Dave Rodriguez tilts his head back. A health care worker in a mask and gown inserts what looks like an extra-long Q-tip into one of Rodriguez's nostrils. The worker pushes it all the way through the nasal cavity until it touches the back of Rodriguez's throat.
They're sitting in folding chairs on a downtown Seattle sidewalk. Swedish Medical Center has set up a mobile COVID-19 testing center here for the afternoon, the first outing in an effort to detect the novel coronavirus in some of the city's most vulnerable people.
Beside them is the building where Rodriguez works. He's a case manager for the nonprofit Plymouth Housing, helping oversee 31 residents who used to be homeless and now need support to stay housed.
"I work with folks who rely on me to be here and be healthy for them," Rodriguez said. "So I just want to make sure I’m healthy."
First, his partner and her son fell ill with COVID-19-like symptoms. Then, Rodriguez started feeling a tickle in his throat and what he describes as "hot flashes." He doesn't have a fever or any other common signs of COVID-19, but he wants to be sure.
The swab takes about five seconds. Rodriguez said it stung, but not too bad. When it's over, he puts a face mask over his nose and mouth and starts shepherding some of his residents through the same process.
Plymouth Housing is Seattle's largest provider of "permanent supportive housing" for single adults, providing apartments and casework for more than 1,000 formerly homeless people in 13 buildings.
It's a population that's especially vulnerable to COVID-19. Underlying health problems such as respiratory illness, diabetes, hepatitis and HIV are common, said the nonprofit's director of social services, Michael Quinn.
Many Plymouth Housing residents live in studio-style apartments, but some live in older buildings downtown with shared bathrooms and kitchens where a virus could spread. That's the case for the 62 residents of this building, the Saint Charles Apartments.
"We feel they’re a very vulnerable population to the coronavirus, and we’re trying to get them as many services as we can," said Paul Lambros, chief executive of Plymouth Housing. "We jumped on this right away because of the fact that we thought, if this gets bad, it’s really going to affect our tenant population."
Swedish plans to take this mobile testing unit — which gets around in what until recently was a van for mammograms — to other Plymouth Housing buildings in the weeks ahead, as well as one of Seattle's busiest homeless shelters, the Downtown Emergency Service Center.
"This is a population that wouldn’t necessarily be able to come to us, so we tried to think creatively on how we could bring our services to them," said Kristen Morrow, director of operations for the Swedish Neuroscience Institute.
Morrow said the free, mobile service removes barriers that might otherwise prevent these residents from getting tested. It also keeps them out of more crowded places, like hospitals, where the virus is more likely to spread.
Between 15 and 20 Swedish staff screen patients for symptoms under event tents pitched on the sidewalk.
They look for fevers above 100.4 degrees, "acute, uncontrollable severe cough" and shortness of breath, said Dr. Michele Arnold, executive medical director of Swedish Rehabilitation and Performance Medicine, who was on site.
Such a combination might warrant a COVID-19 test, but it's subjective. Some patients, like Rodriguez, get tested even without those symptoms.
The nasal swab isn't just uncomfortable for the patients. It can be nervewracking to administer, Arnold said.
"It can sometimes trigger a cough or a sneeze," she said. "And because of that we have to use really a lot of caution to make sure that we're not putting ourselves and our other patients and residents at risk."
Curtis Martin lives in a different Plymouth Housing building, but his social worker drove him to the site to get tested. He's not feeling sick, but he wanted to be tested because he suffers from the respiratory condition COPD, which puts him at risk for complications from COVID-19.
"I'm a little nervous about it," said Martin, 58. "I'm like one of the people that are 80 years old and they're croaking once they get the thing. They say... it settles in your lungs, and COPD's a lung thing. I'm going, 'Oh boy.'"
A health care worker listened to Martin's lungs through a stethoscope, checked his blood oxygen level, and determined he didn't need a COVID-19 test.
Without testing everyone, it's impossible to know if someone is carrying the virus without showing symptoms.
But even a brief check-up allows health care providers to talk with patients about the importance of social distancing and other precautions — and calm their fears, Arnold said.
"We are going to see some residents... who are scared," she said. "People are nervous and there's a lot we don't know. So one of the things we offer is... additional education and reassurance."