Variability in instructions for performance of nasopharyngeal swabs across Canada in the era of COVID-19 – what type of swab is actually being performed?

Abstract Background The primary method of surveillance for the presence SARS-CoV-2 is with nasopharyngeal swabs. Given significant demand swabs, a large number previously untrained and unfamiliar staff are now performing this test. It was noted that there heterogeneity in instructions swabs Canada, contrast to guidance provided by Centers Disease Control Prevention (CDC), Pan American Health Organization (PAHO). objective study review across Canada them those CDC PAHO. Methods A standard series steps swab performance outlined based on CDC, PAHO, New England Journal Medicine instructions. comprehensive search performed August 2020 identify guidelines public health provinces territories Canada. Regional authority also collected. Instructions were contrasted against standardized steps. Results identified all territories, 81 regional authorities. From provincial territorial guidelines, 10/13 (77%) cleared nasal passages before insertion, 11/13 (85%) tilted patient’s head back slightly, 12/13 (92%) inserted parallel palate, but only 3/13 (23%) at least depth two-thirds distance between nose ear. clear majority (81%) followed their respective guidelines. For Quebec pictogram no or technique estimation. Six - Northwest Territories, Nunavut, Ontario, Saskatchewan, Prince Edward Island Alberta recommended 4 cm one-half from nostrils British Columbia Manitoba 7 insertion. Nova Scotia Lastly, Newfoundland, Brunswick Yukon an insertion external ear canal. Conclusion There would not be effective reaching nasopharynx. Graphical abstract