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.