Why Some People’s Covid-19 Tests Hurt More Than Others

Why some people describe the sensation of a test as uncomfortable while others say it’s painful

Millions of Americans have received Covid-19 tests since March — and countless more will likely experience the long wait at a testing site. While there are several tests for the virus on the market, the most common is a nasopharyngeal swab, which involves extracting a viral sample from the nasopharynx — the space between the upper part of the throat and the very back of the nose — and analyzing those results in a lab.

The test is a fairly accurate means of identifying the active virus, whether it’s in an ICU patient or the guy riding shotgun through the drive-through clinic. The only problem: Nobody likes to have their nasopharynx probed. Depending on who you ask, sticking a long, thin swab several inches deep into this chamber of secretions is surprisingly disagreeable, momentarily painful, or downright excruciating.

But how does it really feel?

The experience of getting a Covid-19 test has been described as having your brain “tickled,” or, alternatively, “stabbed” (though it never actually touches your gray matter). Lindsey Simpson, a clinical coordinator for the University of Vermont Health Network’s regional transport team, says it’s more like “laughing soda out of your nose — that warm, fizzy feeling.”

For Andrew Lane, MD, a professor of otolaryngology and director of the Johns Hopkins Sinus Center, “the closest thing might be if you were swimming and you get chlorine all the way back there.”

But sometimes, it’s a lot worse. “It is sharp, it’s stabbing — I can’t even really describe this feeling,” says Olivia Atwood, a 25-year-old hunkered down and quarantining in Boston.

“All told, it’s a very difficult area to swab.”

But that “is the nature of the beast,” says Joe Arrington of the San Antonio Fire Department, which helps conduct testing in the Lone Star State. The beast, in this case, is your very own anatomy. From the outside, the nose looks like a little nub of tissue, but inside, it’s a complex passageway that can differ dramatically between people. Most humans have some degree of a deviated septum — where one nasal passage is slightly smaller than the other. There’s also nasal polyps, alterations from reconstructive surgeries, and damage from earlier broken noses. And everyone has exquisitely sensitive tissue up there.

“The nerve endings in the nose come right to the surface,” Lane says. That’s what makes them so reactive to things like air pollution, chemical irritants, and supersized Q-tips. All told, it’s a very difficult area to swab. Sticking anything far enough up your nose is likely to trigger sneezing, coughing, and tears. Even the most well-administered Covid-19 test will activate your lacrimal gland, which reflexively sends protective fluids, aka tears, surging through the nasal cavity — and down your face.

Fortunately, a stinging sensation in the back of your nose and Oscar-worthy weeping tears should be the worst of the nasopharyngeal test. “If it’s done correctly, it shouldn’t be excruciatingly painful,” Simpson says.

Of course, not everyone’s test is done correctly. Atwood got her first Covid-19 test results from a self-swab test. She stood in a parking lot in Boston and collected the sample from her own nose while a test administrator counted down from 15 behind a wall of plexiglass. “It was uncomfortable. My eyes watered. But I was like, this is okay, I can deal with this,” she says.

But the next time Atwood got tested, it was a different experience. When a doctor inserted the swab into her nose, “my legs, of their own accord, not controlled by my brain, shoot up, and start kicking, as if I’m flailing, as if I’m in the electric chair,” she says. There was a momentary reprieve between nostrils, but the next swab triggered the same pain and the same involuntary response. The worst of it was over in less than a minute, but Atwood’s discomfort lingered. “My right nostril, specifically, continued to hurt for the rest of the day,” she says. Though it eventually resolved on its own, Atwood says the “doors are closed” to professional testers: If she needs to do another Covid-19 test, she’ll swab her nose on her own.

The issue with Atwood’s second test may have been a matter of angle. Instead of aiming the swab up the nose toward the eyeball, Simpson says testers should actually point the tool toward the tragus, that little flap of skin in front of the ear canal. If a swab goes straight up, it could hit any number of obstacles, causing pain or inflammation. It could even harm the olfactory bulb that helps with smell. But if the swab runs roughly parallel to the nasal passage, it shouldn’t hit anything — except mucus.

“It was uncomfortable. My eyes watered. But I was like, this is okay, I can deal with this.”

Good test administrators should also provide a healthy amount of “psychological first aid,” Simpson says. This can include providing an overview of the technique before the test begins, talking people through the insertion process, and even counting down the seconds for each swab. “If you can separate out pain and fear just a little bit, it’s less painful and less fearful,” Simpson says.

People “feel comfortable with things going a few centimeters into their noses,” says Seth Cohen, MD, MSc, a clinical assistant professor at the University of Washington School of Medicine and clinic chief of the UW Medical Center-Northwest Infectious Disease and Travel Medicine Clinics. “But then it continues to go on for a few more centimeters, and a few more centimeters, and that’s when people really get surprised.” People can also be caught off guard by the lacrimal reflex: “If they’re not expecting their eyes to water, that can be even scarier, because their body’s doing a thing they don’t expect,” Simpson says.

Providing this kind of context is helpful even for other, less invasive viral tests. Recently, some sites have begun to use a variety of nasal swabs, which doesn’t go nearly as deep as the nasopharyngeal test, and an oral tests, which involves self-swabbing the inside of your cheek after a productive cough. These methods get far fewer pain-related complaints — but people still benefit from a bit of hand-holding. While every testing site is different, test takers can often call ahead or read up online to determine what exactly their local facilities offer.

Ultimately, individual experiences with the Covid-19 test will vary widely, according to the skill of the test administrator, a person’s individual tolerance for discomfort, and their sense of fear around the test. Research has shown that “when people have control over the pain, they rate it as lower,” says Jeffrey Mogil, PhD, the head of the Pain Genetics Lab at McGill University in Toronto. And, he adds, “pain is not only a matter of intensity, it’s a matter of duration.” Those factors are what make it so hard to cope with the pandemic itself: we don’t know when it will end.

At least a Covid-19 test, no matter how uncomfortable, only lasts a few seconds.

Freelance science journalist. Writes a death newsletter: https://tinyletter.com/elliepses

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