{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T06:47:56Z","timestamp":1768546076764,"version":"3.49.0"},"posted":{"date-parts":[[2020,6,14]]},"group-title":"Infectious Diseases (except HIV\/AIDS)","reference-count":22,"publisher":"openRxiv","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2020,6,14]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:p>The urgent need for large-scale diagnostic testing for SARS-CoV-2 has prompted pursuit of sample-collection methods of sufficient sensitivity to replace sampling of the nasopharynx (NP). Among these alternatives is collection of nasal-swab samples, which can be performed by the patient, avoiding the need for healthcare personnel and personal protective equipment.<\/jats:p>\n                <jats:p>Previous studies have reached opposing conclusions regarding whether nasal sampling is concordant or discordant with NP. To resolve this disagreement, we compared nasal and NP specimens collected by healthcare workers in a cohort consisting of individuals clinically suspected of COVID-19 and outpatients known to be SARS-CoV-2 RT-PCR positive undergoing follow-up. We investigated three different transport conditions, including traditional viral transport media (VTM) and dry swabs, for each of two different nasal-swab collection protocols on a total of 308 study participants, and compared categorical results and Ct values to those from standard NP swabs collected at the same time from the same patients. All testing was performed by RT-PCR on the Abbott SARS-CoV-2 RealTime EUA (limit of detection [LoD], 100 copies viral genomic RNA\/mL transport medium). We found high concordance (Cohen\u2019s kappa &gt;0.8) only for patients with viral loads above 1,000 copies\/mL. Those with viral loads below 1,000 copies\/mL, the majority in our cohort, exhibited low concordance (Cohen\u2019s kappa = 0.49); most of these would have been missed by nasal testing alone. Previous reports of high concordance may have resulted from use of assays with higher LoD (\u22651,000 copies\/mL). These findings counsel caution in use of nasal testing in healthcare settings and contact-tracing efforts, as opposed to screening of asymptomatic, low-prevalence, low-risk populations. Nasal testing is an adjunct, not a replacement, for NP.<\/jats:p>","DOI":"10.1101\/2020.06.12.20128736","type":"posted-content","created":{"date-parts":[[2020,6,14]],"date-time":"2020-06-14T09:34:32Z","timestamp":1592127272000},"source":"Crossref","is-referenced-by-count":21,"title":["Nasal-Swab Testing Misses Patients with Low SARS-CoV-2 Viral Loads"],"prefix":"10.64898","author":[{"given":"Cody","family":"Callahan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rose A.","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ghee Rye","family":"Lee","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kate","family":"Zulauf","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0392-4500","authenticated-orcid":false,"given":"James E.","family":"Kirby","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramy","family":"Arnaout","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2021010205350742000_2020.06.12.20128736v1.1","doi-asserted-by":"crossref","unstructured":"Yang Y , Yang M , Shen C , et al. Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections. medRxiv 2020; : 2020.02.11.20021493.","DOI":"10.1101\/2020.02.11.20021493"},{"key":"2021010205350742000_2020.06.12.20128736v1.2","doi-asserted-by":"publisher","DOI":"10.1038\/s41586-020-2196-x"},{"key":"2021010205350742000_2020.06.12.20128736v1.3","unstructured":"Saliva is more sensitive for SARS-CoV-2 detection in COVID-19 patients than nasopharyngeal swabs | medRxiv. https:\/\/www.medrxiv.org\/content\/10.1101\/2020.04.16.20067835v1 (accessed June 9, 2020)."},{"key":"2021010205350742000_2020.06.12.20128736v1.4","unstructured":"CDC. Information for Laboratories about Coronavirus (COVID-19). Cent. Dis. Control Prev. 2020; published online Feb 11. https:\/\/www.cdc.gov\/coronavirus\/2019-ncov\/lab\/guidelines-clinical-specimens.html (Accessed June 10, 2020)."