Saliva pool tracking and sample analysis kit emerged to meet the demands of Hospital das Clínicas de Botucatu, and were fundamental for monitoring the health of the entire university community.Now, innovations are the object of a registration request with the Unesp Innovation Agency.It is common that, upon hearing the comment “maybe we need to test for covid in your case”, many people involuntarily start scratching their noses.It is an involuntary memory, based on the feeling of discomfort associated with the so-called nasopharyngeal swab collection.This is the name of that kind of sterile "swab" that nurses introduce inside the patient's nostril until reaching the so-called nasopharynx, to then apply a rotation movement that will allow them to collect as many cells as possible - and most likely cause some inconvenience.For the professors, employees and students of Universidade Estadual Paulista, however, the mention of tests can evoke a different, solitary and reserved scene, in which the individual deposits saliva in a small bottle, seals it and gives it to the nurse.All without any feeling of discomfort or pain.This association is the result of almost two years of using the saliva pool screening process for SARS-CoV2, which was initially developed to be used at Hospital das Clínicas da Faculdade de Medicina de Botucatu, and started to be used by the community. unespiana.It is a social technology that is the result of the work of researchers from the Graduate Program in Research and Development of Medical Biotechnology and from the Laboratory of Applied Biotechnology (LBA) of the Hospital das Clínicas of the Faculty of Medicine of Botucatu (FMB).The LBA is coordinated by pharmacist and researcher in molecular biology with an emphasis on human virology Rejane Maria Tommasini Grotto, who is a professor at the Faculty of Agricultural Sciences at Unesp, Botucatu campus.She explains that the idea to develop the saliva collection process as a starting point for clinical exams to detect the SARS-CoV2 virus was born from conversations she had with doctor Carlos Magno Fortaleza, also a professor at FMB and an important reference in the field. of medical research to combat covid-19 in our country.Fortaleza also exchanged ideas with members of the Coronavirus Contingency Center, created in February 2020 by Governor João Dória to articulate actions to combat the pandemic in São Paulo.An effective and much cheaper alternativeThere were good reasons to think about alternatives to the “gold standard” exam, which is the nasopharyngeal swab collection.The first was the demand for this type of examination, which had exploded on a literally planetary scale.The second was the need for a nursing professional to perform the collection procedure.“As much as we wanted to establish close monitoring of the entire Unespian community, it would be financially unfeasible for us to assign a nurse to each of the units to collect the samples.And there would still be the cost of the swab used in each collection”, explains Grotto.Finally, it was found that, due to the fact that we have receptors in our mouths in the oral cavity and in the region of the tongue where SARCS-CoV2 can bind, it would be possible to detect it through a saliva test.A possibility that does not exist in the case of other known lethal viruses, such as HIV.The samples collected via nasopharyngeal swab go through a preparatory stage and after being inserted into equipment capable of isolating the genetic material of the virus.This material is then prepared and inserted into a second equipment, where a test known as Reverse Transcription followed by Polymerase Chain Reaction, or RT-PCR, an acronym made famous by the pandemic, will be carried out.It is this test that will determine the presence or absence of genetic material from the virus infecting the cells of that individual.The commercial individual exam costs about R$ 100.In order to rationalize the resources spent on performing the RT-PCR tests, LBA students and staff developed a sample pool methodology.In it, saliva samples from 15 people are placed in the same tube, forming a mixture, or pool.This “collective” sample is prepared and subjected to testing.If the result is negative, the information will have cost only R$100 – and not R$1500, which would be the cost if each sample had been tested individually.If, on the other hand, the result is positive, then the remaining material from the 15 samples is subjected to further tests, in which the 15 samples are processed individually, making it possible to identify the positive individual or individuals.This is called “opening the pool”.“The test that uses the samples collected by the nasopharyngeal swab is a little more sensitive.But as we do frequent tests, and this frequency can even change according to the epidemiological follow-up, it didn't make much difference”, explains Grotto.Saliva collection was intended for asymptomatic patients only.Originally, the examination was performed through the collection of saliva from asymptomatic individuals.Grotto explains that this strategy was adopted shortly after the beginning of the pandemic.“In the beginning, hospitals started to operate only because of the pandemic.But at that moment there was already a need for a safe return to other activities”, he says.When receiving people with scheduled treatments in hospitals – a surgery, a transplant, etc.– doctors were forced to ask if that individual could not be infected with SARS-CoV2 asymptomatically.If that were the case, it would end up infecting many other people in the environment, including medical personnel.Thanks to the pool system, it was possible to identify any asymptomatic cases at the beginning, thus protecting a large number of patients and professionals at the Hospital das Clínicas de Botucatu.In 2020, 10,000 tests were processed, starting in the middle of the year.The good results led to the recommendation, by the Covid-19 Committee of Unesp, that the saliva collection process be implemented in all Unesp units.Currently, testing has become a habit of the Unespian community.The total number of tests processed reached 240 thousand.Today the average is 160 tests per day, which gives about 5 thousand tests per month.“As we are at a low point in the pandemic, the number of positives drops a lot, which also reduces the number of times it is necessary to “open the pool”, explains the professor.About 80% of saliva pool tests are processed in Botucatu.The remaining 20% ​​are carried out in laboratories located on Unesp's campuses in Araraquara and São José do Rio Preto.The good results even drew the attention of other institutions.Researchers from the Instituto Adolfo Lutz de Bauru, a central health laboratory in the state of São Paulo, also incorporated the work process, and later introduced saliva collection and pooled analysis at their institution.Laboratory is applying for patentIn addition to saliva pool screening, researchers from the Graduate Program in Research and Development of Medical Biotechnology and the Laboratory of Applied Biotechnology have also developed their own kit to diagnose covid-19.This initiative arose from the shortage of commercial kits sold by pharmaceutical companies.Commercial kits already contain all the chemicals, as well as instructions on how to use them, in order to extract the genetic material of the virus from infected cells so that the presence of SARS-CoV2 in a sample can be detected.At the beginning of the pandemic, international demand was so great that they practically disappeared from the market.“It was a time of general confusion.Import problems, delays of weeks or months, lack of material.And we couldn't stop the tests, because the patient's life depended on it”, says Grotto.The alternative found was to acquire, in isolation, the inputs that were part of the kits, and through experimental means to discover the ways to make them functional.The kit produced in-house, that is, in-house, proved to be as effective in tests as its commercial equivalents, and cheaper;around R$ 40. The kit was used throughout 2020 and part of 2021, until the state government began to supply Hospital das Clínicas de Botucatu with commercial kits.Currently, the kit developed by researchers at Unesp is in the registration process through the Unesp Innovation Agency.The next step will be a registration with the National Health Surveillance Agency.“There are laboratories that face difficulties, in terms of resources, to acquire kits from abroad.They will be able to benefit greatly from a cheaper alternative,” he says.These new processes were fundamental to allow a close monitoring of the health of the Unespian community.This monitoring, in turn, translated into a greater sense of security when, throughout 2021, the return to face-to-face work, on the part of the servers, began to occur gradually.” There have been cases of panic due to the pandemic.I think that, in addition to the financial and logistical benefits, the fact that they were being tracked helped make people feel safer to return to work”, ponders Grotto.Usage policy The reproduction of contents is free as long as the Jornal da Unesp and the respective authors are credited, indicating the electronic address (URL) of the original publication.Copyright © 2021 By Jornal da UnespResponsible: Communication and Press Office of Unesp