One Canadian said it felt like a painful poke in his brain. An American heard crackling sounds in her head. A French woman suffered a serious nosebleed. Others got headaches, cried, or were left in shock.
They were all tested for Covid-19 with deep nasal swabs. While many people have no complaints about their experience, the swab test — an essential tool in the global fight against coronavirus — causes visceral aversion, severe writhing or buckling knees for some.
“It felt like someone went right on my brain’s reset button to switch something up,” said Paul Chin, a music producer and DJ in Toronto, of his nasal swab. “There’s really nothing like it.”
“Oh my gosh,” he continued, “the swab just goes further back up my nose than I ever thought or would have guessed — it’s such a long and sharp and pointy kind of thing.”
Since the outbreak of the coronavirus, millions of swabs have been inserted into millions of noses to test for a pernicious virus that has killed millions of people across the planet. One of the ways to fight the virus, officials say, is through extensive testing and testing often. The need was to use a test that people are willing to take repeatedly.
The swab generally fits well.
In some parts of the United States, health professionals hand people the cotton swab to test themselves, ensuring a level of personal comfort. For many South Africans, the only Covid-19 test is a painful one – you see stars or a gag as a nasal swab goes down your throat.
The range of mops raises questions: Who’s doing it right? How deep should the swab slide into your nostril? How long should it stay there? Should an accurate test be uncomfortable? Wrong or not, some countries have a reputation for brutal testing.
First a quick anatomy lesson: No, the Pap smear doesn’t actually stick in your brain.
The swab passes through a dark passage that leads to the nasal cavity. That is enclosed by bone covered with 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’s one of the places where the coronavirus is actively replicating, and it’s where you’re likely to get a good sample of the virus.
Concern about the test can stem from a simple fact: Most people can’t stand it when something is pushed so far up their nose. Plus, the tests invoke some of our darkest fears: of things that could crawl into our orifices and lodge in our brains.
“People are not used to feeling that part of their body,” said Dr. Noah Kojima, a resident physician at the University of California, Los Angeles and an infectious disease expert, on swabs touching the nasopharynx.
Pain comes into play 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 at Johns Hopkins University School of Medicine.
“If you don’t tilt your head back, you won’t get to the throat,” she said. “You’re hitting someone in the bone.”
mr. Chin, the music producer, described his test as a “brain jab” and compared the burning sensation to the effects of inhaling herbs.
“Your whole face is kind of ready to leak,” he said, adding, “I don’t really know if there’s any way to be prepared for it.”
There are three main types of Covid nasal swabs: nasopharyngeal (the deepest), mid-turbinate (the middle), and anterior nostrils (the shallow part of your nose). Early in the pandemic, the deep nasal swab was widely and aggressively administered to adults because the method worked in testing for flu and SARS. While science is evolving, experts agree that the deepest swab is the most accurate.
According to a review of studies published in July in PLOS One, a scientific journal, nasopharyngeal swabs are 98 percent accurate; shallow swabs are 82 to 88 percent effective; mid-turbinate swabs perform similarly.
In South Korea, nasopharyngeal swabs remain the gold standard for Covid testing, said Seung-ho Choi, deputy director of risk communications at the Korea Disease Control and Prevention Agency.
“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 WHO has guidelines on how best to test; complications were rare. According to Australian guidelines, cotton swabs should reach a few centimeters into the nostrils of adults. The U.S. Centers for Disease Control and Prevention say the swab in the center of the turbinate should usually be inserted less than an inch, or until it encounters resistance.
The KDCA guidelines give testers some leeway when scraping the nasopharynx (wiggle or twist 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 skill.
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.
But when they walked out of a clinic in Seoul in November, some people sneezed, rubbed their eyes, or blow their noses. One or two cried.
“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 going to bleed.”
Lee Eunju and Lee Jumi, both 16, said they never wanted to have nasal swabs again. Eunju said it felt like chili powder had been dumped into her nostrils. Jumi said, “It hurt so much.”
dr. Lee says the inconvenience is a trade-off for accuracy. “This doesn’t mean we can ignore the pain every patient feels,” he said.
Many people tolerate the test just fine. dr. Paul Das, a primary care physician at St. Michael’s Hospital in the Unity Health Toronto network, said children often had a harder time.
Some people attribute their experiences to the testers’ technique or to their personalities.
“It stings, it’s a bit 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 footballer, recalls: “I had 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’m a man.”
Some countries are striving to standardize the tests and eliminate human error. Developers in Denmark, Japan, Singapore and Taiwan invented robots to do the job.
dr. Manabe, of Johns Hopkins, insists the smear shouldn’t hurt.
Yet painful stories abound.
Women often report worse pain than men, studies show, but this may be due to a design bias: Some swabs may be too large for a woman’s facial anatomy.
Briana Mohler, 28, had a nose swab in Minnesota in 2020, so excruciating that she could “hear cracks.”
Audrey Benattar, who recently returned to Marseille, France, recalled her trip to a Montreal hospital in May to give birth. There, a Covid swab of the nose left hair with burst blood vessels and balloon catheters in both nostrils to stem the bleeding.
“I’ve never seen so much blood in my life,” said Ms Benattar, 34.
Some argue that nasal swabs rank relatively low on the scale of prudish coronavirus testing.
This year, China required some foreign travelers, including diplomats, to submit to Covid anal swabs, infuriating foreign governments.
Reporting contributed by Aurelien Breeden, Mady Camara, Lynsey Chutel, Vjosa Isai and Ruth Maclean.