Altnernative swab methods for the sick and gross
February 3, 2023 4:30 AM   Subscribe

Are you eating? Don't read this. So I'm super sick. I went to test this morning and did the throat first but what came out of my throat was so gross I didn't want to put it in my nose, so I got another swab and did the brain swab with that, then I stuck BOTH swabs in the same vial of liquid. So my question was going to be is that ok....but...Then after the two minutes the content of the vial was so thick that I couldn't squeeze out a drop and then when I forced it, the dropper lid exploded off...

So the contents of the little tub were so thick that it wasn't going through the dropper at all (not that it was going through was like it was blocked) so then when I forced it and folded the upper (when dropper is facing down) part of the vial to force it out, instead of drops coming out, the dropper lid exploded off and the contents went everywhere not just onto the little part where you're supposed to put 3 drops but also onto the test strip itself (the part where the liquid is supposed to sort of diffuse into).

So...we have two test irregularities. No results yet. But is this a valid test? Any suggestions for how to retry given that I'm probably not going to have less inside-the-head gunk anytime soon?
posted by If only I had a penguin... to Health & Fitness (23 answers total) 1 user marked this as a favorite
Well, I've never swabbed my throat; I understand that some people (maybe even some medical authorities) recommend that, but have the tests really been validated for throat swabs? (I mean nothing's perfect - obviously the tests also haven't undergone the same level of validation with the newer variants either.)

For your nose, at the testing sites I used to go to before rapid tests became widely available, they always had me blow my nose before I swabbed, and this tends to clear out the really chunky stuff.

I definitely wouldn't expect to be able to put two swabs in the same tube - the amount of solution in the tube is chosen on the assumption that you only put one swab in it. The swab absorbs a significant amount of the liquid, and that is factored into how the test works.

If you're going to use two swabs, use two full tests. As you've discovered, there is a limited amount of mucus that you can dissolve in 1ml of buffer solution.

This was not a valid test.
posted by mskyle at 4:39 AM on February 3, 2023 [2 favorites]

From a recent NPR article on testing:
But Baird says perhaps the biggest factor is human error. After all, people doing these tests at home make mistakes and aren't trained like those who are doing COVID-19 tests in a lab.

"There's going to be some people who stick it in their mouth," he says, explaining that not everyone follows the testing instructions as written. Some people even get mucus on the swab, mistakenly thinking mucus will have plenty of virus in it. "Actually you don't want snot on the thing."
posted by zamboni at 4:48 AM on February 3, 2023 [4 favorites]

Best answer: Take a warm shower, blow your nose a whole bunch when you're standing in there. Bend at the waist when you're drying off in the warm bathroom air so you're at a 90° angle and let your sinuses drain. Blow your nose some more. Then immediately do your test following the actual instructions of the test (swab your nose only, follow the instructions!!). I think that'll get you some booger free results.

And even so, you clearly sound like you should be isolating anyway, covid or not. If you're in a high risk category where you'd want to start paxlovid right away, call your doctor now. If you're not, then there's no harm in treating yourself like you're sick (because you are) and finding out if it's covid or not tomorrow.
posted by phunniemee at 5:35 AM on February 3, 2023 [10 favorites]

This is not a valid test.

Please follow the instructions on the test, and do so as exactly as you can. I have never seen an at-home covid test that instructed someone to swab their throat, and I'm assuming your test doesn't either.

Tests are validated within a range of alternate behaviors (swabbing your nose for 12 seconds instead of 10, for example). But this is very, very wide of any range that would be validated for.
posted by griffey at 5:39 AM on February 3, 2023 [1 favorite]

I have never seen an at-home covid test that instructed someone to swab their throat

There's some regional variation on what gets swabbed with at-home COVID tests; the original NHS batch in the UK (which are still in date) came with a long swab and we were instructed to swab the throat as well as the nose, while later ones were nose-only. This isn't an answer to the question, just a note that it's not inconceivable that a home test might require a throat as well as a nose swab depending on region.
posted by terretu at 6:05 AM on February 3, 2023 [3 favorites]

Response by poster: Yeah to just to stop the detail a little bit, the official instructions ARE to swab cheek, throat, and brain as this has been shown to be best since delta, I believe.

