My Turn 2: Facts behind Kootenai Health testing practices

Recent studies have shown saliva polymerase chain reaction (PCR) testing performs as well as nasopharyngeal (NP) swab testing. We are often asked why Kootenai does not offer saliva testing. It is a fair question, and I would like to address it.

At the beginning of the pandemic last spring, Kootenai Health was tasked with creating a laboratory testing process to facilitate a local COVID-19 testing site for the people of Kootenai County. Before implementing our own testing process, we sent COVID-19 samples to labs across the northwest for processing and results took several days to receive.

Having an in-house lab process drastically shortened our waiting period for results. Also at that time, the science around PCR testing clearly showed that NP swabs (nasal swabs) performed better than oropharyngeal swabs and direct sampling of the lung secretions. There was no data or studies in the spring addressing saliva PCR testing as an option.

Based on the information we had available, we proceeded with the construction of new space within the Kootenai Health laboratory, set up a supply chain, a testing center, and purchased equipment for processing and testing based on NP swab sampling. This was a significant investment but was necessary in order to facilitate vital COVID-19 testing for our community.

Many people do not realize that adding a saliva testing option at Kootenai would require significant new space for additional biohazard equipment, new instrumentation, and processing equipment to deal with these specimens prior to running them on a PCR analyzer. Beyond the financial investment and staff training to bring on an additional testing method, we do not currently have space for these additions and therefore would be unable to provide a safe working environment for our employees to process COVID-19 infected saliva.

Two additional issues are preventing us from using saliva testing at this time. All of the COVID-19 PCR tests used nationally have special emergency approval from the Food and Drug Administration called Emergency Utilization Authorization (EUA). These EUAs have very specific rules and regulations for each brand of test. While other testing equipment has EUA approval for saliva testing, currently, none our COVID-19 testing equipment has the necessary EUA approval for the use of saliva testing.

Although the collection of NP swabs may be uncomfortable, it is not considered an invasive procedure itself. Surgical procedures that involve cutting through skin or mucous membranes, or the introduction of larger instruments such as endoscopy or bronchoscopy are considered invasive procedures. Sometimes uncomfortable procedures are necessary, including mammograms, shots, blood draws or other needle sticks. None of these procedures are considered abusive or violative by any national medical organization.

In my practice I have witnessed many people, including children, undergo uncomfortable procedures. We understand having medical procedures can be difficult and result in an emotional or physical response to fear and discomfort. These reactions and emotions are real and are important to acknowledge. We do everything we can to put patients at ease and minimize discomfort.

Kootenai Health has a large team dedicated to continual improvement of testing for our patients. We want our patients to feel safe and supported through all procedures, including testing. We will continue to work hard to do the best we can for our entire community and individual patients, including adding new options for testing and procedures as space and cost allow.

Michael Harvey, M.D., is Medical Director, Kootenai Health Laboratory.