One Canadian said it was a painful injection into his brain. The American heard a crunch in her head. The Frenchwoman has severe nosebleeds. Others had headaches, cried, or were in shock.
They were all tested for COVID-19 with nasal swabs. While many people do not complain about their experience, for some, the smear – a vital tool in the global fight against coronavirus – causes internal dislike, severe bending or bending of the knees.
“I felt like someone right in my brain was trying to switch something,” said Paul Chin, a record producer and DJ based in Toronto, of his nose swab test. “There is nothing like this.”
“Oh my God,” he added, “the smear hits my nose deeper than I could have imagined or imagined. It’s such a long, sharp and pointed thing. “
Since the advent of the coronavirus, millions of swabs have been inserted into the noses of millions of people to check for the harmful virus that has killed millions of people around the planet. One way to combat the virus is through extensive and frequent testing, officials said. It is imperative to use a test that people are willing to take repeatedly.
A tampon usually fits the bill.
In some parts of the United States, healthcare professionals give people a self-test swab to provide a certain level of personal comfort. For many South Africans, the only test for COVID-19 is painful: you see stars or a gag because a tampon goes down your throat.
The range of tampons raises questions: who does it right? How deep should the tampon go into the nostril? How long should he stay there? Should an accurate test be inconvenient? Unfair or not, some countries have a reputation for brutal ordeal.
First, a quick anatomy lesson: no, the smear doesn’t actually pierce your brain.
The swab passes through the dark passageway leading to the nasal cavity. It is enclosed in bone covered with soft, sensitive tissue. At the back of this cavity – more or less at the level of the earlobe – is the nasopharynx, where the back of the nose crosses the top of the throat. This is one of the places where the coronavirus is actively multiplying, and this is where you are likely to get a good sample of the virus.
Dough alertness can stem from a simple fact: Most people can’t stand having something stuffed so hard up their nose. In addition, tests conjure up some of our darkest fears: things that can crawl into our holes and enter our brains.
“People are not used to feeling this part of their body,” said Dr. Noah Kojima, a resident physician at UCLA and an infectious disease expert, about swabs that come in contact with the nasopharynx.
The pain becomes apparent when a tampon – a bundle of nylon attached to a lollipop-like stick – is inserted at the wrong angle, says Dr. Yuka Manabe, a professor of medicine specializing in infectious diseases at Johns Hopkins University School of Medicine.
“If you don’t throw your head back, you won’t get to your throat,” she said. “You’re bumping into someone’s bone.”
Chin called his test “brain prick” and compared the burning sensation to the effect of inhaling spices.
“Your whole face is kind of ready to leak,” he said, adding, “I really don’t know if there is a way to prepare for this.”
There are three main types of nasal swabs for COVID: nasopharyngeal (deepest), middle turbinates (middle), and anterior nasal passages (shallow part of the nose). In the early days of the pandemic, deep nasal swabs were used widely and aggressively among adults because the technique worked for influenza and SARS testing. As science advances, experts tend to agree that the deepest smear is the most accurate.
Nasopharyngeal swabs are 98% accurate, according to a review of studies published in July in the scientific journal PLOS One; shallow strokes are 82% to 88% effective; middle turbinate swabs work in a similar 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 Agency for Disease Control and Prevention.
“Depending on the qualifications of the nursing staff, it may or may not hurt,” he said. But he said, “The nasopharyngeal test is the most accurate. That’s why we keep making them. “
WHO has guidelines on how best to conduct testing; complications were rare. Australian regulations state that swabs must pass a few centimeters above the adult’s nostrils. The US Centers for Disease Control and Prevention says that a swab from the middle turbinate should usually be injected less than an inch or until it meets resistance. Some testers take swabs from both nostrils.
The KDCA guidelines give testers some leeway in how to scrape off the nasopharynx (by rocking or rotating the swab, or both). Choi said experience depends on the brand of tampon, the patient’s pain tolerance, the anatomical structure of the nasal cavity, and the skill of the tester.
Dr. Lee Jaehyun, professor of laboratory medicine at Jeonbuk National University who helped develop the Korean government’s COVID testing guidelines, said the test did not pose the same risk as taking blood.
But when leaving a clinic in Seoul this month, some people sneezed, rubbed their eyes, or blew their nose. One or two were crying.
“I felt like the tampon was scraping my brain,” said 19-year-old Chu Yumi.
Kim Kai, 28, who had bloodshot eyes, said, “I think my nose is bleeding right now.”
Lee Eunju and Lee Jumi, both 16 years old, said they never want to take nasal swabs again. Eunju said that chili powder was poured into her nostrils. Jumi said, “It hurt so much.”
Lee Jaehyun said that discomfort is a trade-off in favor of accuracy.
“This does not mean that we can ignore the pain that every patient experiences,” he said.
Many people tolerate this test well. Dr. Paul Das, family doctor at St. Michael’s Hospital at Toronto’s Unity Health network, said children tend to have a harder time.
Some people associate their experience with the technique of the testers or their personalities.
“It hurts, it’s a little uncomfortable, but I think this person was very gentle,” said 65-year-old Kim Sung Ok outside a clinic in Seoul.
Issa Ba, a 31-year-old footballer, recalled: “I took a COVID-19 test in Conakry, Guinea in August before coming to Senegal. I felt a little pain when they put a stick up my nose, but it wasn’t that bad. And I went through much more pain. I am human.”
Some countries are striving to standardize tests and eliminate human error. Developers in Denmark, Japan, Singapore and Taiwan have invented robots to do this job.
Johns Hopkins’ Manabe insists that the smear doesn’t hurt.
Nevertheless, painful stories abound.
Studies show that women often report more severe pain than men, but this may be due to design bias: some strokes may be too large for a woman’s anatomy.
Briana Moler, 28, had a nasal swab in Minnesota in 2020 so excruciating she “heard a crunch.”
Audrey Benattar, who recently returned to Marseille, France, recalled her trip to a Montreal hospital in May to give birth. There, a nasal swab from COVID left her with burst blood vessels and balloon catheters in both nostrils to stop the bleeding.
“I’ve never seen so much blood in my life,” said 34-year-old Benattar.
Some argue that nasal swabs rank relatively low on the scale of squeamish coronavirus tests.
This year, China has demanded some overseas travelers, including diplomats, to have anal swabs for COVID, infuriating foreign governments.