The problem with self-swab Covid tests for travel: And the solution

An increasing number of airlines are turning to self-test PCR kits, as a way of allowing passengers to certify that they are fit to fly.  European LCCs Wizz Air and easyJet have both signed agreemnents with UK testing company Confirm Testing, where passengers can request kits to be sent to their house for £75 (easyJet) or £85 (Wizz Air), compared to a normal retail price of £119 (US $160).

Meanwhile in the US, Alaska Airlines has announced a number of ways in which passengers can get tested.  One of these methods is to order a home testing kit from Costco.

Though it’s positive that airlines are making it easier for passengers to undergo testing, we see three issues with these tests:

Verification of identity

1 – The easyJet and Confirm Testing kits have no verification.  You need to add your passport details and flight number on the order, but there is no system of making sure the test sample is actually yours, it is essentially self-policed.

Scalability + costs

2 – The Alaska Airlines kit from Costco (as well as a test from Vault Health that Hawaiian uses) does have verification.  But here it involves someone watching you “live” on video while you take the test.  That’s not so easy to scale if you are looking to potentially test tens of thousands of passengers in one go, and it of course also drives up cost.  The Costco test costs $140, meaning that for many families, doing a test in order to travel to somewhere like Hawaii becomes unaffordable.

Impractical

3 – The Confirm Testing kits used by easyJet and Wizz Air use an oral + nasal swab self-collection method. This is not a natural thing to expect members of the public to do. Indeed, the instructional video even says that it may prove to be uncomfortable.

See on the right, for a screengrab, where participants are asked to self-swab a series of points at the back of their throat, and then move the same swab around at the back of their nose several times.

That of course leads to plenty of scope for mistakes, when people don’t do the test properly, or simply can’t bring themselves to insert the swab fully enough into their nose/throat.

It’s interesting to note that the recent PCR test research at Toronto Pearson also involved self swab tests, and we do wonder to what extent the results were skewed due to the method used.

Are mouthwash tests the answer?

As a test method, a mouthwash is better.  When we mention this to our airline partners, quite often we’re met with surprise, as the assumption is that the deep nasal / oral swab method is the only way to conduct a PCR test.  Such is the ignorance that some national authorities, like Fiji, currently specifically ask for deep swab tests.

In fact, a March guidance paper from the WHO says that the correct collection methods “are nasopharyngeal and oropharyngeal swab or wash.” (our emphasis).  Meanwhile, a University of Tokyo study found that “gargle lavage samples have been reported to be more sensitive than throat swabs.” (Contact us and we will send you the original papers).

So using a mouthwash method is accepted, it’s more accurate, and it’s much more comfortable for the passenger. 

Note that these samples can be processed by just about any lab which handles standard PCR tests.

In terms of validation, rather than allocating staff time to watch someone do a self-test remotely, a better method is to have them video the test themselves via their phone and hold up their ID (the same system is used for opening up many online bank accounts).

Reducing staff time reduces the cost, and of course one of the benefits of self-test mouthwash kits is that it allows for greater flexibility when selecting a lab, as any lab within a 24-hour courier radius would be suitable.  Shipping and courier costs can be brought down even more by having drop off points that work in the same way as Amazon drop off boxes, either in retail outlets or at airline offices themselves.

Through our SimpliTested brand, we have a testing solution that allows you to do all this.  Contact us at – testing[at]simpliflying.com, and we can get you up and running within four weeks.

COVID tests for travel are having their Napster-moment. It’s early days and the industry awaits a Spotify-like solution. Mouthwash PCR tests are a step in the right direction.

 

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