Throat ART 101: Is it a better way to detect Omicron? How do you do it at home?

We've probably all taken an antigen rapid test (ART) at this point in the pandemic. But lately, there's been some debate — where should you be swabbing?

All of the 14 Health Science Authority-approved Covid-19 self-test kits instruct users to swab their noses. Recently though, the internet has been abuzz with an ART 'hack' that's said to be able to better detect the Omicron variant — swabbing both the nose and throat.

TikToker and Singapore-based general practitioner Samuel, who goes by Dr Sam and Skingapore online, also recently shared that he managed to detect his Covid-19 infection two days earlier by swabbing his throat.

According to Dr Sam, he did a regular ART on Jan 25 after being told that someone in his household had tested positive. This returned a negative result.

After another negative ART the next day, he decided to try swabbing his throat and his nose as he was experiencing a sore throat. This test turned out to be positive. Meanwhile, he did another ART the usual way, and received a negative result.

His nasal ART finally showed a positive reading two whole days later, on Jan 28.

@skingapore How I detected omicron earlier. Throat ART is still off-label use of ART. #omicron #covidsg #swabyourthroat #singaporecovid19 #omicronvariant ♬ Motivational music(792528) - Draganov89

If you're in a similar situation, here are some facts you should know before you take a swab stick to the back of your throat.

Are regular ARTs inaccurate when it comes to Omicron?

In a nutshell, no. Experts are still backing ARTs as an effective way to detect Covid-19 cases, including the Omicron variant.

According to Dr Michael Mina, former assistant professor of epidemiology at the Harvard T. H. Chan School of Public Health, and current chief science officer at eMed, throat swabs "are not necessary to detect Omicron". Swabbing both the throat and nose is just "marginally better" than a nasal swab.

"The virus will grow exceptionally well in the nose just like the other variants," he advised in a tweet.

Local infectious disease specialist Dr Leong Hoe Nam also told Today that the Omicron variant has a viral load similar to that of Alpha and Beta. This means that people with Omicron aren't likely to experience more false positives than usual.

In response to the growing discourse on throat swabbing, the US Food and Drug Administration has cautioned that most at-home rapid tests are only for use nasally and should be used "exactly as directed".

[embed]https://twitter.com/US_FDA/status/1479548116684709890[/embed]

Why do some advise swabbing the throat?

Research has emerged showing that the Omicron variant thrives in the throat, and may replicate there before moving to the nose.

Unlike Omicron, Delta and other previous variants had more prominent effects on the lungs.

So should I swab my throat or not?

While Dr Sam was open about sharing his throat swab experience on TikTok, he was quick to add the caveat that he is not advocating for others to follow in his footsteps.

You should only consider it if you have extra test kits on hand and have "predominantly throat symptoms", he wrote in a video.

There are also risks involved, he cautioned. If you are not familiar with the throat ART technique or are swabbing someone who is uncooperative, it is best to avoid throat swabs as the stick can break and it can injure the throat.

You should also avoid swabbing your throat if you have had any recent throat surgeries.

Dr Jonathan Li, an infectious disease physician based in Boston also told NBC News that self-administered throat swabs could lead to higher user error compared to nasal swabs.

How do I do it?

You really have to get in there - Dr Sam advises to aim to reach the back of your throat if possible and to avoid swabbing your tongue, cheek or the roof of your mouth.

Swab each side of the throat five times. Then, swab your nose with the same stick and treat the sample as you would a normal ART.

@skingapore GUIDE TO A NOSE AND THROAT ART. Do at own risk ya. Go easy …. #omicron #covid19 #swabyourthroat #covidsg #covidsingapore ♬ Happy Music - Mystix Instrumentals

I tested positive after swabbing my throat and nose. What now?

Nose and throat ART swabs are not officially being used to diagnose Covid-19 at the moment, Dr Sam said.

"A positive ART for nose and throat does not replace a clinic-performed ART for the nose only (even if the clinic-performed nose ART is negative)."

A positive nose and throat ART should just be taken as a "useful early warning" that you may have Covid-19 and should take precautions such as cancelling your plans and isolating yourself.

kimberlylim@asiaone.com