Senior staff at Department of Health have concerns that Mass Testing needs to stop ...

Great article from @JoshHalliday

Rapid Covid testing in England may be scaled back over false positives theguardian.com/world/2021/apr…
From leaked emails ....

Ben Dyson, an executive director of strategy at the health department and one of Matt Hancock’s advisers, stressed the “fairly urgent need for decisions” on “the point at which we stop offering asymptomatic testing”.
“As of today, someone who gets a positive LFD result in (say) London has at best a 25% chance of it being a true positive, but if it is a self-reported test potentially as low as 10% (on an optimistic assumption about specificity) or as low as 2% (on a more pessimistic assumption
Prof John Simpson, head of PHE’s public health advice, guidance and expertise pillar,

"We are a little concerned that this proposal does not provide the evidence needed to justify the extension of testing in the way proposed,
does not consider alternative approaches to achieving the over-arching aim (of reducing community transmission) ...... and does not provide a framework for evaluation that would make it possible to determine if the approach actually achieves what it intends"
Great that some important people are listening.

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More from @deeksj

17 Apr
For the sake of clear Public Health messages, listening to this interview on @theJeremyVine I'm tweeting some responses to the claims made by Peto

#1 "the lateral flow test has the remarkable ability of only picking up people who are likely to be infectious, or other words a danger to others."
It doesn't just pick out ONLY infectious people
It doesn't pick out ALL infectious people
Linkage to infectiousness is unclear.

It can only gives +ve results when viral loads are high (a limitation not an ability). Studies show viable virus in many people with low viral loads.
Read 18 tweets
9 Apr
Take note - @dhscgov rapid tests are being sent out (certainly in schools) with two different (and conflicting) information sheets, one in the box and one given out separately.

(the crumpled one with the picture is in the box, the glossy one is handed out separately).

1/10
The clue to which one is most up to date is on the back page (the one in the box is the out of date version).

2/10
The important difference in on page 2, which has far more info in the box (1st) version than the version given out about who should use the test and what they should do.

3/10
Read 11 tweets
6 Apr
@drdavideyre isn't the 89.5% figure based on the samples in symptomatic index cases taken at the test-and-trace centre? So this shows how good the test works in those who attend test-and-trace with symptoms? Pretty good idea to use them there.
Using this test (or better ones) backed with PCR in test-and-trace centres could revolutionize contact tracing- if people get their results and meet with an infection control team before they leave the centre we will be moving everything forward 3 days. Add in financial help too.
But how well they work in mass testing or contacts will depend on the distribution of viral loads in these groups - which I cannot see that you have any data on in this paper. The Cochrane review showed sensitivity much lower in those without symptoms.

cochranelibrary.com/cdsr/doi/10.10…
Read 5 tweets
30 Mar
Important paper in @bmj_latest from global leaders in test evaluation. Hope will improve quality of studies.
1/n

Guidance for the design and reporting of studies evaluating the clinical performance of tests for present or past SARS-CoV-2 infection bmj.com/content/372/bm…
Thanks to @JennyDoust @KatyJLBell @leeflang_m
@jacdinnes @SallyJLord @SueMallett Janneke van de Wijgert, Sverre Sandberg, Khosrow Adeli,@pmmbossuyt Andrea Horvath for working on this with me. Its a team which covers all important aspects of test evaluation.

2/n
From reading @DHSCgovuk @PHE_uk study reports and many others from organisations around the world, we are aware that the level of understanding about clinical test evaluation studies is often less than ideal.

This paper lays out clear steps to help improve.

3/n
Read 14 tweets
26 Mar
ONS just announced weekly infection rate in secondary school aged children is 0.43%.

Yesterday Test-and-Trace data showed 0.047% of LFTs were positive.

How can we get an estimate of the sensitivity of LFTs from this? I’ve come up with sensitivity=10%

Here are my workings
Three issues

#1 0.047% will include LFT false positives – 0.03% according to DHSC, so 0.017% will be LFT true positives.

#2 0.43% will include PCR false positives – lets go for 1 in 1000 (probably less) to be conservative. So 0.33% will be true cases
#3 ONS data are based on number of children, LFT on number of tests. If assume two tests per week (but only ever one positive per child) then double the rate to 0.034%

So sensitivity seems to be about 0.034/0.33 = 10%

Anybody else want to present a version of these figures?
Read 5 tweets
25 Mar
LFT test results for week to 17th Mar

Flatlining – few cases in schools - costing tons of money - causing many FPs

7.6M tests week, up from 6.3M
@£5 per test=£38M
@£20 (real cost reported from Wales)=£152M

To get 8279 +ve results (0.108% yellow line) many of which will be FP
What happened in secondary schools?

3.9M tests in students, 1805 positive results.

1 in 2140+ve (previous week 1 in 2070).

Would expect 1160 false+ve if 99.97% specificity (Government’s new claim)

64% of +ves were false+ve with kids+bubbles+families isolating unnecessarily
Overall we’ve been above 1000 tests to find one true positive for the past fortnight using the 99.97% specificity figure,

and for 3 weeks using the slightly 99.9% specificity figure.

“Finding needles in haystacks”
Read 5 tweets

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