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Jay Wilson

Examination of C0vid-19 test swabs using microscopy and spectroscopy techniques reveal 8 unexpected elements across 7 test brands...👇

This PDF is a 2023 paper in Toxics titled “Scanning Electron Microscopy and EDX Spectroscopy of Commercial Swabs Used for COVID-19 Lateral Flow Testing.” The researchers examined commercial COVID-19 nasal/nasopharyngeal swabs under scanning electron microscopy and used energy-dispersive X-ray spectroscopy, or EDX, to determine what chemical elements were present in the swab material. Their central finding was that, besides the expected elements making up nylon, foam, and other polymers, they detected several additional elements—including silicon, titanium, zirconium, aluminium, strontium, gallium, sulphur, and fluorine—in at least some of the tested swabs.

Provided below is a section-by-section overview of the PDF:
"Scanning Electron Microscopy and EDX Spectroscopy of Commercial Swabs Used for COVID-19 Lateral Flow Testing"
https://www.mdpi.com/2305-6304/11/10/805

- Abstract -

The abstract explains why the authors performed the study. They argue that COVID-19 testing created an unprecedented demand for swabs, leading to extremely rapid mass production and even the use of 3D-printing methods. They were concerned that manufacturing impurities or by-products might therefore be present in some swabs.

They examined seven commercial brands using SEM to look at the microscopic structure of the swabs and EDX spectroscopy to identify the elements present. They report finding eight elements that they considered unexpected: titanium, zirconium, silicon, aluminium, gallium, strontium, sulphur, and fluorine. Some occurred only in trace quantities, while the authors state that some measurements were close to toxicological exposure thresholds discussed in the literature. Based on this, they call for more research into repeated nasal exposure from frequent testing.

1. Introduction

The introduction begins by describing the huge scale of COVID-19 testing. The paper says that nucleic-acid amplification tests and lateral-flow tests relied heavily on nasal or nasopharyngeal sampling, and cites a figure of approximately 5.07 billion reported COVID tests worldwide between January 2020 and December 2022, excluding many unreported home tests.

Because normal swab production could not meet demand, manufacturing increased rapidly and new production approaches, including 3D printing, were introduced. The authors propose that this rapid expansion made it reasonable to investigate whether manufacturing-related impurities might be present.

They point out that diagnostic swabs can be made from materials including cotton, rayon, polyester, nylon, polyurethane, and foam. Different materials have different structures and can affect how samples stick to and are released from a swab.

An important point made by the authors is that,
at the time of their literature review, they could find very little published research specifically examining the chemical composition of COVID testing swabs. Previous research had primarily studied how well different swabs collected samples or compared their physical characteristics.

They also explain why the location of exposure matters. Nasopharyngeal swabs are inserted into sensitive nasal anatomy. Although they are generally classified as low-risk medical devices, the paper cites reported complications ranging from discomfort, pain, and bleeding to uncommon serious injuries such as skull-base damage and cerebrospinal-fluid leakage. The authors therefore argue that the chemical composition of the swab itself is worth examining, particularly with repeated testing.

The stated purpose of the study was therefore to provide an initial investigation of the microscopic structure and elemental composition of seven commercially available COVID-test swab brands.

2. Materials and Methods

The researchers tested seven COVID-test swab brands:

• iHealth

• Puritan HydraFlock

• Nasal Swab

• MANTACC

• FLOQSwabs

• Kangdaan

• Taizhou

They generally examined two or three samples from each brand. They also included two cotton swabs that were not COVID-test swabs as comparison controls.

The products included foam, nylon, and flocked-nylon swabs. Table 1 also records the sterilization method, CE status, manufacturer, and lot number for each product. Most of the COVID swabs were sterilized with ethylene oxide, while one used radiation sterilization.

The investigators used scanning electron microscopy, or SEM, to examine the tip, sides, and base of the swab heads. SEM essentially allowed them to photograph the fibers and surfaces at microscopic magnification.

They then used EDX spectroscopy to identify the elemental chemical composition of the swab material. EDX works by detecting characteristic X-rays emitted by elements when the sample is exposed to an electron beam.

