Introduction
An outbreak of pneumonia of unknown etiology was detected in Wuhan, Hubei Province of China, in late December, 2019.1,2Since then, the disease has rapidly spread around the globe. The causative agent of the disease was identified to be a novel coronavirus of bat origin,3 later termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2),4 and the disease was named coronavirus disease 2019 (COVID-19).5 The World Health Organization (WHO) designated the COVID-19 outbreak as a pandemic on March 11, 2020.6 As of May 19, 2020, there have been over 4,731,458 laboratory confirmed cases and 316,169 deaths reported globally. In the United States alone, more than 1,477,516 COVID-19 cases and 89,272 deaths have been reported, and the numbers continue to rise.7,8
Many patients infected with SARS-CoV-2 are asymptomatic, however the most common symptoms at the onset of illness are fever, cough, dyspnea, and myalgia.9,10 Some patients may also experience headache, dizziness, loss of taste and/or smell,11 and gastrointestinal symptoms such as nausea, vomiting and diarrhea.10,12 Chest computed tomography (CT) findings of COVID-19 patients show multifocal bilateral ground-glass opacities and areas of consolidation.10,13 Severe-onset disease may lead to acute respiratory distress syndrome and death.12 SARS-CoV-2 is thought to spread primarily through respiratory droplets and from close person-to-person contact with an infected individual.14 The virus has also been shown to survive on surfaces such as plastic and stainless steel for up to 72 hours.15 Currently, the recommended mode of diagnostic specimen collection is from the upper respiratory tract using nasopharyngeal and oropharyngeal swabs. However, this requires close contact between the healthcare worker and individual, and may induce sneezing and coughing which can lead to aerosol generation, and cause transmission of the virus. This method of sample collection may also cause discomfort and bleeding in some people.16 In addition, there is an acute shortage of swabs and protective gear, and an overburdening of the testing centers. Thus, there is a need to explore other evidence based modalities of specimen collection for mass testing and monitoring of COVID-19.