Saliva tests have been approved for use in France - and plans for how and where to deploy such tests, including in schools, are underway.
Dr Lise Alter, director of medical, economic and health evaluations at the medical authority la Haute Autorité de santé (HAS), the body which gave approval, said the change should allow France to “lead mass testing campaigns using repeated swabs that are better accepted [by the public]”.
It comes as a new poll* found that 84% of people in France want faster access to saliva tests so they have an easier way to test themselves.
Pain-free Covid testing
Saliva tests were approved on January 22 after an HAS research group ran 64 trials on 4,520 pairs of positive tests taken from the same patients – one by nasal swab and one by saliva swab. The saliva swabs were found to be 2-11% less sensitive than the nasal swabs and gave 85% reliability (as opposed to 90% for nasal swabs).
Saliva tests are more likely to detect false positives than false negatives.
After a saliva sample is taken by swabbing the inside of the mouth or spitting into a receptacle, samples go through the same process as nasal swabs. They must be sent to a laboratory for analysis before results can be returned, and the process takes around the same amount of time as a nasal PCR test.
But a large advantage of saliva testing is that it is pain-free, while nasal swabs are “invasive and painful – for some people”, Dr Alter said.
Testing solution for children and disabled
The simplicity of taking the test makes saliva tests especially suitable for children and the disabled.
The HAS had previously approved the EasyCov saliva test for patients such as the elderly and disabled showing symptoms of Covid-19 who are not able to get tested via nasal swab for health reasons.
The EasyCov test uses RT-Lamp technology, instead of PCR technology to analyse results, and gives results in 40 minutes. But the tests are much less reliable than PCR tests and so have not been approved for use by the wider population.
Last month the government approved social security reimbursements for people who need to use the EasyCov saliva test, following its approval from the HAS.
Plans for mass testing in schools and universities
The government is now making plans to implement saliva testing in schools and universities in France after the February holidays pending HAS' approval of this. A decision is expected in 10 days.
Health Minister Olivier Véran said yesterday the government objective was to “carry out hundreds of thousands of tests using saliva swabs” in schools.
But schools and parents are waiting for more information. Rodrigo Arenas, co-president of parents’ union FCPE told BFMTV: “We are worried about how it will be implemented… It’s the capacity to have the staff to do it. Either everyone must be able to take the tests themselves or we need specialist staff.”
Saliva tests are already in use in other universities around the world. Students at the University of California, Los Angeles, take tests each morning, with the only pre-requirement being that they do not drink, eat, smoke or chew gum for 30 minutes before being tested.
And the University of Liège in Belgium has used its own saliva tests – at a cost of €600,000 - to test all staff and students each week, with up to 6,000 tests being undertaken each day.
HAS to provide guidance
The HAS will follow up its approval for saliva tests with technical guidance on how the tests should be taken and the role they should play among existing testing methods.
It remains to be established who the tests should be used by, what kind of machinery will be used to analyse results, and how the process will be managed.
As both saliva tests and nasal swabs will use PCR testing technology, laboratories will also have to reorganise their methods for analysing results. Dr Alter said: “We need to prepare and accompany the set up, and propose organisation models that can be applied before any large-scale deployment [of tests].”
The HAS research group will meet with the health ministry and public and private PCR test analysis laboratories to discuss this. Clinical trials are already underway to establish how the saliva testing process could be implemented.
* Poll from Odoxa-Backbone Consulting for news sources FranceInfo and Le Figaro, conducted online from 2-4 February among 1,005 people in France representative of people aged 18 and over.