Does that Covid swab have to go that far down your nose?

A Canadian said it looked like a painful blow to his brain. An American woman heard crackles in her head. A French woman suffered from a severe nosebleed. Others had headaches, cried, or were in shock.

They have all been tested for Covid-19 with deep nasal swabs. While many people don’t complain about their experience, for some, the swab test – a vital tool in the global battle against the coronavirus – breeds visceral aversion, squirming severely or bent knees.

“I felt like someone was going straight into the reset button on my brain to change something,” Toronto music producer and DJ Paul Chin said of his nasal swab test. “There really is nothing like it. “

“Oh, my God,” he continued, “the cotton swab going up just deeper into my nose than I ever imagined or guessed – it’s such a long, pointy, pointy kind of thing. . “

Since the outbreak of the coronavirus, millions of swabs have been planted in millions of noses to search for a pernicious virus that has killed millions of people across the planet. One of the ways to fight the virus, officials said, is to test widely and often. The imperative has been to use a test that people are willing to take repeatedly.

The swab usually does the trick.

In some areas of the United States, health workers hand people the swab for testing, ensuring a level of personal comfort. For many South Africans, the only Covid-19 test is painful – you see stars or a gag because a swab runs down your throat.

The range of swabs raises questions: who is doing it right? How deep should the swab slip into your nostril? How long should I spend there? Should a precise test be uncomfortable? Unfairly or not, some countries have a reputation for suffering brutal testing.

First, a quick anatomy lesson: no, the swab doesn’t actually stab your brain.

The swab passes through a dark passage that leads to the nasal cavity. Which is surrounded by bone covered with soft, sensitive tissue. At the back of this cavity – more or less aligned with your earlobe – is your nasopharynx, where the back of your nose meets the top of your throat. This is one of the places where the coronavirus actively replicates, and it is where you are likely to get a good sample of the virus.

The suspicion about the test can stem from the simple fact that most people can’t stand to have something pushed in their nose. Plus, testing evokes some of our darkest fears: things that can crawl into our orifices and dig into our brains.

“People are not used to feeling this part of their body,” said Dr. Noah Kojima, resident physician at the University of California, Los Angeles and expert in infectious diseases, of swabs touching the nasopharynx.

Pain kicks in when the swab – a nylon tuft attached to a lollipop-shaped stick – is administered at the wrong angle, said Dr. Yuka Manabe, professor of medicine specializing in infectious diseases at the medical school. from Johns Hopkins University.

“If you don’t tilt your head back, you don’t reach the throat,” she said. “You are crushing someone’s bones. “

Mr. Chin, the music producer, described his test as a “brainstorm” and compared the burning sensation to the effects of inhaling spices.

“Your whole face is sort of ready to run,” he said, adding, “I don’t really know if there is a way to prepare for it.”

There are three main types of Covid nasal swab tests: nasopharyngeal (deepest), middle turbinate (middle), and anterior nostrils (shallow part of your nose). At the start of the pandemic, the deep nasal swab was administered widely and aggressively to adults because the method worked when testing for flu and SARS. Although science evolves, experts tend to agree that the deeper swab is the most accurate.

According to a review of studies published in July in PLOS A, a scientific review, nasopharyngeal swabs are 98% accurate; shallow swabs are 82-88% effective; mid-cone swabs work the same way.

In South Korea, nasopharyngeal swabs remain the gold standard for Covid testing, said Seung-ho Choi, deputy director of risk communication at the Korea Disease Control and Prevention Agency.

“Depending on the skills of the medical staff, it may or may not hurt,” he said. But he said, “The nasopharyngeal test is the most accurate. That is why we continue to do them.

WHO has guidelines on the best way to test; complications were rare. Australian guidelines say that the swabs should go up a few centimeters to the nostrils of adults. The U.S. Centers for Disease Control and Prevention says the medium turbinate swab should usually be inserted within an inch or until it meets resistance. Some testers swab both nostrils.

The KDCA guidelines allow testers some flexibility in how to scrape the nasopharynx (by stirring or rotating the swab, or both). Mr Choi said the experience depends on the brand of the swab, the patient’s pain tolerance, the anatomical structure of the nasal cavity and the skill of the tester.

Dr Lee Jaehyeon, professor of laboratory medicine at Jeonbuk National University who helped develop the Korean government’s guidelines on Covid testing, said the test was as low risk as the blood sample.

But coming out of a clinic in Seoul this month, some people were sneezing, rubbing their eyes or blowing their noses. One or two were crying.

“I felt like the swab was scraping my brain,” said 19-year-old Chu Yumi.

Kim Kai, 28, who had bloodshot eyes, said: “I think my nose is about to bleed.”

Lee Eunju and Lee Jumi, both 16, said they never wanted to have nasal swabs again. Eunju said it was as if chili powder had been poured into his nostrils. Jumi said, “It hurts so much.”

Dr Lee says discomfort is a tradeoff for accuracy. “This does not mean that we can ignore the pain felt by every patient,” he said.

Many people tolerate the test very well. Dr Paul Das, a family doctor at St. Michael’s Hospital of the Unity Health Toronto Network, said children tend to go through more difficult times.

Some people attribute their experiences to the technique or personality of the testers.

“It stings, it’s a little uncomfortable, but I think the person was very gentle,” Kim Soon Ok, 65, said outside a Seoul clinic.

Issa Ba, a 31-year-old footballer, remembers: “I took my Covid-19 test in Conakry, Guinea, in August before coming to Senegal. I felt a little pain when they put the stick in my nose, but it wasn’t that bad. And I endured much more intense pain. I am a man.”

Some countries aim to standardize testing and eliminate human error. Developers in Denmark, Japan, Singapore and Taiwan invented robots to get the job done.

Johns Hopkins’ Dr Manabe insists the swab shouldn’t hurt.

Yet painful stories abound.

Women often report worse pain than men, studies show, but it could be due to a design bias: some swabs may be too large for a woman’s facial anatomy.

Briana Mohler, 28, suffered a nose swab in Minnesota in 2020 so excruciating she heard “crack”.

Audrey Benattar, who recently returned to Marseille, France, recalled her trip to a Montreal hospital in May to give birth. There, a Covid nasal swab left him with burst blood vessels and balloon catheters into both nostrils to stop the bleeding.

“I have never seen so much blood in my life,” said Ms Benattar, 34.

Some argue that nasal swabs rank relatively low on the delicate coronavirus testing scale.

This year, China has asked some overseas travelers, including diplomats, to submit to Covid anal swab tests, infuriating foreign governments.

The report was provided by Aurelien Breeden, Mady Camara, Lynsey chutel, Vjosa Isai and Ruth maclean.

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About Hector Hedgepeth

Hector Hedgepeth

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