Acceptance of Saliva-Based Specimen Collection for SARS-CoV-2 Testing Among K-12 Students, Teachers, and Staff

Abstract

Objective: Saliva specimens collected in school populations may offer a more feasible, noninvasive alternative to nasal swabs for large-scale COVID-19 testing efforts in kindergarten through 12th grade (K-12) schools. We investigated acceptance of saliva-based COVID-19 testing among quarantined K-12 students and their parents, teachers, and staff members who recently experienced a SARS-CoV-2 exposure in school.

Methods: We surveyed 719 participants, in person or by telephone, who agreed to or declined a free saliva-based COVID-19 reverse-transcription polymerase chain reaction test as part of a surveillance investigation about whether they would have consented to testing if offered a nasal swab instead. We conducted this investigation in 6 school districts in Greene County (n = 3) and St. Louis County (n = 3), Missouri, from January 25 through March 23, 2021.

Results: More than one-third (160 of 446) of K-12 students (or their parents or guardians), teachers, and staff members who agreed to a saliva-based COVID-19 test indicated they would have declined testing if specimen collection were by nasal swab. When stratified by school level, 51% (67 of 132) of elementary school students or their parents or guardians would not have agreed to testing if a nasal swab was offered.

Conclusions: Some students, especially those in elementary school, preferred saliva-based COVID-19 testing to nasal swab testing. Use of saliva-based testing might increase voluntary participation in screening efforts in K-12 schools to help prevent the spread of SARS-CoV-2.

Keywords: COVID-19; K-12 schools; saliva-based testing; school health; screening.

Figure.

Flow diagram depicting survey results of participants (N = 719) who agreed to (n = 446) or declined (n = 273) saliva-based COVID-19 testing in kindergarten through 12th grade schools, Missouri, January 25 through March 23, 2021. Participants included students and staff members who previously received a positive test result for SARS-CoV-2 and their identified school-based close contacts during their isolation and quarantine periods. (A) 36% of student participants who agreed to a saliva test, or their parent or guardian, indicated they would have declined testing if specimens had been collected by nasal swab. (B) For participating teachers and staff, 31% indicated they would have refused a nasal swab test. (C) 98% of participants who declined a saliva test but answered our survey reported they would have refused a nasal swab test. In addition, 118 participants initially agreed to testing but were lost to follow-up before specimen collection and not administered the survey question, and 6 participants were tested but not asked the survey question.