Wondering How Self-Swab COVID-19 Tests Work? We Found Out

Jul 2, 2020

The CVS drive-through line isn’t just for picking up prescriptions anymore, it’s also a one-stop shop for COVID-19 testing. And the person who is collecting the sample to be tested, isn’t a health care worker—it’s you.

If you’ve wondered what the self-swab process is like, WFAE’s Sarah Delia has this hands-on account.

First things first, before you roll up to the CVS you have to make an appointment online.  You answer a few basic questions like if you’ve had any COVID-19 symptoms in the last 24 hours or have any medical conditions. Not every CVS Pharmacy has  COVID-19 testing available, but luckily a location near my house is. 

For the record, I didn’t have any symptoms, but after weeks of covering protests and being in close proximity with people both masked and unmasked, I felt like it was time to get a test. 

The next day, I’m at a CVS drive-through. I drive up to the window, masked up—they ask you wear a face covering when the pharmacy window is open. Because this is a self-swab test kit, I’m both the patient and health care worker with a really nice CVS pharmacy employee metaphorically holding my hand, which is good because I’m nervous and don’t want to mess up. A large metal drawer extends to my car with the kit. 

With one of the Q-tips in the kit, I’m instructed to swab my left nostril and then hold the swab against the nasal wall for 15 seconds. Then with the same end, repeat on the other side. She recommends making a circular motion with the Q-tip that’s less than an inch in my nostril, and warns me I might feel like I have to sneeze.

Even though I only have to swab each nostril for 15 seconds, I linger a little longer. The whole time I’m wondering, am I to be trusted with collecting such an important sample?

"If you swab the right way which is really not hard to do, you can acutally just do it on your own," says Dr. Yvonne Maldonado, a professor of pediatrics epidemiology and population health at Stanford University School of Medicine.  In a recent study she set out to determine if self-swab testing for COVID-19 is reliable. Basically—can we be trusted to collect our own sample?

The 30 participants in the study had previously been diagnosed with COVID-19. They were asked to do a nostril self-swab made with polyester. There are many different types of swabs and test available at this point. Mine for example was different, I had a cotton swab in my kit. Researchers are evaluating both tests and swab materials to see which are most reliable. Maldonado chose polyester swabs because they have the less likely to cause problems with lab results.

Back to Maldonado's study with polyester swabs, after a self swab collected by the participant, a health care worker did the same nasal swab along with a throat swab. In one case, a participant’s self-swab came back positive, the two swabs collected by the physician tested negative. Overall, 29 out of the 30 participants had exactly the same results, regardless of who collected the swab.

Drivers remain in their cars and administer the self-swab with the guidance of a CVS pharmacy employee.
Credit Sarah Delia / WFAE

"The viral load was about the same, statistically the same, with any method, as well," she said.

Maldonado says self-swabbing kits have many advantages including more people getting tested who might otherwise avoid it because of the invasive and uncomfortable nasopharyngeal swab—that’s sometimes referred to as the brain tickler.

"It saves so much PPE, it saves a lot of provider time and it’s easy and it doesn’t bother people," Maldonado says. "One of our participants was a baby and that baby didn’t even really notice anyone was doing anything, it's so simple."

Maldonado’s now studying people who are asymptomatic. It’s possible people who don’t have symptoms, may not have as much virus in their nose as people who have symptoms, so she wants to verify that self-swabbing works in all situations.

Drivers are asked to wear a face covering when the pharmacy window is open.
Credit Sarah Delia/WFAE

Maybe one day Maldonado says, self-swabbing COVID-19 tests will be as common as at home DNA kits.

"Why shouldn’t self-swabbing work if the disease is naturally transmitted when people are not social distancing and they're just breathing on each other?" says Daniel Janies, a Bioinformatics and Genomics professor at UNC Charlotte. He’s following studies like the one out of Stanford that are verifying the validity of self-swab tests.

"It doesn’t have to be a highly droplet filled cough," Jaines points out. "Apparently there are cases where choirs got together and sang and the mist carrying the microdroplets of virus was enough in the air and they are inhaling and exhaling with their song, that's enough, so why shouldn’t self-swabbing work?" 

The more data available on how the disease is spreading in the community, the better, he says.  So he’s all for people swabbing themselves.

"We’re not endangering health care workers by having them interact with us. And it lowers the barriers of people to people getting tested so I think the benefits are tremendous," Jaines said.

The one tip he has is to go to the drive-through by yourself, if at all possible.

Self-swab kits come with detailed instructions.
Credit Sarah Delia/WFAE

"I would make sure I’m not in the car with anyone else. Just sort of keep the contamination down, the chain of evidence so to speak, keeping that solid," he recommended.

Fortunately, I went on this self-swab joy ride by myself. After I place my swab in a tube, and recap that tube, I seal it in a specimen bag that came with my kit. Several wipes have been provided so I can wipe down the bag before I drop into a metal box that reads “completed test kits only.”

Sealed test kits are deposited into a box at the end of the visit.
Credit Sarah Delia/WFAE

And that’s it. The whole process took about 5 minutes. I’m given my discharge papers and I’m told I’ll get my results online in 2-4 days. Then I roll up my window and head back to my home office.

And in case you’re wondering, a couple of days later I logged into my CVS MyChart account. Good news—in bright green letters the word NEGATIVE is the first thing I saw.