ALL evidence - when evaluated appropriately! - shows these are VERY good at detecting infectious virus
• ~100% if used frequently
• >95% for single samples with high, most likely contagious viral loads
The tests work
We've been evaluating rapid Ag tests on campuses. We find these tests - when used as screening w/out symptoms DO miss most PCR positives!
BUT EXPECTED! - ALL misses were previously detected and already finished isolation.
Ag is MUCH more specific than PCR for contagious virus
this is the whole point of rapid antigen tests - they find people who are currently infectious. They are fast, give crucial immediate results and unlike PCR do NOT stay positive for weeks/months after someone is no longer infectious.
This is also at the center of why people keep confusing them as low sensitivity. They simply cannot be compared against PCR RNA positives. PCR RNA remains positive LONG after someone is infectious. Making PCR a poor tool for knowing who requires isolation.
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Unlike antibiotics where resistance happens w partial doses, to be a risk you also must be taking them in first place.
When considering escape from spike protein derived immunity - must consider everyone w/out sterilizing immunity at risk to induce a mutant upon infection.
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Whether no vaccine or a single dose (or two) people create antibodies against the same part of the protein.
If discussing “partial immunity” or low affinity antibodies, must consider that a fully naive person might pose greater risk for escape than a single dose person
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The details are difficult to describe via Twitter but I’ve tried on many occasions. The described low accuracy is false. These tests are doing very well to catch infectious people. We do NOT want to detect and isolate people who are not infectious and just have old remnant RNA.
I know people want to hate on the government for purchasing tests - but the Innova test is working entirely as expected. Very good for detecting contagious people. Which is the only goal here.
I’d be happy to write an OpEd for @guardian to explain.
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.