I don't think I've ever had a swab come out of my brain with no mucus. But ok, I've taken some Buckley's and will do the shower thing that phunnieme suggests and see what happens. Both the two-swab-exploded test and a second one-swab-not-exploded-but-definitely-mucus test were negative.
posted by If only I had a penguin... at 6:10 AM on February 3, 2023 [1 favorite]

Response by poster: know when you stick the swab not into your nostril but behind your nose? I assume that's my brain back there.
posted by If only I had a penguin... at 6:30 AM on February 3, 2023 [1 favorite]

The "brain" thing really is confusing. I assume you're joking about how how far you need to stick the swab up your nose, but I think when asking for medical advice, being clear is very important. Anyway, you say:

"I went to test this morning and did the throat first but what came out of my throat was so gross I didn't want to put it in my nose"

Are you sure the instructions are telling you to take the same swab you're using in one orifice and put it in another? That doesn't seem right. You definitely need to re-test (maybe with a different type), and see if you can get someone to ask you through the steps as you're doing them.
posted by jonathanhughes at 6:31 AM on February 3, 2023 [1 favorite]

I'm still confused, as an Ontarian; it does go up your nostril, yes?
posted by sagc at 6:31 AM on February 3, 2023

There have absolutely been testing regimes that ask you to swab throat, then nose, with the same swab. Common for PCR testing in my part of Europe when that was a thing. Just to back OP up on that (it's still possible OP is delerious or scraped out too much brain and doesn't have that type of test)
posted by Iteki at 6:35 AM on February 3, 2023 [3 favorites]

Best answer: See point 9 in this link - you’re aiming to swab the tissue lining your nasal passages, not the nostrils.
posted by zamboni at 6:37 AM on February 3, 2023 [1 favorite]

Response by poster: It goes into your nostril and then into the hole that's inside your nostril that goes...wherever it goes. At least that's my understanding and when I do that it feels like the same awful thing they did to me back when you could get a PCR test at the assessment centre. And yes, you're supposed to use the same swab. First cheeck, then throat, then in thorugh the nostril to wherever. Here is a video of throat and nose swab (from 2 years ago before throat and into the nose hold became the preferred method, so it's given as an alternative method not the preferred). Not it says "same swab". The tests also only include enough swabs to use the same swab and only mention putting one swab in the liquid.
posted by If only I had a penguin... at 6:39 AM on February 3, 2023

There's no reason that you *can't* do a nose-only swab and test it, using the second procedure in the PDF you linked to.
posted by sagc at 6:50 AM on February 3, 2023 [1 favorite]

You should be following the instructions that came with the test that you are using. Not a video from two years ago, not the guidance from the province of Ontario to medical professionals. The instructions that came with YOUR test kit.

Behind your "nose" is nasal cavity, sinus, and pharynx. Since you don't know this, kindly, you need to stick to the instructions for laypeople that came in your test kit for laypeople. That's why they send instructions with the tests. For you and me.
posted by phunniemee at 6:51 AM on February 3, 2023 [15 favorites]

Home antigen tests vary. To get a valid test, you need to follow the instructions on the actual physical test you have in front of you. Read the written instructions that came with your test and follow those instructions.
If the Ontario pdf you linked above matches the physical instructions on your test, then follow the “if nose only” option.
posted by nat at 6:54 AM on February 3, 2023 [2 favorites]

Wow, I am sorry everyone's jumping down your throat for being less than perfectly articulate and professional on a free internet question site while you're sick. FWIW your joke about "brain swabs" was not remotely confusing to me on any level; even the military physician who gave me a test in the early days joked about "now it's time to poke you in the brain."

In general if anything has gone wonky at all with an at-home test, it's best to assume the results are invalid. With newer variants it is not as much a slam-dunk to get an accurate read as it was with the OG and delta.

I hope you get a good test soon and feel better soon regardless of the results!
posted by We put our faith in Blast Hardcheese at 7:06 AM on February 3, 2023 [19 favorites]

Best answer: I am from the same area and the OP is in fact correctly following the instructions for laypeople from the local public health experts by throat-swabbing, as also explained clearly in the first PDF they shared. Please stop with the condescending derail and focus on the question asked instead.
posted by randomnity at 7:06 AM on February 3, 2023 [15 favorites]

Yes, Ontario wants us to swab our throats with the kits they gave us, which admittedly only say swab nose, leave OP alone.

