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Why does the KnowNowᵀᴹ test use a saliva sample?

We chose to design our unique KnowNowᵀᴹ test for COVID-19 infectiousness to work with a simple saliva sample, so that it would be comfortable and easy to administer, and to ensure that anyone would be happy to take a test every day if required. We believe that patient comfort and happiness leads to increased participation in routine testing, and ultimately increases the probability that COVID positive patients can be detected before they've had a chance to infect others.

The focus of our first clinical study was to assess the feasibility of using saliva sampling, to refine our saliva collection method, and also to assess the overall usability of the KnowNow test. This was a UK Government-supported National Institute for Health Research (NIHR) study carried out across ten UK hospitals with 100 patients participating. Through this study we determined that saliva sampling was both effective and user-friendly, and identified a specific swab for sampling. We chose not to opt for a spit collection method for our saliva sample, as providing a spit sample can be challenging for some patients, particularly the elderly or those suffering with COVID-19 symptoms.

For other COVID-19 tests, throat and nasopharyngeal swabbing is one of the most common types of sample collection. However, a number of studies have explored various issues with these types of sample collection, including:

  • The sample collection method requires a swab to be inserted into the patient's throat and/or far into their nostril and rotated, causing discomfort to patients due to the procedure’s invasiveness, and even inducing bleeding in their tonsils and posterior pharynx. (1)
  • The discomfort or even pain of the sample collection method has a detrimental impact on compliance for serial testing, as patients are unwilling to subject themselves to the test on a regular basis. (2)
  • Nasopharyngeal sample collection presents a considerable risk to healthcare workers, because it can induce patients to sneeze or cough, expelling virus particles. (2)
  • There are several situations where nasopharyngeal swabs would cause particular harm, such as in patients with coagulopathy, those undergoing anticoagulant therapy, or those with significant nasal septum deviation. (3)
  • These tests are not always successful at the first attempt, even though performed by trained healthcare workers, and shortages of swabs and protective equipment are frequently reported. (3)
  • They show relatively poor sensitivity for SARS-CoV-2 detection in early infection and are inconsistent during serial testing. (2)

Some tests have been designed to work with anterior nasal swabs, as a somewhat less invasive alternative to nasopharyngeal swabs. However, there is some evidence to suggest that nasal swab testing produces less sensitive results and may miss patients with lower viral loads (4).

References:

(1) Exploring salivary diagnostics in COVID-19: a scoping review and research suggestions

(2) Saliva is more sensitive for SARS-CoV-2 detection in COVID-19 patients than nasopharyngeal swabs

(3) Saliva as a Candidate for COVID-19 Diagnostic Testing: A Meta-Analysis

(4) Nasal-Swab Testing Misses Patients with Low SARS-CoV-2 Viral Loads

What is a lateral flow test?

A lateral flow test is a simple diagnostic device designed to detect the presence or absence of a target substance in a liquid sample without the need for specialised and costly equipment.

The most commonly recognised type of lateral flow rapid test strip is the pregnancy test.

Can anyone order KnowNowᵀᴹ Tests?

At the moment, KnowNowᵀᴹ Tests are for professional use only, meaning that they need to be administered by a trained healthcare professional. This means that we can take orders from organisations that have in-house or outsourced healthcare professionals who can perform the tests, or testing service providers.

However, since the KnowNowᵀᴹ Test needs just a saliva sample, it is much easier to administer effectively than other similar tests, and still return highly sensitive results. So we are investigating whether specially-trained, competent individuals could be approved to administer KnowNow tests as well.

We are also in the process of trialling and seeking approval for a variation of the KnowNow test which could be administered by individuals themselves.

Does the KnowNow Test identify all COVID-19 mutations?

The mechanism underpinning the KnowNowᵀᴹ test mimics the means through which the virus interacts with the surface of a human cell in order to detect it. As a result, we expect that it will continue to identify the SARS-CoV-2 virus even in the face of further potential mutation in the future, unlike tests based on antibodies.

