COVID-19: Saliva Testing / Virus Detection in Children / Remdesivir Authorization Expanded / Reinfection in U.S.

By Amy Orciari Herman

Edited by Susan Sadoughi, MD, and André Sofair, MD, MPH

Take a look at some of the latest developments in COVID-19:

Saliva testing: New study findings suggest a potential role for SARS-CoV-2 testing using self-collected saliva samples. In the New England Journal of Medicine, researchers report that among 70 inpatients with confirmed COVID-19, more copies of viral RNA were detected in patient-collected saliva specimens than in clinician-collected nasopharyngeal specimens. Separately, the researchers studied SARS-CoV-2 test results among nearly 500 asymptomatic healthcare workers. Saliva samples were positive in 13; of the 9 who also had nasopharyngeal tests, 7 of the nasopharyngeal tests were negative. SARS-CoV-2 infection was subsequently confirmed in all 13.

More saliva testing: In the Annals of Internal Medicine, researchers report findings from paired saliva and swab (nasopharyngeal or oropharyngeal) specimens from over 1900 high-risk asymptomatic or mildly symptomatic people. Of these, 22 participants tested positive with swab alone and 14 with saliva alone (an additional 34 tested positive on both). The researchers write, "Despite a lower estimated rate of detection relative to swab testing, saliva testing may be of particular benefit for remote, vulnerable, or challenging populations."

Virus detection in children: Of 91 children in South Korea who were monitored throughout their course of confirmed COVID-19 illness, 22% never developed any symptoms. Of those with symptoms, 58% had upper respiratory tract infections and 31% had lower respiratory tract infections. Overall, the median duration of symptoms was 13 days. SARS-CoV-2 RNA was detected for an average of 18 days. Among asymptomatic children alone, viral RNA was detected for 14 days. The findings appear in JAMA Pediatrics.

Remdesivir authorization expanded: The FDA on Friday expanded the emergency use authorization for remdesivir. It's now authorized for use in all adults and children hospitalized with suspected or confirmed COVID-19, regardless of disease severity. (The drug was first authorized in May for those hospitalized with severe COVID-19.) The expansion is based on findings from two randomized trials (one open label) that suggested a benefit from treatment in patients with mild-to-moderate disease.

Reinfection in U.S.: The University of Nevada late last week announced its investigation of a "likely case of COVID-19 reinfection" — the first reported in the U.S. A Nevada man tested positive for SARS-CoV-2 in April; he had mild illness and subsequently tested negative twice. Then, in late May, he became ill again; he developed more severe disease and tested positive again. Genomic analysis of viral samples from the two infections showed "significant genetic discordance," indicating the patient was likely infected twice.