The researchers state that swabs were handled using sterile gloves and that packages were opened immediately before analysis to reduce the possibility of contaminating the samples during the experiment.

They also weighed each swab head so that the elemental percentages detected by EDX could be converted into estimated amounts expressed in milligrams.

3. Results

- Microscopic appearance of the swabs -

SEM images showed substantial differences in the physical structure of different swab materials.

The foam swab had a porous, network-like structure. Flocked-nylon swabs contained many relatively uniform fibers projecting outward from the swab surface. HydraFlock fibers were particularly noticeable because the ends appeared split or unravelled.

The cotton comparison swabs looked much less organized, consisting of fibers of different lengths wrapped around the applicator.

The authors state that they did not see evidence of obvious biological contamination such as bacteria or fungal spores. However, some flocked-nylon swabs had what they described as crust-like material surrounding some fibers.

- Chemical composition detected by EDX -

EDX identified a total of 11 elements.

The dominant elements were unsurprising:

Carbon made up roughly 49-64% of the material, while oxygen accounted for roughly 23-50%. Nitrogen was also present in most of the COVID-test swabs. These elements are consistent with the expected chemistry of nylon, polyurethane, and related polymers.

The additional detected elements were:

Fluorine, silicon, titanium, strontium, aluminium, zirconium, gallium, and sulphur.

These were generally present at much lower concentrations, approximately 0.03% to 1.2% in the elemental analysis. The researchers emphasize that silicon, zirconium, strontium, gallium, aluminium, and sulphur were not detected in their generic cotton comparison swabs.

An important qualification is that the results were not identical among repeated samples. Some elements were detected in only one or two specimens of the same brand. In other words, the study did not show that every swab of a particular brand necessarily contained the same concentration of these elements.

4. Discussion

The discussion is the largest and most important section of the paper. The authors try to interpret what these detected elements might mean biologically, while comparing their measurements with toxicology literature.

They acknowledge that this was only a pilot study with a small number of swabs. They also explain that techniques such as Raman spectroscopy or Fourier-transform infrared spectroscopy could have provided additional chemical information but were outside the scope of the study.

- Expected polymer elements -

Carbon, oxygen, and nitrogen are expected because they are basic components of common swab materials.

Cotton and rayon contain carbon, hydrogen, and oxygen; nylon contains carbon, hydrogen, oxygen, and nitrogen; and polyurethane foam is also constructed from carbon-, oxygen-, nitrogen-, and hydrogen-containing compounds.

The concern of the authors therefore centers on the additional elements, not the ordinary polymer components.

They emphasize that the manufacturer datasheets they examined did not list silicon, titanium, zirconium, aluminium, gallium, or strontium as components.

- Potential bioaccumulation -

The authors repeatedly acknowledge that dose matters and that many of the quantities detected were small.

Nevertheless, they raise a hypothesis that repeated exposure could potentially matter if some of the material transferred from the swab into tissue. They cite literature showing bioaccumulation of aluminium and fluoride and experimental studies involving titanium nanoparticles, zirconium compounds, and silica nanoparticles.

This is an important distinction: the study measured elements in the swabs, but it did not directly measure how much transferred into the noses or bodies of tested people. The authors themselves describe tissue accumulation following swabbing as something that requires further research.

- Fluorine -

The paper discusses fluorine/fluoride in considerable detail.

Fluorine was found in several swab types. The authors review literature linking excessive fluoride exposure with oxidative stress, mitochondrial effects, cellular redox changes, endoplasmic-reticulum stress, and altered gene expression‎.

They calculate that the average fluorine level they detected represented approximately 0.17 mg in a swab head. They compare this with a fluoride NOAEL cited from the U.S. EPA and give a hypothetical example involving two swabs used on a newborn weighing under 4 kg.

However, the paper explicitly acknowledges an important uncertainty: they did not know how much fluorine would actually transfer from the swab into nasal tissue. They call for studies directly measuring this transfer.

- Aluminium -

Aluminium was found in three COVID-test swab types.

The authors note that the quantities were lower than a cited oral lowest-observed-adverse-effect level, but they argue that oral exposure is not directly comparable with nasal exposure.

