Hundreds of millions of COVID tests have been done in over the last year, but some people resist the need and actively avoid taking the nasal swab test; at their peril!
“Think about the millions who’ve been swabbed, but you only hear about the ones that had a bad experience,” says Andrew Lane, MD, director of the Johns Hopkins Sinus Center. “It’s extremely, extremely rare.”
“I have swabbed many patients while working in hospital and also do these swabs on myself every week as a volunteer in a trial. It is unusual to have something that far up your nose – the swab can feel itchy or tickly but it shouldn’t be painful,” says Dr Tom Wingfield of the Liverpool School of Tropical Medicine.
Bad experiences can stem from several issues, thanks to the number of things involved. People tolerate pain differently and have different perceptions of stimuli. And human anatomy varies widely — your nasal passages may be broader or narrower than the person standing next to you.
Another factor: the skill of the technician doing the test. Because testing ramped up so quickly, you’ll find a range of training and experience levels.
The premise of the test itself is another part of the problem. “The body doesn’t like foreign objects entering the nose. It’s an open path from the outside world that goes directly to your windpipe and your lungs. And your nasal cavity is adjacent to your eye and your brain,” Lane says. “That’s a high-priority territory to defend.”
To do the test, a technician inserts a flexible, soft-tipped, 6-inch swab into your nostril. They’ll guide it to the back of your nose until it reaches the nasopharynx — the area where your nasal cavities meet your throat — and swirl it gently. They may leave it there for a few seconds to collect secretions. If the first nostril doesn’t provide enough, they may repeat the process in the other nostril.
The challenge, according to Lane, is that no two noses are the same. “The goal with the swab should be to get to the nasopharynx without hitting anything along the way,” he says. “Unfortunately, the geometry of the nasal passages is different from person to person.”
The mucous membrane that lines your nose has a lot of nerve endings. “In general, the body’s pretty tolerant the first couple centimeters — as far as you can stick your finger in. Beyond that, the mucous membrane reacts to being touched.” Lane says.
That activates involuntary, hard-wired reflexes. Depending on how strongly your body responds, the result can be discomfort, teary eyes, pain, and other reactions. “Some people get gagging, coughing, sneezing — it’s all part of the same reflex,” he says.
As for nosebleeds, that membrane (called the mucosa) is delicate and has lots of blood vessels, says Philip Chen, MD, an associate professor of otolaryngology — head and neck surgery at the University of Texas Long School of Medicine. “Nosebleeds would occur if the swab irritated and broke the surface of the mucosa,” he said. “This might be more likely in really dry climates, at altitude, and if the person has a very narrow nose.”
Fainting has an equally straightforward explanation: “It’s what’s called a vasovagal event. This can occur whenever the body has a very strong response to a situation such as emotional distress or pain,” says Chen. “For some people, the anxiety of having the procedure or the actual pain can result in fainting.”
“It’s such a low risk, I wouldn’t be frightened,” he says. “Your risk of having COVID and not knowing is much higher.”
Tips for a Pain-Free Swab
Because anatomy and pain tolerance vary, there’s no way of knowing if you’re likely to have a bad experience, but these suggestions may lessen your discomfort:
- If you’ve got a stuffy nose, try a spray decongestant, Lane suggests. That can help clear a path and make it less likely that the swab will bump into anything on its way to your nasopharynx. Lie down and put one drop in each nostril, 30-60 minutes before the test.
- Pay attention to the technician’s instructions. Position your head as directed, so they can place the swab at the correct angle. And once they start, don’t move! “Wherever they tell you to put your head, put your head in that spot and keep it there,” says Lane.
