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    Research Letter
    Infectious Diseases
    July 22, 2020

    Comparison of Unsupervised Home Self-collected Midnasal Swabs With Clinician-Collected Nasopharyngeal Swabs for Detection of SARS-CoV-2 Infection

    Author Affiliations
    • 1Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle
    • 2Department of Laboratory Medicine, University of Washington, Seattle
    • 3Seattle Children’s Research Institute, Seattle, Washington
    JAMA Netw Open. 2020;3(7):e2016382. doi:10.1001/jamanetworkopen.2020.16382

    Increased diagnostics are urgently needed to contain the spread of coronavirus disease 2019 (COVID-19). Home self-collected swabs may increase testing access while minimizing exposure risk to health care workers and depletion of personal protective equipment, allowing for early community detection of COVID-19. A comparison of unsupervised home self-collected swabs with clinician-collected nasopharyngeal swabs for COVID-19 diagnosis has not been well described.

    This cross-sectional study was approved by the University of Washington institutional review board and follows the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. Participants provided electronic informed consent. Study participants were recruited from symptomatic outpatients testing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)–positive and symptomatic health care workers presenting to drive-through clinics (eFigure and eAppendix in the Supplement). Participants were provided test kits for unsupervised home self-collection of a midnasal swab. Home swab performance was compared with clinician-collected nasopharyngeal swabs, which were collected by medical assistants and nurses. Cycle thresholds (Ct) are a semiquantitative measure of viral load. Positive test results for SARS-CoV-2 by both approaches were defined as true positives. Results with a positive clinician swab and negative home swab were defined as false negatives. Sensitivity was defined as true positives divided by the sum of true positives and false negatives. Cohen κ was calculated for agreement between the 2 qualitative test results. The threshold for statistical significance was set at 2-tailed P < .05.