University of Utah Health will start using saliva tests for COVID-19

(Photo courtesy of University of Utah Health) A worker holds a collection tube for saliva testing. University of Utah Health and ARUP announced on Thursday, Aug. 20, 2020, that they will begin collecting saliva samples for COVID-19 testing in some clinical settings.

Some Utahns getting tested for COVID-19 soon will be able to spit into a tube instead of having a swab shoved up their noses.

Doctors from University of Utah Health and ARUP Laboratories announced Thursday that they will offer saliva testing for COVID-19 by September — after completing a study that found the spit test detected the virus as well as the traditional, and famously uncomfortable, nasal swab.

“In over a thousand samples, we were able to show with pretty robust confidence in our statistics, we think, that saliva looks to be just as effective as the standard deep swab,” Dr. Kimberly Hanson, infectious disease physician at U. Health and section chief of clinical microbiology at ARUP, said in a videoconference media briefing Thursday.

The findings, and the use of saliva tests, could make the testing process simpler and safer, Hanson said.

“It’s easier to collect, and it’s probably safer for the health care providers as well,” Hanson said, “because spitting saliva into a tube is less likely to generate infectious aerosols.”

Health care workers administering saliva tests, she said, “may not have to wear all the heavy personal protective equipment that we have them wear for the deeper sampling.”

U. Health’s four testing centers — in Sugar House, on Redwood Road, and in South Jordan and Bountiful — should be implementing the saliva tests by mid-September, said Dr. Richard Orlandi, U. Health’s chief medical officer for ambulatory health. The four clinics, he said, administer about a quarter of the COVID-19 tests performed in Utah.

Dr. Julio Delgado, ARUP’s chief medical officer, said the saliva testing would be done with a three-part kit. One part is a piece of paper with the instructions. The second part is the collection tube, which contains about one milliliter of “media,” liquid that would mix in with the collected saliva and keep the sample viable for testing. The third part is a plastic funnel, which connects to the collection tube.

The patient attaches the funnel to the collection tube, then spits into the funnel. Once enough saliva is collected, reaching a “fill line” marked on the outside of the tube, the patient removes the funnel and caps the tube. The tube is then sent in for testing.

“It’s a very simple, very fast procedure,” Delgado said. The U.‘s kits will be made by ARUP, he said.

For the peer-reviewed study — which was published last week online in the Journal of Clinical Microbiology — researchers asked 354 patients getting tested at U. Health’s Redwood Health Center to have three tests performed: The traditional swab (called a nasopharyngeal swab), the saliva test, and a self-administered swab.

When the tests were compared, the saliva test matched the traditional swab tests 93.8% of the time, while the self-administered swabs matched the traditional tests 86.3% of the time.

“It is something to remember that no test is perfect,” Hanson said, “and not all patients had the virus detected with both tests simultaneously.”

The researchers originally had received permission from 368 patients to conduct the study, Hanson said, but 14 were removed because they couldn’t produce enough saliva to fill the tube. That’s a small percentage of patients whose dry mouth prevents them from taking the saliva test, she said; for them, the nasopharyngeal swabs still are available.

Saliva tests must be administered by health care workers to be approved by the federal Food and Drug Administration, Delgado said, so it’s too soon to look for an in-home COVID-19 saliva test kit.

Bill Phillips, founder of Spectrum Solutions, a company in Draper that manufactures saliva test kits, said the U.-ARUP study is in line with other research that shows the effectiveness of the spit test for detecting COVID-19.

Such research, Phillips said, should promote broader acceptance of the saliva test over the nasopharyngeal swab, both in and out of the medical community.

“It takes a little while to change the mindset, that curve of [saying] a swab, because it’s so painful and medical, has a greater level of validity,” Phillips said. He compared it to the old saw that “if it tastes bad, it must be good for you.”

According to market research Phillips has commissioned, “testing will be an ongoing thing for the next five years or greater,” he said, even if a COVID-19 vaccine is ready before then.

Spectrum Solutions manufactures 100,000 saliva test kits a day in its Draper plant, Phillips said. The company is ramping up to produce 500,000 kits a day, using contractors in Wisconsin, North Carolina and California.

Phillips’ company boasts a client list that includes the U.S. Senate, the U.S. Ski and Snowboard team, the Olympics, and several sports leagues. Last week, Spectrum Solutions became the test-kit supplier to Major League Baseball, with plans to produce 275,000 kits for the pandemic-shortened season.