They cite animal studies in which small amounts of aluminium delivered through the nose produced detectable aluminium in the olfactory bulb or inflammatory responses. They also discuss literature showing that aluminium can interact with cellular proteins and influence cytokine activity.

- Silicon / silica -

Silicon was another prominent finding.

The measured silicon concentrations ranged from approximately 5.78 to 49.66 mg/g in the swabs in which it was detected.

The authors compare their measurements with occupational silica-exposure literature and discuss silica nanoparticles. They cite experimental research showing that nanoscale silica can increase inflammatory cytokines such as IL-1ẞ, increase reactive oxygen species, destabilize lysosomes, and lead to cell damage in certain experimental models.

They argue that detecting silicon in several swab brands justifies further investigation of what form of silicon is present and what effect, if any, repeated contact might have on nasal tissue.

One limitation worth emphasizing is that EDX detects the element silicon; by itself it does not establish that all of that silicon was present specifically as toxic silica nanoparticles. Much of the discussion concerns silica toxicology as a possible relevant comparison.

- Strontium -

Strontium was found in one of the tested COVID swabs.

The authors say that toxicological information concerning nasal exposure to non-radioactive strontium is limited. Much toxicology literature concerns radioactive strontium or strontium compounds in which toxicity may actually be caused by another component of the molecule.

Because of these uncertainties, they treat strontium mostly as an unexplained finding requiring additional research.

- Titanium and zirconium -

Titanium and zirconium were found in several swabs.

The paper discusses titanium dioxide, which is widely used in industrial and medical applications. The authors cite animal inhalation experiments in which sufficiently high or repeated exposures to titanium-dioxide particles caused oxidative stress, inflammatory changes, macrophage accumulation, and changes in respiratory epithelium.

They also note that ultrafine TiO, has been classified by IARC as possibly carcinogenic to humans under certain exposure circumstances, particularly inhalation exposure.

Importantly, the authors themselves say that, given the small amount of titanium and zirconium actually found in the swabs, noticeable respiratory damage would not ordinarily be expected from those quantities. Their concern is principally about uncertainty surrounding repeated exposure, particle size, and possible interactions with other compounds.

The authors conclude that they detected eight unexpected elements across the seven COVID-test swab brands.

They argue that the inconsistent concentrations among different specimens suggest that at least some of the material could result from manufacturing or packaging variation rather than intentionally added ingredients. They specifically point to large differences in titanium and zirconium concentrations between replicate swabs as possible evidence of inconsistent manufacturing or quality control.

The researchers openly acknowledge two major limitations:

The brands were selected opportunistically rather than through a comprehensive sampling program, and only a small number of specimens per brand were examined.

They therefore do not claim that their sample represents every COVID swab on the market.

Instead, they argue that the results justify a much larger systematic investigation by health authorities.

The authors also emphasize that there was little information available about what happens to microscopic or nanoscale material from swabs after direct contact with upper respiratory tissue. They call for research specifically measuring whether these materials leave the swab, enter the epithelium, remain there, accumulate, or are removed naturally.

They ultimately apply what they call the precautionary principle and argue against unnecessary frequent swabbing of healthy, asymptomatic individuals until repeated-exposure safety is better understood. This is the authors' interpretation and recommendation based on their pilot findings; the experiment itself did not demonstrate clinical injury in people who used the swabs.

- Supplementary material -

The supplementary material contains individual SEM and elemental-mapping analyses for each swab.

For example, the supplemental figures map carbon and oxygen in iHealth swabs, fluorine in HydraFlock, silicon and aluminium in Nasal Swab, silicon and strontium in MANTACC, silicon and zirconium in FLOQSwabs, titanium/gallium/ zirconium in Kangdaan, and silicon in Taizhou. The two cotton comparison swabs were also separately mapped.

These supplemental images are essentially the underlying visual evidence showing where the EDX system detected particular elements on the tested material.

- Funding, data and conflicts of interest -

The paper states that the study received no external funding. The authors declared no conflicts of interest. EDX elemental-profile data were made available in the supplementary material, with other relevant data obtainable from the corresponding authors.