Why it's important for there to be transparency on COVID-19 test performance?
As the COVID-19 pandemic continues to affect nations across the world, the demand for testing solutions continues to increase every day, with governments, researchers and manufacturers coming up with everything from rapid boots-on-the-ground testing kits to more traditional centralised lab testing solutions, all which come with varying degrees of accuracy/functionality.
The Foundation for Innovative New Diagnostics (FIND), which is a global non-profit organisation driving innovation in the development and delivery of diagnostics to combat major diseases, currently lists 586 different SARS-COV-2 testing solutions which are currently in development, being used for research purposes or ready for deployment today, as of the 26th April. By its own admission, this is not a comprehensive list, and The World Nano Foundation is aware of many other testing solutions in development or readily available which are not featured on this list.
As the crisis continues to evolve, and pressure mounts on world governments to provide practical testing solutions for the masses, the number of different testing solutions also increases each day. So, how can policy makers devise workable testing strategies in this overly complex, highly pressured and ever-evolving environment?
Transparency is the answer. Currently, several manufacturers following best practices are trying to be incredibly open and transparent regarding the test data and functionality of their solutions, and it is important more follow suit. Government testing bodies also need to be transparent about the requirements they expect tests to fulfil, and provide testing data so that test solution providers know how their tests performed under scrutiny, instead of just announcing whether different tests do or do not work.
The variation of tests with varying degrees of accuracy, speed and ease of deployment create a spectrum, from which policy makers can work out the best function for different tests.
How accurate is accurate enough?
To work out the answer to this question, we must first ask; what functions do we want tests to perform? It is also important to recognise that no test is 100% accurate and all tests must form part of a diagnostic protocol.
If you have a large group/community of people, whose infectious status (Positive, Negative, Immune) is unknown, then testing solutions with different accuracy levels can provide different functions.
For example, if you have a test that is 90% accurate, which can be done as a rapid point-of-care test, you can quickly establish with 90% accuracy the size of the problem in a previously unmeasured group. This provides vital data to policy makers for how to manage that group accordingly.
To increase the functionality of that test, policy makers may decide to test a person multiple times, so again using the example above, statistically the accuracy goes up to 99% with the second test and beyond with each subsequent test. They could also test people with the same type of test but made by a different manufacturer, this would enable results to be cross-referenced, and use tests in the most efficient manner by understanding the inherent strengths and weaknesses of different tests.
With mass testing of this nature in progress, policy makers can learn from the results and understand the function of each test used and develop testing programs that are tailored to specific sub-groups of people. For example, you may use one test to triage a group of people, another test to provide confirmatory results, and a final testing solution, such as PCR testing, for more precise analysis of a smaller number of the sub-group.
By having mass testing programs in place, policy makers can quickly change the tests being used as more effective, or more accurate tests become available. The creation of the mass testing process may be more important than what tests you start the process with.