One Canadian claimed it felt like a painful poke in the brain. A woman in America heard crunching sounds inside her head. A Frenchwoman had a severe nosebleed. Others experienced headaches, cried, and were left in shock.
All were tested for Covid-19 by deep nasal swabs. While many people have no complaints about their experience, for some, the swab test — a vital tool in the global battle against the coronavirus — engenders visceral dislike, severe squirming or buckled knees.
“It felt like someone was going right into the reset button of my brain to switch something over,” Paul Chin, a music producer and DJ in Toronto, said of his nasal swab test. “There’s truly nothing like it.”
“Oh, my goodness,” he continued, “the swab just going farther back into my nose than I’d ever imagined or would have guessed — it’s such a long and sharp and pointy kind of thing.”
Millions upon millions of nose swabs have been placed into millions of people’s nostrils to test for the coronavirus, which has caused millions of deaths worldwide. Officials say that testing often and widely is one way to combat the virus. It is essential to use a test people are willing to take multiple times.
The swab is generally sufficient.
Some parts of the United States give people the swab for their own testing, as a way to ensure that they are comfortable. To many South Africans, the only Covid-19 test is a painful one — you see stars or gag because a nasal swab goes down your throat.
The variety of swabbing raises many questions: Who is doing it right, and how? How far should the swab reach your nostrils? How long should it stay up there? Do accurate tests have to be painful? Some countries are known for their brutal tests, whether they are unfair or not.
First, let’s talk about anatomy. The swab does not actually stab your brain.
The swab passes through a dark passage that leads into the nasal cavity. It is enclosed in bone and soft, sensitive tissue. At the back of this cavity — more or less in line with your earlobe — is your nasopharynx, where the back of your nose meets the top of your throat. It is the most likely place where the coronavirus actively reproduces, and you will likely get a good sampling of the virus.
Wariness about the test may arise from a simple fact: Most people can’t stand having something shoved so far up their nose. Additionally, the tests may bring up some of our deepest fears: things that can crawl into orifices and enter our brains.
“People aren’t used to feeling that part of their body,” Dr. Noah Kojima, a resident physician at the University of California, Los Angeles and an expert in infectious diseases, said about swabs touching the nasopharynx.
Pain enters the picture when the swab — a tuft of nylon attached to a lollipop-like stick — is administered at the wrong angle, said Dr. Yuka Manabe, a professor of medicine specializing in infectious diseases Johns Hopkins University School of Medicine
“If you don’t tip your head back, you don’t get to the throat,” she said. “You’re smashing into someone’s bone.”
Mr. Chin, the music producer, described his test as a “brain poke” and compared the burning sensation to the effects of breathing in spice.
“Your whole face is kind of ready to leak,” he said, adding, “I don’t really know that there’s any way to be prepared for it.”
There are three types of Covid nasal swab testing: nasopharyngeal, mid-turbinate and anterior nares. Because it worked for SARS and influenza testing, the deep nose test was widely used in the early stages of the pandemic. Experts tend to agree that the most precise swab is the one with the longest nostril.
A review of studies published in July in PLOS one, a science journal, found that nasopharyngeal and shallow swabs are accurate to 98 percent. They are also effective to 82 to 88 percent, respectively, while mid-turbinate swabs perform similarly.
According to Seung-ho Choi (deputy director of risk communication at Korea Disease Control and Prevention Agency), nasopharyngeal Swabs are still the gold standard in South Korea for Covid testing.
“Depending on the skill of the medical staff, it may or may not hurt,” he said. But he said: “The nasopharyngeal test is the most accurate. That’s why we keep doing them.”
The W.H.O. The W.H.O. has guidelines for how to test; complications are rare. According to Australian guidelines, swabs should be inserted a few centimeters above the adult nostrils. The U.S. Centers for Disease Control and Prevention advise that the mid-turbinate swab shouldn’t be inserted more than an inch or until it meets resistance.
The K.D.C.A.’s guidelines allow testers some leeway on how to scrape the nasopharynx (wiggling or spinning the swab, or both). Mr. Choi said the experience depends on the brand of swab, the patient’s pain tolerance, the anatomical structure of the nasal cavity and the tester’s proficiency.
Dr. Lee Jaehyeon, a professor of laboratory medicine at Jeonbuk National University who helped develop the Korean government’s Covid-testing guidelines, said the test posed as little risk as drawing blood.
As I walked out of a Seoul clinic in November, I noticed that some people were sneezing and rubbing their eyes. One or two people were crying.
“It felt like the swab was scraping my brain,” said Chu Yumi, 19.
Kim Kai, 28, who had bloodshot eyes, said, “I think my nose is about to bleed.”
Lee Eunju, 16 and Lee Jumi, 16, both said they would never want to do nasal swabs ever again. Eunju described it as if chili powder was being poured down her nostrils. Jumi said, “It hurt so much.”
Dr. Lee said that the discomfort is a tradeoff for accuracy. “This does not mean we can ignore the pain that each patient feels,” he said.
Many people can tolerate the test well. Dr. Paul Das, a family physician at St. Michael’s Hospital in the Unity Health Toronto network, said children tended to have a tougher time.
Some people chalk up their experiences to testers’ technique or their personalities.
“It stings, it’s a little uncomfortable, but I think the person was very gentle,” said Kim Soon Ok, 65, outside a clinic in Seoul.
Issa Ba, a 31-year-old soccer player, recalled: “I had my Covid-19 test in Conakry, Guinea, in August before I came to Senegal. Although I felt some pain when the stick was inserted into my nose, it was not too severe. I have also experienced much more severe pain. I am a man.”
Some countries want to standardize the tests and eliminate human error. Robots were invented by developers in Japan, Singapore, Taiwan, and Denmark to do the job.
Dr. Manabe, Johns Hopkins, insists that the swabbing shouldn’t hurt.
There are still many stories of pain.
Women often report worse pain than men, studies show, but this could be because of a design bias: Some swabs may be too large for a woman’s facial anatomy.
Briana Mohler, 28, suffered a nose swabbing in Minnesota in 2020 so excruciating that she could “hear crunching.”
Audrey Benattar recently returned to Marseille, France. She recalled her May visit to Montreal’s hospital to give birth. A nasal Covid swab left her suffering from burst blood vessels. She also had balloon catheters placed in her nostrils to stop the bleeding.
“I’ve never seen so much blood in my life,” Ms. Benattar, 34, said.
Some people argue that nose swabs are not as reliable as coronavirus tests.
China required that all foreigners, including diplomats, submit for anal Covid swab testing. This was a resounding insult to foreign governments.
Reporting was done by Aurelien Breeden, Mady Camara, Lynsey Chutel, Vjosa Isai Ruth Maclean.
Source: NY Times