In April 2020, the UK Government guidance began to emerge around the use of COVID-19 swab tests for the symptomatic testing of individuals which allowed for the timely identification of cases and a period of isolation to minimise further spread. As the pandemic has progressed, so has the capacity and need for swabbing, with its use now being recognised as being crucial for those being admitted to hospital for a procedure or surgery, mass asymptomatic testing for the identification of new strains, and most recently as of February 2021, the twice weekly offering of lateral flow testing if somebody within your household, childcare or support bubble works in or goes to a UK primary or secondary school. In addition, as we ease out of lockdown, their use could possibly aid in the reopening of festivals and stadiums.
Testing for COVID-19 uses the universal procedure of nasopharyngeal swabbing which allows for mucus membranes where the virus may be growing to be collected for testing. Taking swabs from these areas can be uncomfortable, but for some, the experience of swabbing can present additional challenges. We therefore explores the consideration of, and experience of swabbing as a preventive measure against COVID-19 transmission for both adult survivors of childhood sexual abuse (CSA) and parents of children who have been abused with suggestions to assist with the undertaking of self-swabbing for these groups as the impact that COVID-19 has had upon those at risk of CSA has been widely reported with their consequence’s being reflected in increases in funding to third sector organisations.
We are using the NSPCC definition of CSA and discuss swabbing in the context of it being a medical procedure. We have highlighted that self-swabbing can be an uncomfortable procedure, and for adult survivors or for children at risk, additional requirements may need to be considered in terms of the environment where the swabbing takes place. For children being swabbed to facilitate a safe return to educational settings, this may take place at home, possibly in the setting of the abuse, or potentially by the abuser, thus having an unpleasant medical procedure, likely to be accompanied by anxiety or distress in a setting where these feelings are already triggered. For parents/guardians who are conducting a swab on their child/ren who have an experience of CSA, there may be a fear of causing additional trauma and distress to the child. For adult survivors self-swabbing creates an element of control, not afforded to younger children, but again, the setting may be of relevance.
‘As a parent, I’m worried that my daughter who is 8 will be tested as part of returning to school, especially because of the experiences that she has had. At the moment it is voluntary and although it makes me feel a bad parent, I don’t want her to be tested. A problem though is other parents on group chats talking about their children getting tested, which makes me feel pressurised and also my daughter wants to be swabbed because her friends are. I don’t want the swab to cause any bad memories for her or make her worried or sad; I don’t want her to feel it is something she can’t stop.’
This excerpt illustrates some of the additional concerns that swabbing can cause for parents who recognise that such an invasive test could lead to re-traumatisation or re-experiencing of previously distressing situations which can manifest in the form of flashbacks. In terms of educational settings, a trauma informed approach where the child is fully informed of what will happen and what to expect may help alleviate concerns, with the message that they can stop the swabbing at any time by using a pre-arranged signal or word may help them feel in control, likewise: ‘It would be useful where schools have knowledge of children who have been abused in some form to talk to the parent and child about what might make it easier for them, perhaps if they could do it in a familiar room or by someone familiar, or allowing them to take a toy with them or being able to listen to music.’
Holding an item, whether that be a favourite toy or a familiar item that is associated with safety, may mitigate the forced physiological and psychological reminders that swabbing could generate. Using a strategy such as this, as a way of grounding and staying present is also applicable to adults undergoing swabbing; likewise, as we can see here, grounding techniques which utilise the five senses can be of benefit.
‘I listened to music as I was doing my swab. I had wireless headphones on which couldn’t be seen under my hair so only I knew I had them on but I found that the music calmed me and it was this distraction that made it easier to do the test (swab) but it also grounded me so I didn’t get any bad memories or flashbacks.’
Alongside the grounding techniques of which listening to music and holding textured/safe items are examples, and the development of a signal to stop, we have had the following strategies and advice shared with us by an adult survivor who has successfully used these to manage her own self-swab, but also navigating the anxiety of her child being swabbed who is also a survivor.
‘My daughter and I have read the information together from the school and looked at pictures of the process of what will happen. I’ve told her what it was like for me and told her that I was worried but it was better than I expected. It always feels like a fine-line that I’m treading because I want her to be prepared but I don’t want to make her unnecessarily anxious about it and put my worries on her for teachers or volunteers in educational settings, check they [the child] are OK afterwards, and if you have developed a stop word or signal, listen and look out for this and stop straight away.’
‘For adults, think about any worries that you are having before you go and challenge these, one thing I thought of is that millions of people all over the world have had these done, I’m not going to be the only person that has been anxious about it. Telling the person at the centre that I was worried was useful because it gave me reassurance. Take your time; this helped me feel in control and less anxious. Ground yourself with things that you know work like music or talking with friends before or afterwards, and rewarding yourself which for me is a takeaway coffee.’
We want to raise awareness and highlight the need for those supervising or undertaking swabbing to be aware that not everybody will want to, or be comfortable having a swab due to associations to previous experiences. But employing simple measures such as an awareness of the environment in which the swab is being undertaken, negotiating a stop signal and allowing sufficient time can be of benefit to both adult and child survivors and reduce the experience of swabbing as being one that is associated with anxiety or distress.
Alison Welfare-Wilson is a senior research nurse working within Research and Innovation at Kent and Medway NHS and Social Care Partnership Trust; Emma Green is both a survivor of childhood sexual abuse (CSA) and a parent of a child that was abused; Imogen Sargent is a National Institute for Health Research clinical research team leader, NIHR Advanced Leadership Programme (ALP) alumni.