},{"key":"2021010205350742000_2020.06.12.20128736v1.5","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciaa631"},{"key":"2021010205350742000_2020.06.12.20128736v1.6","doi-asserted-by":"crossref","unstructured":"Arnaout R , Lee RA , Lee GR , et al. SARS-CoV2 Testing: The Limit of Detection Matters. bioRxiv 2020; : 2020.06.02.131144.","DOI":"10.1101\/2020.06.02.131144"},{"key":"2021010205350742000_2020.06.12.20128736v1.7","unstructured":"Callahan CJ , Lee R , Zulauf KE , et al. Open Development and Clinical Validation Of Multiple 3D-Printed Nasopharyngeal Collection Swabs: Rapid Resolution of a Critical COVID-19 Testing Bottleneck. J Clin Microbiol 2020; : JCM.00876-20, jcm;JCM.00876-20v1."},{"key":"2021010205350742000_2020.06.12.20128736v1.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2020.104442"},{"key":"2021010205350742000_2020.06.12.20128736v1.9","unstructured":"Rhoads DD , Cherian SS , Roman K , Stempak LM , Schmotzer CL , Sadri N. Comparison of Abbott ID Now, Diasorin Simplexa, and CDC FDA EUA methods for the detection of SARS-CoV-2 from nasopharyngeal and nasal swabs from individuals diagnosed with COVID-19. J Clin Microbiol 2020; : JCM.00760-20, jcm;JCM.00760-20v1."},{"key":"2021010205350742000_2020.06.12.20128736v1.10","unstructured":"Minich JJ , Ali F , Marotz C , et al. Feasibility of SARS-CoV-2 virus detection from consumer-grade cotton swabs. medRxiv 2020; : 2020.05.12.20073577."},{"key":"2021010205350742000_2020.06.12.20128736v1.11","unstructured":"McCormick-Baw C , Morgan K , Gaffney D , et al. Saliva as an Alternate Specimen Source for Detection of SARS-CoV-2 in Symptomatic Patients Using Cepheid Xpert Xpress SARS-CoV-2. J Clin Microbiol 2020; : JCM.01109-20, jcm;JCM.01109-20v1."},{"key":"2021010205350742000_2020.06.12.20128736v1.12","doi-asserted-by":"crossref","unstructured":"Kojima N , Turner F , Slepnev V , et al. Self-Collected Oral Fluid and Nasal Swabs Demonstrate Comparable Sensitivity to Clinician Collected Nasopharyngeal Swabs for Covid-19 Detection. medRxiv 2020; : 2020.04.11.20062372.","DOI":"10.1101\/2020.04.11.20062372"},{"key":"2021010205350742000_2020.06.12.20128736v1.13","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcv.2020.104417"},{"key":"2021010205350742000_2020.06.12.20128736v1.14","doi-asserted-by":"crossref","unstructured":"Berenger BM , Fonseca K , Schneider AR , Hu J , Zelyas N. Sensitivity of Nasopharyngeal, Nasal and Throat Swab for the Detection of SARS-CoV-2. medRxiv 2020; : 2020.05.05.20084889.","DOI":"10.1101\/2020.05.05.20084889"},{"key":"2021010205350742000_2020.06.12.20128736v1.15","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc2016321"},{"key":"2021010205350742000_2020.06.12.20128736v1.16","doi-asserted-by":"crossref","unstructured":"Basu A , Zinger T , Inglima K , et al. Performance of the rapid Nucleic Acid Amplification by Abbott ID NOW COVID-19 in nasopharyngeal swabs transported in viral media and dry nasal swabs, in a New York City academic institution. bioRxiv 2020; : 2020.05.11.089896.","DOI":"10.1101\/2020.05.11.089896"},{"key":"2021010205350742000_2020.06.12.20128736v1.17","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.00913-20"},{"key":"2021010205350742000_2020.06.12.20128736v1.18","unstructured":"Anonymous. Abbott RealTime SARS-CoV-2 Emergency Use Authorization Package Insert. REF 09N77-095, 51-608445\/R1. https:\/\/www.fda.gov\/media\/136258\/download (accessed June 8, 2020)."},{"key":"2021010205350742000_2020.06.12.20128736v1.19","first-page":"276","article-title":"Interrater reliability: the kappa statistic","volume":"22","year":"2012","journal-title":"Biochem Medica"},{"key":"2021010205350742000_2020.06.12.20128736v1.20","doi-asserted-by":"crossref","first-page":"672","DOI":"10.1038\/s41591-020-0869-5","article-title":"Temporal dynamics in viral shedding and transmissibility of COVID-19","volume":"26","year":"2020","journal-title":"Nat Med"},{"key":"2021010205350742000_2020.06.12.20128736v1.21","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2008457"},{"key":"2021010205350742000_2020.06.12.20128736v1.22","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(20)31022-9"}],"container-title":[],"original-title":[],"link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1101\/2020.06.12.20128736","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,15]],"date-time":"2026-01-15T13:44:43Z","timestamp":1768484683000},"score":1,"resource":{"primary":{"URL":"http:\/\/medrxiv.org\/lookup\/doi\/10.1101\/2020.06.12.20128736"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,14]]},"references-count":22,"URL":"https:\/\/doi.org\/10.1101\/2020.06.12.20128736","relation":{},"subject":[],"published":{"date-parts":[[2020,6,14]]},"subtype":"preprint"}}