Second, we are so frequently talking about sensitivity bc no one wants to miss a case (will come back to this...) but what is equally or even more important when we consider frequent rapid antigen tests to suppress outbreaks with millions of them daily is SPECIFICTY
3/
That is, how many false positives
Although Abbott EUA suggest 1.5% false positive rate (too high if using millions a day for public health screening) numerous reports now from “field use” are showing MUCH better
Here instead of 1/75, they found only ~1/850 !! false pos
4/
A number of other studies and non-researchers using in different institutions are finding similarly VERY good specificity - all above 99.5%!
5/
Sensitivity here was also very good and precisely as expected for an antigen test.
Here, >93% of positives with moderate or high viral RNA loads (measured via PCR) were detected.
PCR+ Samples with LOW RNA loads were uniformly missed. 6/
Essentially all data at this point is demonstrating that samples beyond Ct values of 30 (depending on the lab/assay, but this is largely the case) are largely unable to be cultured and thus do not appear to usually have viable / likely transmissible virus.
7/
However, PCR can stay positive for weeks after culturable virus disappears. So, while antigen test in this study and others miss those samples - when it comes to public health screening, where the goal is catching INFECTIOUS people, this is OK!
Although the BinaxNOW is currently only authorized for symptomatic use by a medical professional, this study in random people on the street shows just how powerful these tests can be!
9/
Right now our surveillance testing plus contact tracing is unlikely to identify >5% of ppl in time to interrupt their onward transmission
Wide deployment of antigen tests like this one, for frequent use, 10M/ day could greatly enhance this to 40% detection in time to act!
10/
This study adds to the mounting evidence that these tests can be used in a comprehensive program to beat back this virus. And to do so in a way that could be independent of major lockdowns and enable individual decision making by people, in privacy of their own homes.
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In this paper they define a “False Negative” as a PCR test that turns negative and then has another positive after it.
OK. So you’re probably thinking – yeah… that makes sense.
2/
To interpret this – you must ask what was the Ct value of the positives that came after and, if available, the Ct values of the false negatives that were missed….
Please read on, it’s important to understand this.
3/
This plan can work with only 10M paper strip antigen tests per day in whole of US
US Govn't can produce / fund these tests. Ship to participating households. 20 paper strip tests per household...
3 are different (but look same) and are for rapidly confirming positives.
2/
We do NOT need all people to "buy into" the program. These tests are used in private (think... next to toothbrush) and need only half of a community to decide to participate.
So if 50% of people don't want to - they don't need to. Not mandatory... the plan still works!
3/
We do have to be cautious in interpreting these early results (from a press release) and we don’t know if same level of protection will persist long-term or if this is driven a lot by early effects more than robust immune memory
Nevertheless, this is a positive data point
2/
A couple of other items we will need to look out for
Even it protects from symptomatic disease, does it also protect from onward transmission?
The assumption is it would largely do this (and this would underpin herd immunity). But blocking transmission isn’t a sure bet
3/
Frequent testing is needed to detect people early before infecting others. They must be highly scalable and for buy in, very convenient - i.e. home use
10M Rapid tests/day (i.e. antigen bc scalable / simple) can form the foundation to build back economy
Frequent tests alone won’t be the end all be all of this pandemic. Not by a long shot. These can greatly reduce odds of transmission - when used en masse, odds of onward transmission (i.e. Rt) can plummet.
To work, also need huge social/economic safety nets, + masks/distancing.
Although new administration will not officially start till January, we have options now. @JoeBiden and team led by @vivek_murthy can start now to engage manufacturing and begin planning/building these at scale w promise of payment once in office, as one example.
Headline says as much as 1M Americans getting COVID daily. This is based on a back of the envelope calculation
We know that only 10% of cases may be diagnosed. So if we have 100k diagnosed daily, then the thinking is that x10 = 1 million
But this misses a crucial piece
2/x
Even though 100k+ new cases DETECTED daily, and we can multiply by 10 for underdiagnosis and get 1M... this is not NEW cases happening daily. This is prevalence of virus positivity daily....
To convert to daily INCIDENCE (Ie new infections daily) takes another step
3/x
Adoption of strategies that aim to allow people to test themselves, privately,simply, at home, 1-2x/week could help suppress outbreaks quickly. Especially in context of other public health measures.
We don’t need perfect compliance, at all. We just need decent compliance - we can achieve this. Like herd immunity, we don’t need this to be everyone, just enough people to drop R<1. I estimate 10% of people in a community would test at home per day. So need not have perfection
We still need reporting so public health officials can keep track
No problem... we work w Google, Apple and whoever else to make voluntary reporting easy as a FaceTime call. If I can see my twin brother 2000 miles away w the push of a button, I should be able to report a result