OP, I've done the exploding tube thing too, it's annoying, make sure cap is on tight, hold upsidedown for a few seconds for mucus to rise, squeeze gently and really slowly. Good luck and godspeed.

PS. everybody I know has covid right now, you probably have covid.
posted by stray at 7:18 AM on February 3, 2023 [2 favorites]

I had exactly the same issue with Siemens CliniTest brand. As far as I could tell, the filters on their nozzles tend to dry up or become otherwise non-porus very quickly (in all cases I tried, the expiration date had not passed, but this simple thing didn't work).

Is that the kind of test you used?

If you don't have any other brands of tests*, my experience has showed that dumping the gross contents onto the test cassette (the drop place, not the test strip) seems to work anyway. When I didn't have COVID these tests were negative using that method. When I did get COVID, they were positive.

* - BTW: do not use Quidel Quickvue (or the generic CVS brand, which are the same). For me and many others these are *always* (slightly) positive.
posted by pjenks at 7:21 AM on February 3, 2023

I think I've realized another bit of the confusion:

* Here in the USA, 99.9% of us who are testing ourselves for Covid are using the at-home rapid tests, which indeed instruct you only to swab inside the nose. I believe that that is why you're getting a lot of confused answers from people wondering "why the heck are you swabbing your throat".

* However - folks, the OP is in Canada, and the public health system is different there, so they actually are following proper guidelines.

So based on that (and issuing the caveat that I'm from the USA) - if I were in your shoes, this is exactly the point at which I'd be reaching out to a doctor or nurse on the phone to ask a) how to take that test at home, or b) whether a home test is even going to be accurate or necessary given the circumstances. It may be that your symptoms are such that they may want you to get to an urgent care or some kind of clinic and have the pros do it - or, they may have ideas for how to de-gunk yourself so you can try again more successfully. Or they may know whether this is cause enough to forgo the test entirely for a few days. But a doctor or nurse is much more likely to be able to have that knowledge and make that call, I suspect, so I'd reach out to them.

And listen, I feel ya on not wanting to pull yourself together to leave the house if they say you should, but sometimes you have to call in the big guns, you know? A few years back I got a super-tiny glass splinter stuck in my foot, and after me and my roommate spent two days faffing around trying everything we could to get it out, I finally went to an urgent care - and what he pulled out was so tiny that he needed a scalpel and a high-powered magnifying glass to find the damn thing, so there was NO WAY IN HELL that my roommate or I would ever have been able to handle it ourselves with cheap tweezers.
posted by EmpressCallipygos at 7:25 AM on February 3, 2023 [2 favorites]

While most people in the US under a collapsed public health system are unaware of this, functional countries have been debating nasal vs nasal + throat for a long while now, so please keep in mind just because YOU haven't heard of something does not mean it does not exist and is obviously wrong.

OP In this case, given the spectacular fail of the last test, I'd say take another one - maybe after a few hours sitting upright, maybe have a little gargle with warm salt water now and then see how things are in a few hours, or take a sudafed if you've got the good stuff - doing only the (probably as noted in the instructions) "3/4 length of the stick" swab up the nose, up there at the edge of the "brain" zone, and see what that one says. Assume you have COVID for now, and behave accordingly.
posted by Lyn Never at 7:53 AM on February 3, 2023 [5 favorites]

Maybe you could try using a neti pot with warm, boiled and cooled salt water to rinse out all the gunk, and then do the recommended swabbing before you fill back up with mucus. I’m not sure if the rinse would have an effect on the detectable virus load, but since you’re swabbing multiple sites, maybe that would mitigate the risk of virus getting washed out of your nose (and at least you wouldn’t be blowing the cap off the vial).
posted by music for skeletons at 8:03 AM on February 3, 2023

Response by poster: Thanks, all. The Buckleys actually cleared all the mucus. Mucus-free test was also negative. As have all the (admittedly mucus-contaminated) tests I've been doing for almost a week now.

And for the record I'm swabbing according to the instructions provided by the government of Ontario to lay people for use with the specific tests provides by the government of Ontario. The instructions differ from those in the box but the government (after initially saying "do what the box says) tested the the new swab method and decided it was superior and announced that people should disregard the box instructions and do this instead. For the brand of test that I used, provided by the same government that is giving the guidelines.
posted by If only I had a penguin... at 5:34 PM on February 3, 2023 [2 favorites]

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