Early COVID-19 images of swabbing from Wuhan, China, looked more like an Ebola news story – health care workers were completely immersed in personal protective equipment (PPE), inserting swabs so deep that brain damage seemed difficult.
When COVID-19 (and testing) spread around the world, there were reports of “the brain scratch“,” brain teasers “or” brain tickling “swabs. Maybe this was your experience early in the pandemic. Maybe these stories have put you off to test so far.
But if you go to a drive clinic today, you probably have another swab, one that has been inserted briefly and is not as far up as before.
So if fear of the swab itself stops testing, here is what you need to know about these soft swabs.
‘Brain scrapers’ are less commonly used in referral clinics
The swabs that test COVID-19’s reputation are the nasopharyngeal swabs. Although these are considered the “gold standard” of testing, they are undoubtedly uncomfortable.
You remove your mask and blow your nose to clear your nasal passages. Then try not to sneeze, cough or claw while a health worker inserts a long, flexible shaft about 12 cm (4.7 inches) into the nose and back of your throat (until resistance is). They then twist the swab against the back of your throat.
The insertion distance is significant. Close your eyes and imagine inserting a thin one as the length of the space between your nostrils and the outer opening of the ear. The health worker must rotate the swab to maximize contact with the contents in the back of the nose before removing it.
The swab can cause your eyes to water, a reflex cough or neck. Because of this risk, personnel must wear full PPE to avoid the risk of being exposed to and inhaling infected particles and aerosols.
This type of swab is still used in some clinics, and different jurisdictions around the world have different testing policies.
You will be happy to hear, things have changed
As the pandemic evolved, so did methods of testing, with evidence gathering on how well they work.
For example, some Australians have tested their saliva, including Victorians against the start of the state’s second wave.
But more commonly used now in a typical referral clinic are a combined swab of the throat and nose.
You will be happy to know that the health worker first wags your throat before using the same swab around your nose (and not the other way around)! This is the so-called oropharyngeal / nasal swab.
First, the health worker will use a tongue depressor to keep your tongue under, then swipe the area behind and next to the tonsils. Then they will take a nasal spray.
If they take a superficial pennant, they will ask you to look straight ahead before inserting the swab forward until there is some resistance. Then they will hold the swab in place for 10-15 seconds while rotating, before repeating this in the other nostril.
When they take a mid-turbinate nasal (also called deep nasal) swab, you lift your head slightly backwards. The health worker will then insert the swab horizontally (instead of vertically) until there is resistance (about two to three centimeters). They will then rotate the pupper for 10-15 seconds before repeating on the other side.
Why did the swabs change?
If someone sticks a swab stick will stick our collective nose up, the test must be accurate and reliable.
But what if other options were almost as good, without so much invasion, coughing and increased exposure risk for health care workers?
In late March and April, organizations including the US Food and Drug Administration and US Centers for Disease Control, and Australia’s Public Health Laboratory Network, announced that they wanted to move away from deeper nasopharyngeal swabs after using nasal swabs for this kind of testing.
The recommendation in Australia is to use a combined throat / deep nasal lavage, but if the healthcare professional deems it necessary, a nasopharyngeal swab.
Since then, research suggests the gap between absolute best (nasopharyngeal) and the occurrence of a gag or cough-inducing reflex (nasal) may not be as great as once thought.
Comparative studies show that throat / nasal swabs are as sensitive as nasopharyngeal to detect SARS-CoV-2, the virus that causes COVID-19.
Other studies show that throat / nasal swabs are practical, inexpensive, accurate and reliable.
Not convinced yet? Your brain is really safe
Gathering evidence suggests that the newer nasal passages are safer, more reliable, cheaper to complete and less unpleasant. They also save expensive higher-class PPE for where it is needed – in our healthcare facilities.
So with testing rates down in Victoria and asking for more testing in New South Wales, this is a reminder that we need to continue testing, testing, testing, as well as practicing hand hygiene, social distance, and wearing masks.
Craig Lockwood, Associate Professor Implementation Science, JBI and Lucy Crawford, Clinical Lecturer.
This article was republished from The Conversation under a Creative Commons license. Read the original article.
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