Sense and Sensitivity -Can An Inaccurate Test Be Better Than No Test At All (original) (raw)
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Background In the initial phase of the Covid-19 pandemic, difficult decisions had to be made on the allocation of testing resources. Similar situations can arise in future pandemics. Therefore, careful consideration of who should be tested is an important part of pandemic preparedness. We focus on four ethical aspects of that problem: how to prioritize scarce testing resources, the regulation of commercial direct-to-consumer test services, testing of unauthorized immigrants, and obligatory testing. Main text The distribution of scarce resources for testing : We emphasize the use of needs-based criteria, but also acknowledge the importance of choosing a testing strategy that contributes efficiently to stopping the overall spread of the disease. Commercial direct-to-consumer test services : Except in cases of acute scarcity, such services will in practice have to be allowed. We propose that they should be subject to regulation that ensures test quality and adequate information to user...
Balance of Risk in COVID-19 Reveals the Extreme Cost of False Positives
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COVID-19 public health responses, including lockdowns and diagnostic testing strategies, have had consequences. Economic costs (see the CHD paper in this issue) could reach $16 trillion dollars, 90% of the US annual GDP. While harm to small businesses, unemployment, worsening poverty, death from cancer, increased suicides, social isolation, and restriction of freedom all increase the perceived need for drastic responses from the top, flawed measures are costly. A diagnostic assay[1] of tests for COVID-19 depends for its validity on its sensitivity and specificity assessed in terms of the true positive rate (TPR), false positive rate (FPR), true negative rate (TNR), and false negative rate (FNR) of the assays. In this pandemic, Real Time — Polymerase Chain Reaction (RT-PCR) testing has been relied on for drastic top-down responses (as in shutting down the economy of whole nations or the entire world). Here I focus on false positive results where RT-PCR testing suggests many infection...
Testing and Being Tested in Pandemic Times
Sociologica, 2020
The coronavirus pandemic is witness to a great proliferation of two types of tests. The first type is testing – medical tests as well as epidemiological models that simulate and project the course of the virus. In the second type, actors, organizations, and institutions are being tested in this moment of social and political crisis. This essay analyzes the similarities and differences between these two major types of tests in order to understand their entanglements in the crisis. In the process, we find a great diversity of tests operating in multiple registers, themselves not clearly demarcated, often combining and sometimes conflating, for example, scientific and public discourse. The study opens by identifying three aspects of testing, drawn from the sociology of testing. First, tests are frequently proxies (or projections) that stand for something. Second, a test is a critical moment that stands out – whether because it is a moment deliberately separated out or because it is a puzzling or troublesome “situation” that disrupts the flow of social life. Third, when someone or something is put to the test, of interest is whether it stands up to the challenge. These insights serve as the building blocks for addressing three major issues – representation, selection, and accountability – regarding testing in the time of the coronavirus crisis. In this moment we see a new model of testing: from statistical calculation of risk in a population to algorithmic prediction about the riskiness of particular persons.
BMC Public Health
Background In May 2020, the Scottish Government launched Test and Protect, a test, trace and isolate programme for COVID-19 that includes a PCR testing component. The programme’s success depended on the willingness of members of the public to seek out testing when they experienced symptoms and to comply with guidelines on isolation should they test positive. Drawing on qualitative interview-based research, this paper analyses public understandings, expectations, and experiences of COVID-19 testing during the early stages of the programme. Through anthropological and sociological analysis of the findings we aim to contribute to social understandings of COVID-19 testing practices; and to inform the design of population level testing programmes for future pandemics. Methods Between 7 July and 24 September 2020, 70 semi-structured interviews were conducted with members of the general public (aged 19–85) living in the Lothian region of Scotland. Interviews were held online or by telepho...
2021
SARS-CoV-2 rapid antigen point-of-care (PoC) and home tests are available to laypeople. This raises questions regarding the drivers and barriers of people’s willingness to use tests, their understanding of test results and the psychological and behavioural consequences of positive and negative test results. Four cross-sectional data collections, including survey items, open text answers and three experiments, were therefore conducted between December 2020 and March 2021, involving 4,026 German participants. The majority was willing to use PoC or home tests. People will be more likely to use tests when they are inexpensive and easy to use or when they are a necessary (given low infection rates) for obtaining access to public and social life. However, people urgently need information about what a test result means and how they should behave. Recommendations based on the present findings could make rapid testing a successful pillar of pandemic management.