Nose swabs or throat swabs? COVID patient questions conventional guidance after tests miss her case

RALEIGH, N.C. (WTVD) -- It's a question some scientists are taking a deeper look at: Nose or throat -- what is the best way to do a COVID-19 test? A woman says she swabbed both her nose and throat and got different results. One said she has COVID-19. The other says she doesn't.

Jacklyn Lacey spoke to ABC 11 from her home in downstate New York. She's still recovering from COVID-19.

It's been nearly four weeks since her initial exposure. But Lacey said most of the nasal swab, at-home, rapid-result COVID-19 tests she has taken came back negative.

"So my partner and I both tested, we antigen-tested negative. And so, then I tested again, nasal swab, and it was negative, she said. "I can't really sleep at night because I'm thinking I'm pretty sure that this is COVID. And it means it's just not showing up."

Lacey had a sneaking suspicion that the easy-to-use antigen tests she and so many are using at home to test for COVID were not picking up the viral load in her system. So she tried again. This time, no nasal swabbing. Instead, she swabbed saliva from her throat.

"And that's when I got my first positive," she said. "I didn't get confirmed until I was in an emergency room on Saturday. PCR test confirmed."

With her COVID-19 case confirmed, Lacey, a health anthropologist who studies virology, kept trying to match the results at home using the nasal swab antigen tests.

"I'm a scientist. And I was like this is a very unfortunate situation I'm in, but at least I can maybe try to figure out some data to see if what is going on is what I think is going on."

ABC11 took Lacey's concern and suspicion to Dr. Thomas Denny, chief operating officer at Duke University Medical School's Human Vaccine Institute.

"Yes, I do believe (nasal swabbing) is effective (at detecting the Omicron variant)," Denny said. "We have to keep in mind that the nasal swabbing technique is a technique that all the testing platforms have been validated for. And you should not change an approach without going back and doing a re-validation."

Back in New York and still in recovery from her coronavirus battle, Lacey remains convinced the guidance on COVID-19 testing is overdue for a change.

"If we can't trust the testing methods to get this illness at the point in time when it's most infectious, then even when we're trying to do the right thing, we can't protect each other," Lacey said. "To me, that's really sad. And that's really scary."

There is some very early research on nasal swabbing vs. throat swabbing. However, the sample size is small and the studies have not yet been peer-reviewed. But the early evidence does suggest that saliva samples swabbed from the throat produce quicker and more accurate results than the antigen nasal swab COVID-19 tests that many people take at home.