key: cord-1039557-1m0u5kho
authors: Wyman, Michael T.; Symms, John; Viscusi, Chad
title: Nasal Foreign Body, an Unanticipated Complication of COVID-19 Care: A Case Report
date: 2020-12-28
journal: J Emerg Med
DOI: 10.1016/j.jemermed.2020.12.034
sha: 18eefeffc6e6453b9761f2d2f50c22d49b5cbc98
doc_id: 1039557
cord_uid: 1m0u5kho

Background COVID-19 has changed the way we practice medicine. Standards of care are evolving in an effort to diagnose, manage and treat the cause of this global pandemic, as well as to protect the healthcare workforce. These practices can have unexpected and potentially dangerous consequences, particularly for patient populations with confounding factors that put them at increased risk for complications and poor outcomes. Case Report A 52-year-old previously healthy female presents with four days of nasal pain and discharge after utilizing a home collection kit in an attempt to obtain a nasopharyngeal viral sample for COVID-19 testing. Why Should an Emergency Physician be Aware of This? With treatments, policies and procedures that are rapidly evolving and often deviating from established, evidence-based, usual care in response to the COVID-19 pandemic, emergency physicians must be cognizant of and monitor for poor outcomes and potential downstream complications, especially in underserved patient populations

The novel coronavirus was first identified as the cause of a pneumonia outbreak in Wuhan, 24 China, in December 2019 1 . The responsible pathogen, severe acute respiratory syndrome 25 coronavirus 2, "SARS-CoV-2," or simply COVID-19, was isolated on 7 January 2020 2 , and the obtained viral samples 6 , but we fear that such complications will become more and more common with increased reliance on patient self-swabbing to obtain viral samples. month prior to presentation, and therefore was prohibited from working her retail job. Her 50 employer's return-to-work policy required a negative COVID test following resolution of 51 symptoms. Four days prior to presentation to our facility, she obtained a nasopharyngeal self 52 swab testing kit from a national pharmacy chain. She was personally responsible for the cost of 53 testing, and this was the cheapest option she could find. She successfully obtained a sample from 54 the right nare but after attempting to obtain a sample from her left nare, she withdrew the 55 nasopharyngeal swab applicator and retrieved only part of the applicator. She presents with 56 concern that the tip of the applicator remains in her nose as she feels significant discomfort in the 57 upper region of the left nostril and excessive secretions on that side.

The patient had been previously evaluated twice for the same concerns, first at an urgent care 60 center and next in the ED at a large, local outside community hospital. Despite extensive efforts, 

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