The impossible tampon

It should make a tampon. Easy to say, much more complicated to do. And not for lack of availability of the exam, but for the objective impossibility of doing so by the subject who should be tested. Among the many, there is also this aspect in the mare magnum of needs and attention that the health emergency from Covid-19 has determined: the question concerns people with an intellectual or relational disability, for whom it is not only difficult (like everyone else) to find one's way in the jungle of tests available (molecular, rapid, salivary, blood ...) but for which it is the same procedure for taking the sample to be analyzed that is difficult, if not impossible.

For a person with intellectual disability, undergoing an invasive procedure such as that of the oropharyngeal molecular swab, ie with the removal from the nose and / or mouth, can be a source of serious discomfort and upset. In addition to not perceiving the meaning of the operation, and therefore to experience it as a negative irruption in one's body environment, a person with special needs, for example with neurodevelopmental disorders or with an autism spectrum disorder, will tend not to give the minimal cooperation at the time of the test, with a clear risk - where the procedure is nevertheless performed - of experiencing the test as an abuse, causing a real trauma. 

For months, associations that deal specifically with disabilities have been warning about these aspects, which are all the more important now than in the past due to the significant increase in the availability of tests available. In reality, it is explained, even if the tests have diversified, their execution is always particularly difficult: the oropharyngeal swab (traditional or rapid) is not very different from a salivary test, and a blood sample is even more invasive in non-collaborating subjects.

This is why in many cases the execution of the test requires the use of sedation, with all the consequences of the case in organizational as well as relational terms. But even without getting to sedation, to be understood as the last option, and which still requires stringent rules of execution, what is essential is that adequate paths must be prepared so that the test is carried out in optimal conditions. This is not the case with the drive-ins that we have come to know: a test in the car, perhaps after a long wait, in a precarious and not very reassuring environment, would easily provoke uncontrollable reactions and in fact make the examination impossible. Among the alternatives proposed, on the one hand tampons at home, with the collaboration and supervision of family members, in a reassuring and psychologically more suitable environment; on the other hand, the entrusting of the procedure to those structures that have been treating these patients for some time, such as occurs in the dental departments specializing in the treatment of non-collaborating people. And where it is necessary the use of specialized, informed and up to the task.

Stefano Caredda
NP november 2020