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The Sky Has Its Limits in COVID-19 Testing

At the time of writing, in July 2020, the COVID-19 pandemic has already inflicted dramatic international restrictions, including airports closing and limiting international travel. It has been suggested that re-opening of airports should involve and even rely on testing travelers for COVID-19. This...

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Autores principales: Linn, Shai, Tzafrir, Shay, Gueron, Shay
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Rambam Health Care Campus 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426551/
https://www.ncbi.nlm.nih.gov/pubmed/32792044
http://dx.doi.org/10.5041/RMMJ.10412
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author Linn, Shai
Tzafrir, Shay
Gueron, Shay
author_facet Linn, Shai
Tzafrir, Shay
Gueron, Shay
author_sort Linn, Shai
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description At the time of writing, in July 2020, the COVID-19 pandemic has already inflicted dramatic international restrictions, including airports closing and limiting international travel. It has been suggested that re-opening of airports should involve and even rely on testing travelers for COVID-19. This paper discusses the methodology of estimating the detection and diagnostic accuracy of COVID-19 tests. It explains the clear distinction between the technical characteristics of the tests, the detection measures, and the diagnostic measures that have clinical and public health implications. It demonstrates the importance of the prevalence of COVID-19 in terms of determining the ability of a test to yield a diagnosis. We explain the methodology of evaluating diagnostic tests, using the predictive summary index (PSI), and the minimum number of tests that need to be performed in order to correctly diagnose one person, which is estimated by 1/PSI. In a population with low prevalence, even a high-sensitivity test may lead to a high percentage of false positive diagnoses, resulting in the need for multiple high-cost tests to achieve a correct diagnosis. Thus, basing a policy for opening airports on diagnostic testing, even with the best test for COVID-19, has some limits.
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spelling pubmed-74265512020-08-25 The Sky Has Its Limits in COVID-19 Testing Linn, Shai Tzafrir, Shay Gueron, Shay Rambam Maimonides Med J Special Issue on the COVID-19 Pandemic At the time of writing, in July 2020, the COVID-19 pandemic has already inflicted dramatic international restrictions, including airports closing and limiting international travel. It has been suggested that re-opening of airports should involve and even rely on testing travelers for COVID-19. This paper discusses the methodology of estimating the detection and diagnostic accuracy of COVID-19 tests. It explains the clear distinction between the technical characteristics of the tests, the detection measures, and the diagnostic measures that have clinical and public health implications. It demonstrates the importance of the prevalence of COVID-19 in terms of determining the ability of a test to yield a diagnosis. We explain the methodology of evaluating diagnostic tests, using the predictive summary index (PSI), and the minimum number of tests that need to be performed in order to correctly diagnose one person, which is estimated by 1/PSI. In a population with low prevalence, even a high-sensitivity test may lead to a high percentage of false positive diagnoses, resulting in the need for multiple high-cost tests to achieve a correct diagnosis. Thus, basing a policy for opening airports on diagnostic testing, even with the best test for COVID-19, has some limits. Rambam Health Care Campus 2020-07-31 /pmc/articles/PMC7426551/ /pubmed/32792044 http://dx.doi.org/10.5041/RMMJ.10412 Text en Copyright: © 2020 Linn et al. This is an open-access article. All its content, except where otherwise noted, is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Special Issue on the COVID-19 Pandemic
Linn, Shai
Tzafrir, Shay
Gueron, Shay
The Sky Has Its Limits in COVID-19 Testing
title The Sky Has Its Limits in COVID-19 Testing
title_full The Sky Has Its Limits in COVID-19 Testing
title_fullStr The Sky Has Its Limits in COVID-19 Testing
title_full_unstemmed The Sky Has Its Limits in COVID-19 Testing
title_short The Sky Has Its Limits in COVID-19 Testing
title_sort sky has its limits in covid-19 testing
topic Special Issue on the COVID-19 Pandemic
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7426551/
https://www.ncbi.nlm.nih.gov/pubmed/32792044
http://dx.doi.org/10.5041/RMMJ.10412
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