Nasal Swabs, Not Throat Swabs, Give the Most Accurate COVID Rapid Test Results

Kid gets nasal swab COVID test

Getty Images / Yawar Nazir

Key Takeaways

  • Consumers are finding that rapid tests don’t always detect the omicron variant.
  • Some people are swabbing their throats instead of their noses when taking a rapid test and getting more accurate results.
  • Experts say despite reports of using throat swabs for testing, it is important to follow the directions on the test to avoid faulty results.

A nasal swab for a COVID-19 test can be difficult for anyone, especially kids. Despite the discomfort, with the omicron variant of the virus quickly spreading, tests are in high demand. The fast evolution of cases has created long lines at testing centers, and left people scrambling for rapid testing kits. Unfortunately, even after using rapid tests, some people complain about less-than-optimal results. The tests with nasal swabs, they say, aren’t consistently detecting omicron.

Some people say swabbing their throats instead of their noses provides more accurate results when testing for the omicron variant. For parents looking for a more child-friendly testing method, this news may bring a sigh of relief. But experts say hesitate to recommend the method without more research.

“What we’re doing now is completely assessing, in a really rigorous and systematic way, the answer to the question, where does the omicron variant actually live? Is it in the throat more? Is it in the nose? Is it in the saliva?” states Wilbur Lam, MD, PhD, pediatric hematologist/oncologist, Aflac Cancer and Blood Disorders Center at Children’s Healthcare of Atlanta. Dr. Lam works with a team that examines COVID tests for effectiveness.

Experts say it will take finding the answers to these questions, as well as research and studies to back up the findings, to know if throat swabbing is truly a viable alternative for rapid test detection of the omicron variant.

In this article, we’ll look at the differences between the omicron variant and previous variants, how inaccurate COVID test results are leading people to seek testing alternatives, and why throat swabbing may be an attractive but not effective option.

The Allure of Throat-Swabbing

Since the inception of COVID testing, there have been concerns about test results giving false positive or false negative results. A small US-based study, which has not yet been peer-reviewed, noted several cases where people transmitted the omicron variant after receiving a false-positive rapid test. The same study also stated that the virus was detected in saliva before it was detected via nasal swab. Part of the reason that nasal swabbing may not be as effective on the variant is because it acts differently than previous COVID-19 variants.

Wilbur Lam, MD, PhD

What we’re doing now is completely assessing, in a really rigorous and systematic way, the answer to the question, where does the omicron variant actually live? Is it in the throat more? Is it in the nose? Is it in the saliva?

— Wilbur Lam, MD, PhD

“The preliminary data really does show that by and large most of the symptoms that we get from this variant, the omicron variant, seems to be more on the upper respiratory side, meaning it’s more like sniffles, sore throat, cold, as opposed to those horror stories we had in the beginning of the pandemic,” notes Dr. Lam. 

While experts say omicron can be less severe than previous variants, the symptoms can still be serious. The location of the symptoms also makes a difference.

“It is of course very contagious. But it seems to cause more of a throat problem. People have complained more about a sore throat or cough, instead of a runny nose,” states Kunjana Mavunda, MD, a pediatric pulmonologist and travel medicine physician at KIDZ Medical.

People may believe that the sore throat indicates a greater ability to detect the virus in the throat. For that reason, swabbing the throat and gathering a saliva sample seems to may seem to make more sense to them. That reasoning, however, is not enough for experts to recommend using the tests in a way that is not intended. While researchers looked at collecting samples from throat, saliva, and the nose when developing COVID tests, the rapid test is designed to detect the virus in the nose.

“The rapid test goes and looks for, it’s called an antigen, which is … molecules that are on top of COVID, and it looks to see if you have any of those specific molecules, and it comes back positive,” explains Daniel Ganjian, MD, pediatrician at Providence Saint John’s Health Center.

Some PCR tests are approved by the FDA to use saliva, cheek, or throat samples. Those tests, administered by professionals, are the only ones where those collection methods are recommended.

Follow Test Directions, Experts Say

A quick search of Google yields an abundance of “how-to” videos for parents to help their children through COVID testing. The message is clear: it can be hard for little ones and even older kids to endure the nasal swab. Though companies have designed tests to make the anterior nasal swab much easier to take than the nasopharyngeal swab that is far-reaching and painful, it can still be a challenge for children with sensory issues. The idea of a throat swab may seem attractive and better than nothing at all. However, experts say that’s not the case.

“The best case is still to do the test the way it is authorized, because there’s scientific data behind it,” notes Dr. Lam.

That data has not been collected on using a throat swab for a rapid COVID test.

“You need studies of hundreds if not thousands of swabs,” states Dr. Ganjian. “If you use a test the wrong way, then you can get what’s called a confounding variable. For example, perhaps the saliva has an enzyme in it that causes a test to become positive, and it has nothing to do with COVID.” Dr. Ganjian also notes that certain throat bacteria and even acid from food can cause a false positive for a COVID test.

Other substances in the throat can also impact the outcome of the test.

“Even though you may have a bit more of a viral load in the back of the throat, there might be more mucus associated with the sample collection,” Dr. Mavunda advises.

Ultimately, despite perceived comforts, experts say it is best to use the test the way it is prescribed and intended. And for rapid tests on the market now, that means swabbing the nose.

Moving Forward

In the coming weeks, Dr. Lam notes he and his team are crafting additional tests proven to detect omicron. In the meantime, experts say following the directions that come with the test is key. Consider the big picture and the reason for performing the test in the first place.

Kunjana Mavunda, MD

What I like to suggest is think about why you’re doing the test and think about the timing of when you’re doing the test. If it’s for travel and you have to have the test, it doesn’t matter to the patient if it’s a false negative. It matters to the people around the patient.

— Kunjana Mavunda, MD

“What I like to suggest is think about why you’re doing the test and think about the timing of when you’re doing the test. If it’s for travel and you have to have the test, it doesn’t matter to the patient if it’s a false negative. It matters to the people around the patient,” Dr. Mavunda concludes.

What This Means For You

You want a method that is effective yet as painless as possible to test your child for COVID. And with the disdain of many children — and parents — for nose swabs, a throat swab would seem a more comfortable way to detect the omicron variant. But doctors advise sticking to the testing instructions for an accurate result. Ultimately, getting the correct results is the most important thing.

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  1. Adamson B, Sikka R, Wyllie AL, Premsrirut P. Discordant sars-cov-2 pcr and rapid antigen test results when infectious: a december 2021 occupational case series. medRxiv. Published online January 5, 2022:2022.01.04.22268770.