV-2 the virus that causes COVID-19. This follows on from an increased reluctance by people to have the nasal and throat swab done.

The focus is on the non-invasive nature of this type of testing and the resultant points of it being feasible, acceptable and the increased demand to the medical system being able to be met, of collecting the saliva samples in busy screening clinics.

The saliva test was trialled in the laboratory at the Doherty Institute in Melbourne VIC, and in labs around the world. Results suggest this approach could be an alternative to swab testing in certain settings and for certain people. While it has been used in some parts of Australia, it is not as of yet widely available.

The positives of saliva testing 

For young children and people with disability, and people with an aversion to the invasive nature of a swab, the process of saliva testing may be the answer. The collection of saliva collected in the mouth and spat into a specimen jar may be more preferable to some people, especially those deemed to be vulnerable such as children, the elderly who may have conditions that render them anxious or confused and some people with disabilities.

The negatives of saliva testing

The drawback is the lower accuracy rate of the results with the saliva testing compared to the swab testing.

“The Doherty Institute found nasal and throat swabs were 95 per cent accurate, while saliva was between 84.6 per cent and 87 per cent.”  

The Australian, June 30, 2020

Saliva collection - What is it?

The information below comes from Victoria DHHS who were using Saliva testing earlier in the pandemic, but are not currently offering the service.

• Saliva testing is an option for individuals aged 3 years and above. There is no confirmed saliva collection method for children under 3 years of age, who cannot be directed to spit sufficient amounts of saliva into a container.
  
  
• There is no specific container for saliva specimen collection. Consideration should be given to the spill risk and potential contamination of the outside of the container. The size of the container should be sufficient to ensure at least 2ml of saliva is collected. 
  
  
• At least 2mls of saliva needs to be collected into the collection container. 
  
  
• A person should collect saliva in their mouth and spit carefully and slowly into the container. 
  
  
• This may require a person to pool saliva in their mouth for at least a minute. 
  
  
• The person should repeat collecting and spitting saliva into the container until 2ml is collected. This could be done repeatedly over a 30minute period. 
  
  
• Note: Saliva only testing (without a paired nose or throat swab) is not as sensitive (accurate) as nose and throat swab testing, and therefore should only be a last resort option if a swab sample is not possible.

• The most accurate way to test for COVID-19 is a nose and throat swab collected by a health professional.
  • If you are worried about this, talk to your GP about what the other options could be.
    
    
• In some circumstances, you may be able to perform the test yourself. Your doctor or a health professional should help you and explain how to collect the sample correctly.
  • This is called self-swabbing or self-collecting.
    
    
• A health professional supervised parent/guardian/trusted carer collected swab may be an option for children and adults who cannot tolerate a health professional collected swab and are unable to perform a self-collected swab themselves.
  
  
• Saliva testing may be an option in some circumstances when a swab is not possible, for people aged over 3 years. This decision needs to be made by your doctor. Your doctor will also need to organise the test and send it to their pathology provider marked as a ‘saliva specimen’. Your doctor will receive the results from the test. 
  
  
• There are issues to consider with saliva testing.
  • • It is a new way of testing for COVID-19 so we do not know how accurate it is.
    • A lot of saliva is needed. It may take someone over a minute to collect enough saliva in their mouth. If it is easier, a person can spit small amounts into the cup over a 30 minute period.
    • At least 2 ml is required.
    • There is only 1 lab in Victoria that can test saliva, and so it may increase the time it takes for the result.
      
      

Saliva testing - is it available

Queensland - Updated 2/9/2020

In Queensland, QML Pathology are accepting Saliva Testing which is sent on to Queensland Health. 

You are required to source a sterile sample pot, and return it to QML with the pathology request. Online PDF Pathology Request Forms for QML Pathology are available here for your medical practitioner.

Saliva testing is no longer used in Melbourne or Victoria. For testing options, contact your GP or the Victorian COVID Hotline on 1800 675 398 and press option 9 to speak to their new Victorian call-to-test service.

NSW Health does not recommend Saliva testing.

"Home-based" testing

Mention has been made of the saliva test becoming a ‘home-based’ coronavirus test however, there remain many unanswered questions regarding this concept and it is not currently on offer.

Personal anecdote:

The following personal anecdote gives an indication of the nature of swab testing which for this lady felt quite overwhelming.

My daughter Chloe* was feeling like a cold (was) coming last week. (She) Went and had a test last Monday at Chadstone, Victoria. Her report, very efficient, lots of safety and risk management processes in place, orderly and contained process for drive-through tests. Phone number and name double-checked at least three times as you progressed towards having the test, so your results could come back to you and also for contact tracing processes. 

As you got to do your test, the heavily PPE nurses, allied health professionals talk to you very slowly and clearly and check that you have understood. Immediately prior to having the throat and nasal test, as they are doing the test they say. You may not touch me, or hold me, and you must try and stay very still.Chloe* said that the nasal swab really hurt very much, and you could actually feel the pressure of the wand being inserted up to and into your eyes. She felt an involuntary reaction to cry, that is just tears streaming involuntarily from impact.

She said she was grateful but it was also scary being told not to touch the health professional because on impulse one would have tried to grab the wand. She held on tight to her seat belt as a means to control. She got her results next day. All clear. Chloe* commented that it was a two hour round trip gig, but smooth, efficient, vigilant and clean.

Further Information

Being such a new concept there will be more information becoming available on saliva testing in various forms through the media both by digital and print form. The following sources may be useful to access the most up-to-date information regarding saliva testing. Plus we will add more as it comes to hand.

 * Name changed on request

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