7 ms·

What is the expectation people will actually get the swab far enough back to collect a meaningful sample? Having been on the receiving end of a nasal collected

What is the expectation people will actually get the swab far enough back to collect a meaningful sample? Having been on the receiving end of a nasal collected flu test, it was a pretty deep probing. I’m kind of doubtful most people can do it to themself properly without some prompting to ‘go deeper’.

James_Henry 6y ago
There's evidence that for Covid-19 it's not necessary to go as far back as people have been going. There's also evidence that self-collection works well. The FDA has acknowledged this before and allowed self-collection with physician oversight before they allowed this test.
- MikeAmelung 6y ago
  Where is this evidence? How does this square with the evidence that RT-PCR tests are already coming back falsely negative, probably due to missing the virus while swabbing? Pardon me for being skeptical, but this is all from the same people who have bungled this every step of the way.
  - cbhl 6y ago
    I'm having trouble finding the actual study, but UnitedHealth Group, working with the Bill & Melinda Gates Foundation, Quest Diagnostics, and the University of Washington did a study on the efficacy of self-swabbing. https://techcrunch.com/2020/03/25/study-behind-updated-fda-guidance-shows-self-swab-tests-are-as-effective-as-those-done-by-clinicians/ https://techcrunch.com/2020/03/25/study-behind-updated-fda-g...
  - James_Henry 6y ago
    I found the paper. I haven't read through it so I can't say if it is actually any good, but it is good enough that the FDA changed their recommendations because of it (that might not mean much, of course). https://www.medrxiv.org/content/10.1101/2020.04.01.20050005v1 https://www.medrxiv.org/content/10.1101/2020.04.01.20050005v...
    - MikeAmelung 6y ago
      Thanks for tracking it down. Doesn't seem to be any problem with accepting their results that it's almost as good as a nasopharyngeal swab, so you won't see me complaining about it again.
  - takeda 6y ago
    Not really an evidence, but looks like their instructions explicitly say to not insert it deep: https://www.pixel.labcorp.com/covid-19-sample-collection https://www.pixel.labcorp.com/covid-19-sample-collection
biased_coin 6y ago
Prompting to 'go deeper' could potentially be done over a video call. I hope LabCorp does some sort of beta testing to know how well people do with instructions.
- James_Henry 6y ago
  https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2#troubleobtainingviraltransport https://www.fda.gov/medical-devices/emergency-situations-med... The FDA doesn't think it is necessary to go that deep.
throwaway55554 6y ago
Put a mark on the swab, put a rubber band around the mark on the swab and say it has to go back that far. Have a test for adults and another for children. But, the video from the actual labcorp website someone else posted shows it does not actually have to go very deep.
- edoceo 6y ago
  Even adult noses are different sizes, the depth is a relative measure.
jacobriis 6y ago
You only need to swab the edge of your nostril for this test. https://www.pixel.labcorp.com/covid-19-sample-collection https://www.pixel.labcorp.com/covid-19-sample-collection
- clumsysmurf 6y ago
  It was my understanding, that its easy to get false negatives with this kind of test because the virus moves down the respiratory track as time goes on. Too early, its not sensitive enough. Too late, nothing there. It has to be in a specific window of opportunity. Can somebody jump in and correct me if I am wrong?
  - fspeech 6y ago
    It is now thought that the virus can also infect cells in the nose. Cough and nasal discharge could also bring virus from deeper parts of the body to the nasal passage.
  - cypherpunks01 6y ago
    It does move down the respiratory tract, but nasal epithelial tissue can still contain/produce the virus for awhile even after it "moves". For me, I was able to physically feel the inflammation move down from my throat to lungs to abdomen, but that was 5 weeks ago, and I just tested positive on a deep nose swab rtPCR given yesterday. A lot of people are testing positive for surprisingly long time. I wouldn't be surprised if a light nasal swab like being discussed here doesn't pick up anything post-symptoms, whereas PCR with the deep nasal swab may still be detectable for a longer time after primary symptoms have faded.
LatteLazy 6y ago
I think they're just assuming you will pay 119USD (Plus tax and shipping) for a box because coronavirus. What you do with it after your transaction clears really isn't their concern...

