Since the beginning of the pandemic, we’ve been swabbing our nostrils for COVID-19. Should we start swabbing throats instead?
No, you should not, according to the Food and Drug Administration, as well as several public health experts who spoke with VICE News and said the best way to test is to follow the directions.
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The suggestion that we add throat swabs to self-administered tests has gained steam on social media in recent weeks, particularly after the FDA issued a warning that some antigen rapid tests may not be sensitive enough to detect the Omicron variant.
Dr. Eric Feigl-Ding, a Harvard nutritionist and epidemiologist whose relentless Twitter commentary on COVID-19 has divided public health experts, retweeted a follower Saturday who said her husband tested negative via a nasal swab. Then, after following Ding’s suggestion to add a throat swab, the woman’s husband apparently tested positive.
“Omicron is very different from all other variants. We need to adapt to changing testing strategies,” Ding tweeted, adding: “This story made my day!”
There is preliminary research indicating that nasal swabs might not always be sufficient to detect Omicron. A preprinted study from last month looking at 382 patients at a hospital in South Africa found that mid-turbinate tests—the technical term for those extremely uncomfortable nasal tests—detected Omicron 86% of the time, compared with saliva tests, which detected it 100% of the time.
Other countries instructed people self-testing to swab their throats well before Omicron appeared. The United Kingdom published guidance in May 2020 instructing people self-testing to collect both nasal and throat swabs, and hospitals and health agencies in countries like Australia and Canada have also encouraged throat swabbing.
Others have touted swabbing your throat in order to get a positive result, including former Harvard epidemiologist Michael Mina and others who’ve tried it.
But on Tuesday, the FDA issued guidance on at-home tests saying you should not actually do this, citing safety and efficacy concerns. “The FDA advises that COVID-19 tests should be used as authorized, including following their instructions for use regarding obtaining the sample for testing,” the FDA told the New York Post Tuesday, adding that it had “safety concerns regarding self-collection of throat swabs.” (The FDA did not immediately respond to VICE News’ request for comment.)
Dr. Rachel Graham, an assistant professor of epidemiology at the University of North Carolina’s Gillings School of Public Health, echoed those concerns in an email to VICE News Tuesday.
“A throat swab is going to be more sensitive than a shallow swipe in a dry nose, but it’s difficult to self-administer correctly,” Graham said. “Aside from the high likelihood of triggering a gag reflex if you haven’t done one before, you can also hit the tonsils or uvula and potentially skew the results.”
While Graham said that clinical COVID-19 tests “could be more sensitive with the oropharyngeal swab,” she noted that “it’s harder to administer in bulk like it needs to be at testing stations or in the Walgreens drive-thru.”
“People should not do anything different than what was clearly validated and shown to work,” said Thomas Denny, the chief operating officer at the Duke Human Vaccine Institute at Duke University.
“My view on testing is pretty straightforward. And that is that whenever you want to do a test, you need to go through a validation process,” meaning running evaluations and studies to make sure throat swabbing actually does help.
Dr. Barun Mathema, an assistant professor of epidemiology at Columbia University’s Mailman School of Public Health, told VICE News that some studies show a “pool sample”—meaning samples from different parts of the body—appears to be better than a nasal sample alone. Mathema said he doesn’t “see any harm” in testing both nasally and via the throat, but with an important caveat.
“They should be looking at whether the packaging says that [swabbing] the throat is also OK. And I think that’s an important thing,” Mathema said.
Denny conceded that while there may ultimately be some utility in throat swabbing, the scientific evidence for it isn’t there yet.
“There could be some valid data there that says an alternative sample is beneficial, but one would need to validate that,” Denny told VICE News—meaning running evaluations and studies to make sure throat swabbing actually does boost testing accuracy.
“I would not start advising people to switch samples just because they may think it’s easier or because social media says it’s better.”
“I think there’s a lot of information out there,” Denny said. “Everybody’s looking for a simple way out of this. And unfortunately, there’s not a simple way out of it.”
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