1. A New Kind of Nasal Test

The first time I underwent a COVID-19 nasal swab test was on May 14, 2020, a date etched in my memory due to the anxiety I felt, which I documented to calm myself. I've never been fond of anything entering my nose. In my past as a whitewater kayaker, I faced numerous dangers—upside-down flips, sharp rocks, and raging currents—but the thought of water rushing up my nose was far more terrifying.

I observed others getting tested at a COVID screening site in a parking garage. The swabs were quite intimidating, and I watched as the nurse's arm seemed to vanish into the patient’s nose, often resulting in silent screams of discomfort. The test, known as a nasopharyngeal swab, requires the swab to reach deep into the throat. It sent shivers down my spine.

As a Staff Scientist in a laboratory nested within the Biochemistry Department of a large research university, I am a small cog in a vast bureaucratic machine. When the pandemic struck, the university closed down around mid-March, maintaining only essential operations. I was part of the team that kept our lab running.

When the university reopened in May 2020, staff were required to undergo testing for COVID-19, and I was among those who needed to provide proof of a negative result. I managed to survive the intrusive test and was cleared to return to work.

By late May, our building was filled with staff who had all tested negative. However, the situation posed a dilemma: everyone returned home to untested family members who might be exposed to the virus, increasing the risk of transmission back at work. Thus, the initial negative test quickly lost its reassuring value.

2. Evaluating the Next Steps

With the arrival of COVID-19, the university administration had to rise to the occasion. They were tasked with assessing the risks associated with the virus, determining how to navigate the pandemic within the academic community, and implementing solutions. Despite my appreciation for them, I couldn't shake the feeling that there was a fundamental issue when so many resources went to administrative roles rather than those executing the necessary work.

The administration had to juggle conflicting priorities regarding testing. They needed to strike a balance between testing frequency and the financial implications for the university. Questions arose about the testing methods, whether to test individuals or groups, how to track results, and how to maintain privacy.

Eventually, the administration announced via email that we would have weekly self-administered nasal swab tests. The thought of conducting this test on myself filled me with dread, as I envisioned the awkwardness of maneuvering a swab up my nose while trying to avoid triggering my gag reflex.

3. The Self-Administered Test

The graduate school where I work is adjacent to the medical school. I managed to schedule my tests weekly from July through September, navigating a somewhat glitchy online system. On the day of my first test, I made my way nervously to the medical school.

Markers on the floor ensured we maintained proper distancing. As I reached the front of the line, a large sign inquired about any COVID-19 symptoms. A no-touch sanitizer dispenser was available, and a nurse in full protective gear checked that we complied with all safety measures and directed us to check-in.

Tables were organized to maintain distance between individuals. Staff members were protected by barriers and disinfected surfaces between patients.

The World Health Organization (WHO) outlines three primary modes of COVID-19 transmission:

• Fomites: Contaminated surfaces, like door handles, where droplets from coughs or sneezes settle.
• Direct Inhalation: Breathing in droplets expelled by others during conversation or laughter.
• Aerosols: Tiny droplets that can travel long distances in the air.

These transmission methods underscore the WHO’s guidance on hand hygiene, surface disinfection, mask-wearing, and social distancing.

At the check-in, a nurse took my identification details, printed a label for my sample tube, and handed it to me along with a sterile swab. Relief washed over me when I saw the swab—it was significantly smaller than the previous nasopharyngeal swab, making the upcoming procedure seem less daunting.

After verifying my information, I was instructed to remove the cap from the tube and prepare for the self-test. I inserted the swab about an inch into my nostril and began to twirl it. Surprisingly, it felt pleasant, a stark contrast to the discomfort of my first test. After a brief count, I switched nostrils for the same procedure and finished the test with a sense of accomplishment.

4. The Weight of Test Results

While relieved by the ease of the mini-swabs, I was still haunted by the uncertainty surrounding the test results. Unlike antibody tests that require blood samples, this was designed to detect the presence of the virus's RNA. The testing method primarily used is known as RT-PCR, which converts RNA from the sample into DNA for analysis.

The next day, an email confirmed our results. I logged in to see that my test had come back negative. Yet, despite the relief of each negative result, anxiety persisted. Had I sanitized my hands properly? Was I inadvertently exposing myself to the virus?

The fine print in the test report was daunting. While a positive result indicated a potential infection, a negative result did not guarantee safety. Factors like improper sample collection or virus mutation could lead to false negatives, and the test was authorized for emergency use rather than full FDA approval.

Each week, I grappled with the anxiety of waiting for results, even as I reminded myself of the comfort provided by the gentle swab. As I left the testing site, the latest updates from the WHO about aerosol transmission loomed in my mind, introducing another layer of concern into my already anxious thoughts.

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