James_Henry 6y ago

There's evidence that for Covid-19 it's not necessary to go as far back as people have been going. There's also evidence that self-collection works well. The FDA has acknowledged this before and allowed self-collection with physician oversight before they allowed this test.

MikeAmelung 6y ago
Where is this evidence? How does this square with the evidence that RT-PCR tests are already coming back falsely negative, probably due to missing the virus while swabbing? Pardon me for being skeptical, but this is all from the same people who have bungled this every step of the way.
- cbhl 6y ago
  I'm having trouble finding the actual study, but UnitedHealth Group, working with the Bill & Melinda Gates Foundation, Quest Diagnostics, and the University of Washington did a study on the efficacy of self-swabbing. https://techcrunch.com/2020/03/25/study-behind-updated-fda-guidance-shows-self-swab-tests-are-as-effective-as-those-done-by-clinicians/ https://techcrunch.com/2020/03/25/study-behind-updated-fda-g...
- James_Henry 6y ago
  I found the paper. I haven't read through it so I can't say if it is actually any good, but it is good enough that the FDA changed their recommendations because of it (that might not mean much, of course). https://www.medrxiv.org/content/10.1101/2020.04.01.20050005v1 https://www.medrxiv.org/content/10.1101/2020.04.01.20050005v...
  - MikeAmelung 6y ago
    Thanks for tracking it down. Doesn't seem to be any problem with accepting their results that it's almost as good as a nasopharyngeal swab, so you won't see me complaining about it again.
- takeda 6y ago
  Not really an evidence, but looks like their instructions explicitly say to not insert it deep: https://www.pixel.labcorp.com/covid-19-sample-collection https://www.pixel.labcorp.com/covid-19-sample-collection

biased_coin 6y ago

Prompting to 'go deeper' could potentially be done over a video call. I hope LabCorp does some sort of beta testing to know how well people do with instructions.

James_Henry 6y ago
https://www.fda.gov/medical-devices/emergency-situations-medical-devices/faqs-diagnostic-testing-sars-cov-2#troubleobtainingviraltransport https://www.fda.gov/medical-devices/emergency-situations-med... The FDA doesn't think it is necessary to go that deep.

throwaway55554 6y ago

Put a mark on the swab, put a rubber band around the mark on the swab and say it has to go back that far. Have a test for adults and another for children. But, the video from the actual labcorp website someone else posted shows it does not actually have to go very deep.

edoceo 6y ago
Even adult noses are different sizes, the depth is a relative measure.

jacobriis 6y ago

You only need to swab the edge of your nostril for this test. https://www.pixel.labcorp.com/covid-19-sample-collection https://www.pixel.labcorp.com/covid-19-sample-collection

clumsysmurf 6y ago
It was my understanding, that its easy to get false negatives with this kind of test because the virus moves down the respiratory track as time goes on. Too early, its not sensitive enough. Too late, nothing there. It has to be in a specific window of opportunity. Can somebody jump in and correct me if I am wrong?
- fspeech 6y ago
  It is now thought that the virus can also infect cells in the nose. Cough and nasal discharge could also bring virus from deeper parts of the body to the nasal passage.
- cypherpunks01 6y ago
  It does move down the respiratory tract, but nasal epithelial tissue can still contain/produce the virus for awhile even after it "moves". For me, I was able to physically feel the inflammation move down from my throat to lungs to abdomen, but that was 5 weeks ago, and I just tested positive on a deep nose swab rtPCR given yesterday. A lot of people are testing positive for surprisingly long time. I wouldn't be surprised if a light nasal swab like being discussed here doesn't pick up anything post-symptoms, whereas PCR with the deep nasal swab may still be detectable for a longer time after primary symptoms have faded.

LatteLazy 6y ago

I think they're just assuming you will pay 119USD (Plus tax and shipping) for a box because coronavirus. What you do with it after your transaction clears really isn't their concern...