Chantal Vogels studies bugs. A medical entomologist at the Yale School of Public Health, her expertise is mosquitoes, ticks and the nasty viruses they spread.
“Human research is new to me,” she said.
But she went from studying the very small to the very tall as part of a Yale team trying to solve the biggest problem in the United States through an improbable population of research subjects: NBA players.
That same Yale team was granted an emergency use authorization by the Food and Drug Administration on Saturday for a product called SalivaDirect, which uses spit instead of swabs to test for the novel coronavirus in people suspected of having Covid-19.
FDA commissioner Stephen Hahn called SalivaDirect “groundbreaking” in its efficiency, and Trump administration testing coordinator Adm. Brett Giroir said that it was “yet another testing innovation game-changer that will reduce the demand for scarce testing resources.”
The next aim is to prove that SalivaDirect can detect the virus in people who don’t feel sick, as experts consider asymptomatic screening critical to preventing silent transmission and crushing the spread. That work is being done with help from the NBA.
The Yale team is one of several research efforts that have generated enthusiasm for the idea that spitting in a tube is as effective a test as subjecting yourself to a nasopharyngeal swab.
The FDA has authorized five saliva tests for emergency use, but SalivaDirect’s materials cost less than $5 per sample and can produce up to 90 results in fewer than three hours in a laboratory, which means it can scale without stressing a complicated supply chain.
“This could be a very helpful tool in getting people back to work and back at school,” said Isaac Bogoch, a University of Toronto infectious diseases specialist who is not involved with the research. “You don’t have to have a giant swab shoved to the back of your nose or to the back of your throat, so getting a sample is way easier and way more convenient. That cannot be overstated.”
Infectious disease experts say there remains a dire need for cheaper, faster testing options—including spitting in any sterile container—and flooding the country with such tests is the only way to restore normalcy until there is a proven vaccine or successful treatment.
Unlike other saliva tests, SalivaDirect doesn’t require expensive chemical reagents or special collection devices, which allows the product to be affordable and easily accessible. The samples cost between $1 and $5 and can be sent to any laboratory.
The other thing that makes it unique among testing options is SalivaDirect’s affiliation with the NBA.
Anne Wyllie, a Yale medical microbiologist, happened to be working on another study using spit tests when she realized that saliva could be a weapon in this pandemic. After sharing the promising results of spit tests to diagnose coronavirus infections, Dr. Wyllie, Nathan Grubaugh and their team needed validation studies to be authorized by regulators to offer their product more widely.
That meant they needed spit. The NBA had spit to give.
The unlikely alliance began when NBA officials contacted Dr. Wyllie’s team in May after reading news coverage of work that had not been published in a peer-reviewed journal. Robby Sikka, a trained anesthesiologist in his first season as the Minnesota Timberwolves’ vice president of basketball performance and technology, was intrigued and felt the unique circumstances of the NBA restart meant the league had the resources to help power scientific research in urgent times.
“If you didn’t do it in that moment, it was a complete failure of opportunity,” he said. “You had to do something with your population or, frankly, you don’t deserve to play sports. If you don’t do the research to show a value to society, what else are we doing sports for?”
There is almost nobody in the world being tested so often and in so many ways as NBA players. For the last two months, In their home markets and in their Walt Disney World bubble, they have given three different kinds of samples: nose, mouth and saliva.
The nasal and oropharyngeal swabs were shipped to Quest Diagnostics and BioReference Laboratories facilities. The saliva gets delivered to Yale. The saliva tests are paired to swabs from the same players and team staffers—not that the test subjects are recognizable names. They are bar codes and randomized numbers.
Winning over the FDA required proving that spitting is as effective as swabbing in detecting the presence of the virus. The Yale researchers needed to find a population with lots of asymptomatic people they could test frequently to show their saliva and swab results closely matched.
The rich data of anonymized NBA stars provided them with access to the infection trends of a regularly tested collection of young, healthy people. They were able to compare the results of saliva against the swabs of some of the 44 players who tested positive in June and July. The work is part of an effort they called the Surveillance with Improved Screening and Health Study—SWISH for short.
It’s a mutually beneficial arrangement. The NBA is contributing to science in real time. It’s also buying a social offset to public resentment over its ability to secure a private stream of tests with overnight turnaround speeds.
The work is an example of the blazing pace of science in the pandemic. Dr. Wyllie’s research went from ambitious idea to experiment to preprint to validation study to emergency use authorization in about five months. The notoriously slow process had to accelerate to match the speed of the virus’s spread as experts shifted their attention to this mysterious pathogen and went hunting for resources, funding and human guinea pigs.
The development of SalivaDirect was enhanced by the Covid-19 Sports and Society Working Group, a collaboration of experts from universities and the private sector, including Dr. Sikka, researchers from Yale, Harvard University and Johns Hopkins University, and former Centers for Medicare and Medicaid Services head Andy Slavitt. Dr. Wyllie, a New Zealand native who grew up playing basketball and even owned the Timberwolves jersey of Kevin Garnett, is now part of this working group with connections to the NBA.
The study is continuing with NBA staffers in Disney World, as the Yale team attempts to show that saliva can be used to detect the virus in a large asymptomatic cohort.
But they’re now running into a problem that’s good for basketball and tricky for them: There have been zero positive cases reported from inside the bubble.
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