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6% (95% CI 93.0% to 100%) with Cohen's k of 0.90 (95% CI 0.69 to 1.0. The sensitivity, specificity, positive and negative predictive values of NP swabs compared with BAL were 83.3% (95% CI 53.5% to 100%), 100%, 100% and 97.3% (95% CI 92.1% to 100%), respectively. BAL was used infrequently to assess COVID-19 in busy institutions. NP swabs have a high concordance with BAL for COVID-19 testing, but negative NP swabs should be confirmed with BAL when clinical suspicion is high. BAL was used infrequently to assess COVID-19 in busy instituti