Increased SARS-CoV-2 Testing Capacity with Pooled Saliva Samples.

Area of Science:

• Clinical diagnostics
• Virology
• Public health

Background:

• Accurate and efficient testing is crucial for managing infectious diseases like COVID-19.
• Saliva-based testing offers a less invasive alternative to nasopharyngeal swabs.
• Optimizing testing strategies can improve resource allocation and public health response.

Purpose of the Study:

• To evaluate the feasibility of pooling saliva samples for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection.
• To quantify the impact of pool size on SARS-CoV-2 test sensitivity.
• To determine optimal pooling strategies based on varying virus prevalence.

Main Methods:

• Analysis of saliva sample pooling for SARS-CoV-2 testing.
• Assessment of sensitivity reduction across different pool sizes (5, 10, and 20 samples).
• Modeling of testing strategies considering virus prevalence thresholds.

Main Results:

• Test sensitivity decreased with increasing pool size: 7.4% reduction for 5 samples/pool, 11.1% for 10 samples/pool, and 14.8% for 20 samples/pool.
• Pooling of 5 samples is more efficient when virus prevalence exceeds 2.6%.
• Pooling of 20 samples is effective for screening strategies when virus prevalence is below 0.6%.

Conclusions:

• Saliva sample pooling is a viable strategy for SARS-CoV-2 testing, with sensitivity trade-offs.
• The optimal pool size depends on the local prevalence of SARS-CoV-2.
• Strategic pooling can enhance the efficiency of large-scale screening efforts.