The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spike (S) protein mediates virus entry by binding to the host cell receptor, human angiotensin converting enzyme 2 (hACE2), and catalyzing virus–host membrane fusion. The S protein also mediates cell–cell fusion, potentially allowing the virus to spread virion-independently. Here, we compared the fusogenicity of SARS-CoV-2 variant S proteins using a cell–cell fusion assay. In cells overexpressing hACE2, cell–cell fusion ability of all tested SARS-CoV-2 variants was similar to that of the Wuhan-Hu-1 strain. However, in cells with endogenous hACE2, SARS-CoV-2 variants, especially the Delta variant, stimulated significantly greater cell–cell fusion than the original strain. Our results showed that the Delta variant S protein is highly fusogenic and can spread rapidly by utilizing small amounts of hACE2.

Since the outbreak of coronavirus disease 2019 (COVID-2019), the infection has spread worldwide due to the highly contagious nature of severe acute syndrome coronavirus (SARS-CoV-2). To manage SARS-CoV-2, the development of diagnostic assays that can quickly and accurately identify the disease in patients is necessary. Currently, nucleic acid-based testing and serology-based testing are two widely used approaches. Of these, nucleic acid-based testing with quantitative reverse transcription-PCR (RT-qPCR) using nasopharyngeal (NP) and/or oropharyngeal (OP) swabs is considered to be the gold standard. Recently, the use of saliva samples has been considered as an alternative method of sample collection. Compared to the NP and OP swab methods, saliva specimens have several advantages. Saliva specimens are easier to collect. Self-collection of saliva specimens can reduce the risk of infection to healthcare providers and reduce sample collection time and cost. Until recently, the sensitivity and accuracy of the data obtained using saliva specimens for SARS-CoV-2 detection was controversial. However, recent clinical research has found that sensitive and reliable data can be obtained from saliva specimens using RT-qPCR, with approximately 81% to 95% correspondence with the data obtained from NP and OP swabs. These data suggest that self-collected saliva is an alternative option for the diagnosis of COVID-19.