Thread by @MariaGlymour

Plenary from @michaelmina_lab at #SER2022.
Testing is not just a medical tool! Most of the discussion of testing is focused on medical diagnostics but testing is a public health tool. We need to start thinking/evaluating testing as a population health tool.

Applications of tests for public health? test to isolate; test to exit isolation; test to enter/stay; test to go; contact tracing. Medical testing is for patient; testing for public health is for others.

Conflating what are medical vs public health tools is a major problem. Priority for medical tests (FDA's priority): high sensitivity. Secondary considerations: cost and speed. For public health, we need to prioritize fast, frequent, accessibility, affordability over sensitivity.

Sensitivity not as important for public health because change in viral load is fast and most transmission occurs in periods of very high viral load. A result that takes 10 days to return is almost useless for public health.

For screening for school or work entry, using an 80% sensitivity test w/ 15 min turnaround is WAY better for public health than 100% sensitivity with 2 day turnaround. Yet time TO THIS DAY has not been incorporated into regulation of tests.

Extraordinary- we *still* don't have a way to regulate public health tests - they are all regulated like medical tests. FDA priorities are still all about sensitivity.

A test should NOT be a choice between equitable access vs public health surveillance. We can have monitoring that is 24/7 on demand.

This was a very insight-packed talk. Thanks @michaelmina_lab. Next up on the society for epidemiologic research plenary session @zeynep...