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Old 01-04-2022, 10:09 AM
 
3,982 posts, read 1,832,941 times
Reputation: 8531

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Hoping a (medical) professional – who isn’t guessing - can chime in here -

My Christmas vacation destination (not USA) had clear requirements: “PCR / nasopharyngeal ("np") administered by a medical professional. No nasal swab and No Self-Administered Test - even if witnessed." That rules out walgreens and the rest...I called the local urgent care and explained the situation, and they said: "Yep - nasopharyngeal is what we do here."

Day of the test - it was the swirly shallow nose swab. And I said: "Hey, this is supposed to be np!" And ya know what she said?

1. They're all the same. PCR is PCR is PCR.
2. CDC doesn't require them.
3. The method doesn't appear on the test result anyway.

And my response was:

1. They are not “the same”- because I have this definition from my destination gov’t.
2. CDC is for USA - meaningless out of the country.
3. If the “method” doesn’t appear – then you’re admitting there is more than one method.

And though I didn’t know it at the time – the method (“source”) does indeed appear on the test.

I was lucky - the destination "examiner" was overwhelmed and under qualified, not familiar with American forms - and simply asked me if it was "the deep swab" - so I said - quite honestly - "sure felt like it!" And they let me in.


So - if you're a medical professional - can ya help me out here? What's going on? Why is there a lack of understanding even among nurses? OR - Am I wrong? And how so? I'm willing to learn..


I've had the np (out of the country) twice now - and it ain't the shallow swirly swab.

 
Old 01-04-2022, 10:58 AM
 
Location: San Diego, California
1,147 posts, read 841,305 times
Reputation: 3502
Not sure what you are asking.

The NP knows the difference on how to collect an oral swab vs a nasopharyngeal swab. They are not the same.

Every test approved by the FDA or even unapproved tests (home-brewed), must indicate the source as a part of the test procedure. One can not deviate from sources stated on the written and approved procedure. The procedure was validated based on that source and that source or sources only. If you want to expand sources then you must perform validation studies with that new source. You can't on your own pick or use any source you want. Back during the anthrax terrorism days there were envelop sources of anthrax but us in a hospital setting were not allowed to test such samples because out license is limited to clinical samples and not environmental samples. Clinical labs working with the FBI needed special waivers from the FDA in order to test such samples.

Originally the testing started off with nasopharyngeal sources only. Other options wold have been hypertonic saline induced sputum, sputum and bronchoscopy and Bronchoalveolar Lavage (BAL). The closer to the lung the better the yield meaning less false negatives. Nasal swabs had slightly more false negatives. When comparative studies were done with nasal swabs and Nasopharyngeal swabs, they were close enough. The nasal swabs were less obtrusive.

The CDC makes recommendations but exceptions can popup based on specific needs. I would assume the NP didn't care to make exceptions. The source does show up on reports that I am aware of which only adds to the fact that it is a major contributor to the interpretation of the test. Rather than requiring a BAL sample, which has less false negatives, the recommendations are to simply repeat tests when the viral load is higher with time.

So to answer your question directly there isn't a lack of understanding on the part of nurses only that they didn't care to fulfill your request because they didn't feel it important based on CDC recommendations. Other countries don't follow CDC recommendations and we don't follow other countries recommendations. They should have been upfront with you from the beginning.
 
Old 01-04-2022, 11:25 AM
 
Location: On the wind
1,464 posts, read 1,069,278 times
Reputation: 3577
This is why it's important to ask if the testing site knows about International testing requirements for travel, and is able to deliver on them. The NP obviously had no idea of the importance of a NP PCR for travel. They used to have travel clinics some years ago. Guess those have faded away.
 
Old 01-04-2022, 01:27 PM
 
Location: near bears but at least no snakes
26,638 posts, read 28,466,335 times
Reputation: 50448
Thank you for the informative replies. To ensure that the usual jokesters don't join in, I am closing this thread.
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