Despite some poor messaging in UK - Rapid Ag tests work WELL to find CURRENTLY INFECTIOUS ppl
Frequent rapid Ag testing sensitivity is >95% to find infectious people.
(ppl get confused & say they're low sensitivity - but that's when compared to RNA on PCR from prior infection)
A major attribute of rapid Ag testing is they can be FREQUENT
It's not the sensitivity of a test to find virus particles that matters
It's the sensitivity of the testing program to find and isolate infectious people that matters.
For that, PCR often fails. Rapid Tests do well.
PCR fails for detecting and isolating infectious people:
1) Bc it is usually NOT frequent (Cannot catch contagious peoplebefore they have symptoms if not testing frequently)
& 2) Results take a long time. So even when you do find an infectious person, they still spread for days
This is NOT to say that we should not do PCR. But if it takes more than a few hours to return a result, it should be reserved for clinical medical diagnostics. NOT for screening and finding infectious people. unless it is being performed 2x/week - which it almost never is.
Also, Important to this discussion too... New research is showing that rapid antigen tests being performed by self (rather than a professional) is working essentially as well as a medically trained professional.
To determine this, the researchers performed a systematic analysis of swabbing and running PCR on post-mortem individuals.
These ppl would not have been detected/confirmed as having COVID otherwise and thus not officially reported owing to a lack of testing infrastructure
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As @brookenichols has discussed, rapid Ag testing isnt only a powerful tool for frequent use to slow spread (as I’ve discussed) - it is also a powerful tool for less resourced countries to access and massively scale up testing to get formal estimates of transmission/cases
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This 🧵 is on SPECIFICITY or the issues of False POSITIVES and rapid antigen tests.
Many people are concerned that these fast, inexpensive tests cause too many false positives and will overload PCR labs...
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Rapid antigen tests can have 98%-99.9% specificity meaning between 0.1% and 2% of tests run might be falsely positive.
If prevalence is low, even a 99.9% specificity could mean many of the positive tests are falsely positive.
But w rapid tests, there are rapid solutions!
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Many ppl instinctively worry that a false positive will mean an erroneous 10 day isolation and that huge numbers of people are going to require laboratory based PCR confirmation tests and this will overload the system.
But, Unlike antibiotics, the comparison has to consider even greater “only partial immunity” among those who have had no vaccine by the time they get infected.
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@apoorva_nyc@TakeWeightOffMD The immune response is going to develop whether you’ve been vaccinated or not. If you’ve had no vaccine, then there is going to be much more “only partial immunity” that the virus gets to play around with and “test out”
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@apoorva_nyc@TakeWeightOffMD We have to very careful to not forget what the baseline is here. W antibiotics, the Bacteria is only exposed to a partial dose if youre on antibiotics. With immunity, the virus is exposed to a partial dose whenever you’re not already protected while immunity builds up.
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In the very same study that concludes rapid Ag tests do not work in asymptomatic people, the authors failed to state the rapid Ag tests SUCCESSFULLY CAUGHT 100% of ASYMPTOMATIC PEOPLE who had likely contagious virus.
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If testing Asymptomatics randomly (vs. repeatedly) - they are MOST likely to be found post-infectious -> EXPECT Ag to be -ve MOST of time someone is PCR +ve
The very paper @CDCgov links to that concludes rapid Ag tests do not perform well in Asymptomatics literally shows 100% sensitivity for culture +ve samples in Asymptomatics
Massive failure to not emphasize this for asymptomatic screening.