Rapid testing for the masses

Anthony Papagiannis
Thessaloniki, Greece

 

A summer camp of flowers. Photo by author.

Ten young girls are queueing outside the makeshift surgery. They are between eleven and fifteen, they wear face masks, they giggle and tease each other and try to encourage the timid ones before the coming ordeal. What is this going to be? Their first visit to a gynecologist? Nothing so memorable. They are due for a rapid antigen test for SARS-CoV-2. We are still in the throes of the pandemic, even though things are not as bad as during last winter. I am providing temporary medical cover in a girls’ summer camp, and yesterday a febrile lass had tested positive. Two more asymptomatic carriers were found in her tent, so we decided to test everybody, according to the standing health protocol. This is my main job for the day. Last night I went through our medical supplies, and we clearly needed many more test kits than were available. So the camp foreman made a round of the local pharmacists this morning to harvest eighty or so kits—along with staff, our target population numbers over a hundred persons.

From similar previous experience, I set up the workshop. Pen and paper to record names, along with a serial number to mark each test cassette. Arraying of the materials. Long swab for the nostrils. Buffer solution in tiny plastic tubes with dropper caps. The test cassette itself. One bag for the soiled disposables, one for packaging and other clean waste for recycling. All set. Here we go.

The girls are coming in groups of ten. I give them a brief talk to allay their fears: they have had such tests before at school, and the experience is not exactly pleasant. A couple of them have been indoctrinated by their parents against nasal testing: they have to ring and ask them first. The parents know the rules: if they refuse testing, they will have to come and collect their child. I explain that the reactions to nose swabbing—a burning sensation, cough, sneeze, or eye watering—are essentially protective reflexes of the upper respiratory tract. I ask them to be patient for the two or three seconds it takes to swab both nostrils properly, and promise to be as gentle as possible.

The fun begins. It is a peculiar sort of entertainment to watch the reactions, not only of the person being tested, but also of the surrounding group. Some girls step bravely forth on their own with no escorts, pull down their masks, accept insertion of the stylet with some grimacing but no sound of complaint, then strut proudly back to wait for the result. Many more are hand-held by their friends who provide vocal reassurance alternating with alarming remarks: “You will feel your nose burning,” and “It may actually reach your brain,” and so on. All this is said amidst bursts of giggling and comments in the background. Many ask for not-too-deep probing. And every so often there is one child scared stiff, almost crying, who has to be restrained by two or three of her colleagues to undergo the procedure. Deep nose sniffing or wrinkling makes swabbing more difficult and painful, but we fortunately have no nosebleeds or other untoward event.

The routine—name recording, opening the next kit and numbering it, taking the specimen, buffering it, and squeezing four drops in the little well of the cassette—goes on with brief interruptions. Every ten minutes or so I glance at the test row; some more tests are complete, and I announce the negative results which are received with hollers of enthusiasm by the expectant crowd. Next batch of girls, next carton of test kits. Different manufacturer means slightly different packaging of the materials, and therefore some minor modification in the order of movements. On and on.

At the end of four hours I have tested one hundred and seven persons, including myself at the end. All are negative, with just two exceptions. That second red line at the T indication signals the end of the camping period for these girls, who unfortunately will have to leave today. And the whole process will have to be repeated in a couple of days, per protocol. Although the ratio of two per one hundred is nothing like I had feared the night before, you never know what degree of spread has already occurred. Some other doctor is scheduled to cover the next few days, and the task of mass testing will fall on her lap.

My immediate concern is my own future status: it is Friday. Will I be able to return to work on Monday? I am triple vaccinated, and have also had an episode of infection afterwards, but I will have to test myself again on Sunday and live in semi-quarantine until then. Uncertainty: the inevitable companion of this unique pandemic.

 


 

ANTHONY PAPAGIANNIS is a practicing pulmonologist in Thessaloniki, Greece. He graduated from the Aristotle University of Thessaloniki Medical School. He trained in Internal Medicine in Greece and subsequently in the United Kingdom, and specialized in Pulmonary Medicine. He also holds a postgraduate Diploma in Palliative Medicine from the University of Cardiff, Wales, United Kingdom. He is a postgraduate instructor in palliative medicine in the University of Thessaly, Larissa, Greece. He edits the journal of the Thessaloniki Medical Association, and blogs regularly.

 

Summer 2022  |  Sections  |  Infectious Diseases