The Weekly Dose September 3, 2020 Welcome to The Weekly Dose! Each week, we will review one scientific article, summarizing the research and providing key takeaways. Our goal in this endeavor is to make science understandable and accessible to all.

This week we reviewed research conducted by scientists at Yale University that supports the use of saliva specimens in the diagnosis of SARS-CoV-2 as an alternative to nasopharyngeal swabbing. The researchers, who published their findings in an August 28 correspondence on the New England Journal of Medicine website, presented the results of two studies in the article.  In the first study, the investigators simultaneously collected saliva and nasal swab samples from 70 hospitalized patients who previously tested positive for SARS-CoV-2--based on nasal swabs--when they were admitted to the hospital. The samples were tested several times over 10 days using both methods, with three outcomes compared: (1) viral load (measured by RNA copies) and related positive (vs. negative) test results; (2) change in viral load over time; and (3) consistency of findings (positive/negative) across measurements. The results? Saliva testing detected more point-in-time RNA copies (and thus, a higher proportion of positive tests) than nasal-swab testing, both tests showed similar decreases in viral load after the onset of symptoms, and saliva testing proved less variable* in producing test results over time than nasal testing.

In the second study, the researchers set out to confirm earlier studies’ findings that SARS-CoV-2 RNA is detectable in saliva specimens of asymptomatic individuals. As in the first study, they compared saliva and nasal samples, but this time from 495 asymptomatic healthcare workers. The saliva tests identified SARS-CoV-2 RNA (i.e., positive cases) in 13 asymptomatic participants, 9 of which provided nasal-swab samples on the same day, of which only 2 tested positive. Unsure whether the discordant findings were the result of false positives in the saliva tests or false negatives in the nasal tests, the investigators later obtained and analyzed a second nasal sample. The second test indicated that all 13 saliva-positive cases had detectable levels of virus in their nasal samples, suggesting the latter explanation (i.e., false negative nasal tests in the earlier sampe). The authors offered that one possible explanation for the high proportion of false negatives might be differences among healthcare workers in swabbing technique.

Key Takeaways:  Saliva specimen testing has the potential to increase detection of SARS-CoV-2 in both symptomatic and asymptomatic patients. At-home collection of saliva samples eliminates the need for a healthcare professional to be involved in sampling, which reduces labor costs and those associated with PPE and swabbing materials, and eliminates risk of nosocomial infection associated with nasal testing in hospitals, healthcare facilities, and mobile testing sites.  *There were three times when a negative nasopharyngeal test was followed by a positive one, as opposed to one time when a negative saliva specimen was followed by a positive one.

Important Articles from the Last Week:  CDC has not reduced the death count related to COVID-19 Doctors Chase Treatment for Kids Threatened by Dangerous COVID-19 Syndrome COVID-19 Can Wreck Your Heart, Even if You Haven't Had Any Symptoms COVID-19 cases in Europe back to March level, EU health body says Health officials worry nation not ready for COVID-19 vaccine U.S. Won't Join WHO-Led Coronavirus Vaccine Effort, White House Says How the Pandemic Has Changed Cancer Screening and Care Steroids cut death rates among critically ill COVID-19 patients, major study finds Why Coronavirus Is Surging in the Midwest Right Now The magnitude of America's contact tracing crisis is hard to overstate

Who is VSC?  Vital Statistics Consulting (VSC) is a healthcare consultancy that specializes in the evaluation of policies and programs and provides independent, rigorous, innovative analysis to support data-driven recommendations that improve healthcare quality and organizational efficiency.

What's New at VSC? VSC remains actively engaged in the response to the COVID-19 pandemic. We are nearly at the completion of data collection for a serosurvey that we conducted for a large federally-qualified health center (FQHC) in New York, the results of which will be published in a peer-reviewed manuscript. We look forward to sharing our findings with you! Our CEO, Dr. Jessica Steier, received certification through the American Red Cross in two areas: Returning to Work During COVID-19: Safe Work Practices and Psychological First Aid: Supporting Yourself and Others During COVID-19. Jessica will also be moderating a virtual event for the Diversity Alliance for Science called COVID Voices. Simply described, the event showcases a diverse panel of speakers reflecting on the pandemic from varying perspectives. The segment will air on 9/29 and we will be sure to post a link so you can check it out! 

Employee Spotlight Each week, The Weekly Dose will introduce readers to one of our team members. This week, Dr. Izabela Aleksanderek, VSC Scientific Communication Consultant, is in the “spotlight.” We have asked her three questions, the answers to which reveal some of her professional and personal inspiration for working in the field of health science.

Which people and/or events influenced your decision to work in this field?   I happened to end up in this field by chance. It all started during my PhD studies and work as a post-doctoral fellow. I loved science, summarizing collected data in multi-tab spreadsheets, and writing up the technical results. However, I quickly realized I did not want to spend my entire career in the academic world writing research grants. During my post-doctoral fellowship, I joined American Medical Women's Association (AMWA), which seemed to check off all the boxes of my dream job: science, writing, work-life balance, and flexibility. Following some academic writing, a client introduced me to the world of health economics and outcomes research, dossier work, and market access research. It was an unconventional path, but feels like “it was meant to be”.   What was the answer you gave people as a child when asked what you want to be when you grow up? I wanted to be a doctor, specifically a pediatrician.  What advice would you give yourself 3 years ago? 3 years from now? “In the end, we only regret the chances we didn’t take.”  "Don’t let the fear of the unknown or failure stand in the way of trying something new." During the difficult times, I also like to remind myself, “this too shall pass.”

We welcome your feedback! Tell us what you think of The Weekly Dose and feel free to send article suggestions for future editions. Contact us by e-mail at info@vscgrp.com or call us at 1-877-VIT-STAT.

‌ ‌ ‌