We have modelled the difference between the Wuhan and 501Y mutations in a recombinant protein model to give us initial analytical evidence that the KnowNow test reacts to these variations of concern. And we are currently carrying out a study on live samples of these and other mutations to gather practical evidence of this.

In fact, we predict that the KnowNowᵀᴹ test may potentially become even more sensitive as the virus mutates to become more infectious. And we will continue to carry out further analyses and studies to support this prediction, and confirm that KnowNow continues to function on newer mutations as they arise.

How should used KnowNowᵀᴹ Tests be disposed of?

Used tests, swabs and buffer dropper tubes should be disposed of as potentially hazardous clinical waste.

Is KnowNowᵀᴹ approved and safe?

The KnowNowᵀᴹ test has been developed to Vatic's stringent standards of quality and safety.

It has undergone the necessary clinical trials and performance tests and has been shown to meet the specific requirements published by the UK's Medicines and Healthcare Products Regulatory Agency (MHRA).

The KnowNow test has been CE marked for professional use in a healthcare setting and has been registered for use in the UK and the EU.

How should KnowNowᵀᴹ tests be stored?

KnowNowᵀᴹ Tests should be stored between 2 and 30 degrees celsius, which means it's fine to store it at room temperature in the UK's mild climate.

There's no need to store it inside a fridge, unless you're expecting extremely hot weather. If you do choose to refrigerate the test though, just make sure it comes to room temperature before using it.

The KnowNowᵀᴹ Test device should also be stored still sealed in its foil pouch. Once removed from the foil pouch, it should be used within one hour.

How long does a KnowNowᵀᴹ Test take?

The KnowNowᵀᴹ test will provide a result within 17-18 minutes of an individual arriving for their test.

The process of taking the saliva sample, mixing it with the buffer solution and dropping it onto the KnowNow test device should take a clinical professional no more than 2 to 3 minutes.

It then takes just 15 minutes for the test result to develop in the KnowNow device test results window.

The test result should not be read and interpreted after 60 minutes. If it wasn't possible to read and interpret the results between 15 and 60 minutes after dropping the solution into the sample well, the test should be discarded and the process repeated with another new test and saliva sample.

How does KnowNowᵀᴹ compare to COVID-19 PCR tests?

KnowNowᵀᴹ offers two key benefits over polymerase chain reaction (PCR) tests.

The first benefit is that the KnowNowᵀᴹ test needs only a saliva sample, which can be taken easily and comfortably from the mouth. PCR tests usually need a nasopharyngeal, anterior nasal or tonsil sample, all of which are painful and unpleasant for the individual being tested and more challenging to collect effectively for the clinical professional administering the test. No one wants to be made to cry or gag, or make someone else cry or gag, on a regular basis!

The second benefit is that the KnowNow test uses its unique detection mechanism to determine whether an individual is actually infectious, whereas PCR tests identify whether SARS-CoV-2 viral matter is present in an individual's body, regardless of whether it is already inactive.

Although PCR tests have been seen as the "gold standard" test for the SARS-CoV-2 virus, they do have a number of drawbacks. Laboratory processing is required, meaning that there is a delay before results can be returned, and the associated costs are relatively high. Also the detection mechanism does not specifically identify whether individuals are infectious. In fact, PCR tests detect the virus long after the infectious period, and individuals can continue to test positive for a mean of 17 days after they have stopped being able to infect others (source). This means that people who are not infectious are unnecessarily quarantined as a result of a positive PCR test.

What is SARS-CoV-2?

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the name given by the International Committee on Taxonomy of Viruses (ICTV) to the virus responsible for causing the disease, COVID-19.

Why are you called Vatic?

The adjective "vatic" means "describing or predicting what will happen in the future," and derives directly from the Latin word vates, meaning "seer" or "prophet."

We chose this name as it speaks to our mission to make healthcare more proactive and empowering, through predictive screening for acute disease.

Had COVID - 19 symptoms in the last 2 days? Apply here to help us make testing accessible to all.