The Problem with Deep Nasopharyngeal Swabs

(Note: I am not saying to not get tested. My speculation is that the deep nasopharangeal swab (NS) probably has a non-zero risk associated with it based on the rationale I provide below. And it is just a speculation based on science. This test is more invasive than a nasal swab which only goes 1” into your nose. There are also other tests which are less invasive and provide little to no risk, such as the saliva test.)

There are many ways to collect specimens for detecting the presence of SARS-CoV-2. One of the most prevalent sample collection methods is the deep nasopharyngeal swab (NS). (This is different and much more invasive than a nasal swab)

In this method, a swab is inserted through the nostril and moved until it stops at the nasopharynx (see picture below). The swab is then rotated for a specified period time to collect secretions, then the swab is removed and placed into sterile viral transport media. They may repeat the procedure on the other nostril.

After giving this sampling method much thought, I believe this could be putting people at increased risk of being infected with the virus. I can’t make the assertion that this is true with 100% confidence, nor can I quantify the percentage; however, I do think it is something that should be seriously considered.

This is my rationale. Humans have a pretty robust immunity-based defense system that starts with our nose and mouth, and then progresses through our nasal cavities and then into our lungs. When inhaled antigens (such as virus and bacteria) enter our nose, they immediately encounter a line of defenses that make up the mucosal immune system. This system can prevent pathogens from entering our lungs and can stop an exposure event before it turns into a full fledged upper respiratory infection. This system is our front line defense system, and prevents us from an untold number of illnesses on a daily basis.

The mucosal immune system includes several components, and includes the the mucosa-associated lymphoid tissue (MALT), also called mucosa-associated lymphatic tissue. MALT is found in various submucosal membrane sites of the body, such as the nasal cavity, nasopharynx, gastrointestinal tract, lung, salivary glands, eye, and skin. This system constitutes helper TH1 and TH2-cells, macrophages, antigen-presenting cells, cytotoxic T lymphocytes (CTLs), plasma cells, antibodies, and memory B cells.

So, let’s say you breathe in some SARS-CoV-2 virus particles. The mucus lining your nasal cavities will capture the virus, and the MALT will go to work to start developing a line of defenses against the virus. If it’s successful, it could stop the infection dead in its tracks, especially if you already have IgA antibodies and memory B cells and memory T cells that were programmed from previous exposures to the other 4 coronaviruses that cause the common cold.

But let’s say these virus particles are residing and sequestered in what they would first encounter when entering your nose: the concha, and in particular, the inferior nasal concha. Research has shown that the MALT immune response is active in this structure within our nose.

Now, you go to get test. They take a 6 inch long swab and move it through your nose and through this region of the concha, picking up any viral particles that are attached to any structures along the inside of your nasal cavity, and then deposit those particles on the back side of your nasopharynx. The reason they chose this region to sample from is because nasopharyngeal tissue is believed to be great host tissue for the virus to replicate in. And it would make sense to sample from this location if the person were already infected to the extent where virus was beginning to multiply in this tissue.

But what if the virus is contained to the concha and the immune system is busy dealing with the presented antigens such that the infection will not progress any further down the respiratory pathway? It wouldn’t be smart to take this nascent infection and then inoculate it further down your respiratory pathway with a 6 inch swab.

As a second scenario, let’s say that you haven’t been exposed to the virus and you proceed to a testing site where presumably hundreds of other people are being tested. Due to the number of people and the closed quarters, there is undoubedtly some level of viral particles in the air. They remove a swab from the sterile kit and the swab is exposed to virus-laden air at this facility before it enters your nose. Even 1 virus particle could attach itself to the swab. Then, they send this virus particle all the way back to your nasopharyngeal cavity, essentially inoculating you with the virus and providing the virus with a head start by inserting it into a prolific viral stomping ground.

Based on both scenarios above, there’s a real probability (I don’t know how large) that an uninfected person who comes into the clinic may be directly inoculated with the virus deep in the nasopharynx.

This is unbelievably ignorant. Why take the risk of possibly infecting uninfected people?

There are safer ways to take samples, so if you need a test, please ask your health provider for another option other than the deep nasopharyngeal test. Both home administered nasal swabs and saliva samples have been proven to be accurate, and they pose no additional risk to infection. Below, I’ve posted the studies conducted by Stanford and Yale on these other sampling methods.

(New Post: What if God left behind a message in the laws of nature that reveals his identity? –> CLICK HERE TO READ )


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