SEATTLE—I’ve kept my eyes on the Seattle Coronavirus Assessment Network (SCAN) since its formation in March, in part because I desperately wanted to know whether I might’ve caught COVID-19. Hence, “coronavirus assessment” sounded good to me. SCAN’s pilot program landed in one of the United States’ earliest confirmed outbreak regions, and its pitch—hundreds of tests a day, all conducted via free take-home swabbing kits—was open to public sign-ups.
Clearly, I wasn’t alone in wondering about possible COVID-19 contraction. (In my case, a seasonal burst of nagging cough and sinus-like chest tightness couldn’t have come at a worse time.) SCAN’s site was hounded by demand, and it typically informed visitors that a given day’s tests were accounted for, please try again tomorrow.
Roughly one month after public sign-ups began, something in the supply-and-demand chain opened up widely enough for me to successfully sign up this past weekend—as a civilian, mind you, not as a member of the press requesting special access. What follows is my anecdotal experience with what remains the United States’ only free take-home COVID-19 testing program—and what health officials and citizens alike can learn from it.
Two types of Gates: Bill and questionnaires
While SCAN is described as a collaboration between multiple Seattle-area health agencies, only one entity is named in terms of funding: “Gates Ventures (the private office of Bill Gates).” No other partner is listed in the “funding” department, not even Amazon, which is listed as a provider of “infrastructure and logistics capability.”
That funding detail matters in a sector where the public number attached to home COVID-19 tests hovers around the $120-per-test mark, including LabCorp’s Pixel kit, which received FDA approval earlier this week as the “first [authorized] diagnostic test with a home collection option for COVID-19.” As of press time, LabCorp restricts orders to those who self-identify as “a healthcare worker or first responder.”
The SCAN sign-up process includes a different gating mechanism for test requests, should its sign-up process move beyond “we are out of kits for today”: a question about symptoms common to coronavirus carriers, including fever, difficulty breathing, or cough. As a seasonal allergy sufferer, I’ve had a chronic, mild cough for the entirety of March and April, so I clicked “yes” and was able to otherwise complete the sign-up process. (Afterwards, I opened an incognito tab, went through the sign-up process, and clicked “no” on the same gating question, which informed me that I was not eligible. Then I clicked back, changed my answer to “yes,” and was allowed entry to the sign-up process.)
After filling out a questionnaire, SCAN’s instructions were clear: I needed to be available the next day to receive and use a home testing kit. It would be delivered at my designated porch or doorstep by 11am, and I would need to put my completed test into an envelope for SCAN pick-up no later than 4pm that day.
I’d like to get this out of my nose now, please
The above gallery shows what comes in the kit: a plastic swab; a sealed tube full of pink liquid, better known to medical professionals as viral transport media; a flimsy, biohazard-labeled baggie; an instructional card; and a return envelope. I read the instructions, shoved a swab into my nose, put the resulting swab into a vial, sealed that up, and placed the finished kit onto my porch. The complete process took eight minutes.
Unlike LabCorp’s take-home Pixel kit, which comes with cotton swabs, the one I received from SCAN relies on a wholly plastic “scraper” piece. SCAN representatives tell Ars Technica that the primary differentiation between its test and LabCorp’s is its use of universal transport media (UTM), the pink liquid in my vial, as opposed to LabCorp’s use of saline. “We have conducted experiments demonstrating that SARS-COV-2 virus/RNA—as well as the human RNA that we detect as a quality control measure for sample collection—are stable for up to 9 days in UTM, even at summer temperatures,” SCAN representatives said in an email to Ars Technica.
SCAN’s instructions ask users to do two things: “insert swab halfway up the nose, about 1 inch,” and “press swab against the side and rotate swab 5 times.”
I used my smartphone to film myself following these instructions, and I’ve included a few photos from that uncomfortable experience.
To be clear: the thin nature of the scraper, plus its visible one-inch demarcation, means it can reach SCAN’s recommended depth without any issue, and the mild discomfort was reasonable enough. As in, it felt like I had a piece of plastic in my nose that wasn’t supposed to be there. No pain, no itch, no jolt. I simply had a sense of, “I’d like to get this out of my nose now, please.” Either way, it’s much less invasive than the multiple inches of swab depth seen in other nasopharyngeal techniques, like this one demonstrated by the New England Journal of Medicine last week.
Notice the language in SCAN’s instructions (along with instruction-manual images in the top gallery). What might that language lead you to believe about the swabbing procedure? In my case, I assumed it meant firmly pressing the swab’s tip against the skin inside my nose, then simply rotating the whole thing—so that it scraped against one wall of my nasal cavity.
While putting this article together, I discovered that SCAN’s main portal, which I blew past in the rush of trying to secure a test, includes an instructional video. This video isn’t mentioned anywhere in the included pamphlet, and it wasn’t referred to or linked in any of the emails I received or any of the “you have successfully signed up” messaging within the Web portal (which I would have gladly watched while waiting roughly one day for my test to arrive).
SCAN’s official video reveals an entirely different kind of swab rotation, so that it touches all of the skin in your nasal cavity. (The one thing this user and I have in common is apparent discomfort on our faces when doing the swabbing part.)
Listing image by Sam Machkovech