Students will return to school in several states and territories from next week.
The New South Wales and Victorian governments will provide staff and students with rapid antigen tests for twice-weekly surveillance testing for the first four weeks of term.
With a total of 24m self-test kits to be delivered across the two states in the coming weeks, experts share tips on how to make at-home nasal swabbing as painless as possible for daunted adults and kids.
Talk it through
Dr Eric Levi, an ear, nose and throat surgeon in Melbourne, says it is important for parents and guardians to demystify the testing process, emphasising that it may be uncomfortable but not painful.
“It shouldn’t hurt like a PCR test,” Levi says. “A lot of kids have had bad experiences in the past and the thought of having [a RAT] twice a week – or, in some special circumstances, daily – for the next few weeks or months is quite scary for them.”
To reduce anxiety about rapid testing, Levi recommends that adults show their children a how-to video so they know what to expect, and also discuss what the child is most comfortable with.
“Most kids do have a preference: they want to lie down on their bed … or they want to hug a pillow, or they can sit on their parent’s lap if they’re young kids,” he says.
To minimise first-day stress, Levi recommends doing a practice run a few days in advance. It may be helpful to practise with a cotton bud before using a precious RAT kit, he adds.
‘Go low, go slow’
Dr Karen Price, president of the Royal Australian College of General Practitioners, says it’s important for adults to have a clear idea of how to perform a RAT “so that they’re not afraid and they don’t feel they’re going to hurt their children in any way”.
Price recommends carefully reading the instructions specific to the particular brand of rapid test, or watching a manufacturer’s video if available.
“The biggest, scariest part is that people aren’t sure how you stick something in your nose safely,” she says.
In children, a swab should be inserted only 1 to 2cm into the nostril, compared to 2 to 3cm in adults.
Both Levi and Price emphasise that due to the anatomy of the nasal cavity – which extends backwards and downwards – the direction the swab is inserted in is important.
“It’s really important to not go up vertically but to go back horizontally,” Price says.
The swab should be inserted gently along the bottom of the child’s nose, a technique Levi describes as “go low, go slow”. It can help to stabilise a squirming child by resting their head against a pillow or a parent’s arm.
The swab then needs to be rotated several times, “long enough to gently pick up as much goo [as necessary], which is where the virus will be,” Price says.
What about non-nasal RATs?
There are currently two TGA-approved brands of self-administered RATs that do not involve a nasal swab.
One is a saliva test, which involves holding a device under the tongue for two minutes. The other, termed an “oral fluid test”, involves spitting into a tube.
Both require that the person taking the test refrain from eating or drinking for a period of time beforehand, as accuracy may be affected.
Unlike nasal swabs – which will be provided by state governments to students for free – these tests must be individually bought.
“Doing it twice a week, if they’re going to cost about $20 per test, is going to be pretty expensive in the long run,” Levi says. “The vast majority of kids – as long as parents know how to do it slowly and comfortably – would be able to do well with a nasal swab.”
Unlike PCR tests, nasal swabs should only be used up the nose and are not designed to work accurately as throat swabs. “If it’s not recommended for use in the throat, then it shouldn’t be used in the throat,” Price says.
Levi adds: “A lot of people want to find an alternative [to nasal swabs] because people are afraid of the pain. But if you teach them how to do it well, then you demystify the whole experience and you’re probably going to be just fine.”
Supervision and accuracy
Victoria Health guidance says kids under 12 should have a parent or guardian perform the test, while children 12 years and older who want to do the test themselves should be supervised to make sure they follow the steps correctly.
There are certain fluids that can fake a positive RAT result, Levi says. Overseas, there have been reports of pupils spoofing tests by using orange juice or other liquids. It occurs due to a chemical reaction in the test, rather than the substance itself containing Covid.
Experts have said it’s possible to spot a faked positive test by washing it with the provided buffer solution to restore the test strip to the correct pH.
“It’s really important for teenagers to understand they’re participating in a major community public health response,” Price says. “We really want accurate results as much as possible because they’ll protect other people and they’ll protect themselves.
“Anything that interferes with the accuracy of that information is going to challenge the public health services and also the way that we respond in future.”