I want to clarify this 👆is a very nice and well written article by @TomChivers - pertaining to conventional one-off testing
Frequent accessible testing is however different & repeated use of one or more tests must be factored in to sens/spec calculations & Bayes probabilities
Since false pos are of concern bc they mean ppl isolate when they do not need to, then w that definition @TomChivers it would be interesting if you follow up w a piece on the VERY high false pos PCR rate bc many/most PCR positives are detected AFTER the isolation window passed
For some reason very very few want to discuss this crucial piece which is absolutely known - even CDC and others recognize it.
Yet no one talks about it.
Requiring isolation AFTER the 10 day isolation window is complete is as bad as a false positive causing isolation.
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This is why we must offer confirmatory rapid tests along w any rapid test program
If we give ppl 20 of test A, we need to give 1-2 of test B - a confirmatory test to use immediately if a pos shows up on A. Can be Ag or Molecular, at home test.
Many rapid tests have False positive rates of 1 in 1000 or less. This is great. But when using huge numbers to control spread, it’s better to have that number at 1 in 10,000 or lower. A simple test A +B if A is positive algorithm would vastly improve specificity.
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If we fail to consider a simple addition of a relatively small number of accessible, rapid confirmatory tests, the population may lose confidence. Like all the testing problems, there are simple solutions. We should run with them. Rapid confirmatory tests is one of those.
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qPCR is highly specific as a medical test to appropriately identify SARS-CoV2 RNA....
but qPCR is terribly NOT specific as a public health test to determine who should still be isolating (though looking at Ct values can help)
This is not good for public health.
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We never should have made qOCR the gold standard for evaluating public health tests. It was a mistake from the beginning bc as CDC readily says - you stay positive on a qPCR test for weeks after you are done transmitting. The specificity is terrible as a public health tool
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We know that frequent accessible testing with rapid results can be a critically important tool to slow transmission, keep R<1 and prevent surging cases. Why? because anyone can be exposed to the virus and not realize it until after they have become infectious.
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I hope this new initiative will demonstrate the effectiveness of accessible, frequent at-home rapid testing and subsequently inform national policy to make at-home rapid testing available to all Americans without a prescription (and ideally for free!)
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Population-wide Rapid testing over a two week period of time (Rapid Ag testing of ~50% of population each weekend for two weekends in a row) PLUS subsequent quarantines led to ~70% reduction in prevalence.
Figure above shows the relative reduction in prevalence that occurred - which was consistently substantial across the regions where the population wide rapid testing was performed. Centering around 58%. Compared to what would have happened, the effect was even greater (70%)
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The authors used mathematical models to help understand if the effect noted was due solely to tests, solely to the isolation and quarantines imposed or to both.
They found very strong evidence that it was the overall program - the rapid testing PLUS the behavioral changes
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THREAD: Statement on new FDA guidelines for Screening programs
Today FDA announced new guidelines for screening programs (i.e. testing asymptomatic individuals frequently to detect positive cases before they spread to others). fda.gov/news-events/pr…
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While this appears to be good news and a positive step forward to increasing regular testing for public health, we still don’t have a full understanding of how to interpret these guidelines.
There are a few details that we are trying to get clarification on from the FDA.
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For Ex:
1) Does this allow schools to implement a screening program without a CLIA waiver or prescription? (both barriers to testing)
2) Will FDA designate previously approved tests for screening purposes or will the test developers need to apply for a screening claim?
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Today I am announcing a new massive public health research study - with @Citibank - to use and evaluate frequent at-home rapid testing. The study is evaluating how well workplace infections are prevented by frequent home-tests.
The study is evaluating whether rapid home-tests used ever M/W/F can successfully prevent workplace transmission better than current status quo of symptom screens and evaluates how well non-medical ppl can perform the tests on their own.
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The rapid tests - which aren’t yet EUA’d but are used globally and we’ve found to be very effective in pilots - are being introduced in conjunction with @LivePerson’s Bella Health app to provide AI-powered assistance to help people at home learn how to use the tests.
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