In this systematic review, a search of the MEDLINE and medRxiv databases was conducted to assess the diagnostic accuracy of saliva nucleic acid amplification testing (NAAT) for COVID-19. The search strategy yielded 385 references, and 16 unique studies were identified for quantitative synthesis. Eight peer-reviewed studies and 8 preprints were included in the meta-analyses (5922 unique patients). There was significant variability in patient selection, study design, and stage of illness at which patients were enrolled. Fifteen studies included ambulatory patients, and 9 exclusively enrolled from an outpatient population with mild or no symptoms. In the primary analysis, the saliva NAAT pooled sensitivity was 83.2% (95% credible interval [CrI], 74.7%-91.4%) and the pooled specificity was 99.2% (95% CrI, 98.2%-99.8%). The nasopharyngeal swab NAAT had a sensitivity of 84.8% (95% CrI, 76.8%-92.4%) and a specificity of 98.9% (95% CrI, 97.4%-99.8%). Results were similar in secondary analyses. These results suggest that saliva NAAT diagnostic accuracy is similar to that of nasopharyngeal swab NAAT, especially in the ambulatory setting. These findings support larger-scale research on the use of saliva NAAT as an alternative to nasopharyngeal swabs.

This article compared the outcome of COVID-19 in immunosuppressed solid organ transplant (SOT) patients to a transplant naïve population. In total, 10 356 adult hospital admissions for COVID-19 from March 1, 2020 to April 27, 2020 were analyzed. Bivariate analysis found transplant status, age, gender, race/ ethnicity, body mass index, diabetes, hypertension, cardiovascular disease, COPD, and GFR < 60 mL/min/1.73 m2 to be significant predictors of combined death or mechanical ventilation. After multivariate logistic regression analysis, SOT status had a trend toward significance (odds ratio [OR] 1.29; 95% CI 0.99–1.69, p = .06). Compared to an age, gender, and comorbidity-matched control group, SOT patients had a higher combined risk of death or mechanical ventilation (OR 1.34; 95% CI 1.03–1.74, p = .027).

This study extracted data from the electronic health record on hospitalized patients with SARS-CoV-2 testing at six hospitals from March 4th through September 9th, 2020. The outcomes between SARS-CoV-2 positive KTR and controls: SARS-CoV-2 positive non-KTR, SARS-CoV-2 negative KTR and SARS-CoV-2 negative non-KTR were compared. Of 31,540 inpatients, 3213 tested positive for SARS-CoV-2. There were 32 SARS-CoV-2 positive and 224 SARS-CoV-2 negative KTR. SARS-CoV-2 positive KTR had higher ferritin levels [1412 (748,1749) vs. 553 (256,1035), p < 0.01] compared to SARS-CoV-2 positive non-KTR. SARS-CoV-2 positive KTR had higher rates of ventilation (34% vs. 14%, p < 0.01 vs. 5%, p < 0.01) vasopressor use (41% vs. 16%, p < 0.01, vs. 17%, p < 0.01, vs. 12%, p < 0.01) and acute kidney injury (AKI) (47% vs. 15%, p < 0.01, vs. 23%, p < 0.01, vs. 10%, p < 0.01) compared to SARS-CoV-2 positive non-KTR, SARS-CoV-2 negative KTR, and SARS-CoV-2 negative non-KTR, respectively. SARS-CoV-2 positive KTR continued to have increased odds of ventilation, vasopressor use and AKI compared to SARS-CoV-2 positive non-KTR independent of Elixhauser score, Black race and baseline eGFR. Mortality was not significantly different between SARS-CoV-2 positive KTR and non-KTR, but there was a notable trend towards higher mortality in SARS-CoV-2 positive KTR (25% vs. 16%, p=0.15, respectively).