COVID-19 Sample Collection Guidelines

General Guidelines

Store specimens at 2–8°C and ship overnight to authorised lab centres on ice packs. Label each specimen container with the patient’s ID number (e.g., medical record number), unique specimen ID (e.g., laboratory requisition number), specimen type (e.g., serum) and the sample collection date.

The Centre for Disease Control and Prevention (CDC) recommends taking an upper respiratory nasopharyngeal swab (NP) for the initial diagnosis of 2019-nCoV. Oropharyngeal swab (OP) collection can be considered as a lower priority but if collected, it must be combined with NP using the same tube. If other swabs are unavailable, the collection of only OP is acceptable. Collecting sputum is recommended only for patients with productive cough. Sputum induction is not recommended. Samples must be collected at the earliest once a Patient Under Investigation (PUI) is identified as infected, regardless of the time of symptoms observed. Follow strict infection control precautions while collecting specimens.

**Personal Protective Equipment (PPE) is mandatory to prevent infection during sample collection. Those collecting specimens must comply with recommended infection control precautionary measures including correct use of disinfectant and maintaining personal hygiene.

The following describes all the essential measures to be carried out for sample collection, packaging and transport

To Diagnose 2019 Novel Coronavirus –

Note: To protect individuals and the environment, health authorities need to use Personal Protective Equipment (PPE) and follow all biosafety precautions.

Requirements for Sample Collection:

1. Sample vials and Virus Transport Medium (VTM)
2. Absorbent material, parafilm, seizer, sealing tape
3. Leak-proof container for secondary storage like a zip-lock pouch, 50ml centrifuge, cryobox, plastic container

How to Collect Specimen

The following details have been adapted from the WHO guidelines on COVID-19

Specimen Type1:

Oropharyngeal and Nasopharyngeal Swab

Instructions: Collect oropharyngeal and nasopharyngeal samples on dacron, rayon or polyester flocked swabs with plastic shafts only. Avoid usage of swabs with wooden shafts or those made of calcium alginate as they consist of substances that may inactivate the virus. Combine both the swab in a single sterile tube to increase the viral load using 2–3 ml of *VTM.

*For shipping the sample for viral detection, use VTM that contains antibiotic and antifungal supplements. Avoid freezing & thawing of specimens repeatedly.

Specimen Type2:

Bronchoalveolar lavage (BAL)

Instructions: Collect 2–3 ml of BAL in a sterile dry container.

Specimen Type3:

(Endo)tracheal aspirate, nasopharyngeal or nasal wash/aspirate

Instructions: Collect 2–3 ml of tracheal aspirate in a sterile dry container.

Specimen Type 4:

Sputum

Instructions: Have patients rinse their mouth with water. Ask them to expectorant deep cough sputum directly into a sterile dry container.

Note: Specimen Type 3 & Specimen Type 4 are usually collected for testing patients with severe respiratory illness.

Specimen Packing and Transport

Step1:

Use **PPE like an impermeable apron, N95 masks, non-sterile latex gloves, face shield or goggles, head covering, suitable rubber boots, etc.

Step2:

Using parafilm, seal the tip of the sample vials.

Step 3:

Place the sample vials (primary container) in a leak-free secondary storage container like centrifuge tube and Secure the secondary container using a zip-lock pouch.

Step 4:

Place the zip-lock pouch in a thick plastic container and tightly cover it with the lid. For further protection & to avoid leakages.

Note: Sample vials can be placed in a zip-lock pouch directly, covered by absorbent material and seal using heat-sealing or rubber bands. This zip-lock pouch must be secured in another plastic pouch before transfer.

Storage

Store specimens at 2–8°C for up to 72 hours after collection. If a delay in testing or shipping is expected, store specimens at -70°C or below.

See recommended Guidelines for Testing COVID-19.

Shipping to CDC or your government-accredited testing facility

PUI’s specimens must be packaged, shipped, and transported according to the current edition of the International Air Transport Association (IATA) Dangerous Goods Regulations. Store specimens at 2–8°C and ship overnight to CDC or government-authorised laboratories on ice packs. If a specimen is frozen at -70°C ship overnight to CDC or government-approved testing facility on dry ice.

Shipping to ICMR-NIV, India

PUI’s clinical specimens, official documents, and specimen request form for testing of COVID-19 should be sent to — The Director, ICMR-National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune, Maharashtra, Pin: 411001

For shipment-related queries/information, kindly contact Dr. Sumit Bharadwaj (Scientist B, Influenza Group) on email: sumitduttbhardwaj@gmail.com, phone 020–26006290/26006390

Shipping Details of WHO-referenced countries are available here.

Countries that have no testing capacity and national COVID-19 laboratories with limited experience on COVID-19 virus testing are encouraged to send the first five positives and the first ten negative COVID-19 samples to WHO reference laboratories providing confirmatory testing for COVID-19.

Start Testing for COVID-19 here.

Check out other articles on COVID-19.