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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doaj-75af4ddc666d4cdfb3067f9c644620152020-11-25T03:19:51ZengRambam Health Care CampusRambam Maimonides Medical Journal2076-91722020-07-01113e002010.5041/RMMJ.10412The Sky Has Its Limits in COVID-19 TestingShai Lin0Shay Tzafrir1Shay Gueron2School of Public Health, The University of Haifa, Haifa, IsraelSchool of Management, The University of Haifa, Haifa, IsraelDepartment of Mathematics, The University of Haifa, Haifa, IsraelAt 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.https://www.rmmj.org.il/issues/46/1117/manuscriptbayes’ theoremcovid-19diagnostic testsepidemiologyflightsmethodsscreening |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Shai Lin Shay Tzafrir Shay Gueron |
spellingShingle |
Shai Lin Shay Tzafrir Shay Gueron The Sky Has Its Limits in COVID-19 Testing Rambam Maimonides Medical Journal bayes’ theorem covid-19 diagnostic tests epidemiology flights methods screening |
author_facet |
Shai Lin Shay Tzafrir Shay Gueron |
author_sort |
Shai Lin |
title |
The Sky Has Its Limits in COVID-19 Testing |
title_short |
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_sort |
sky has its limits in covid-19 testing |
publisher |
Rambam Health Care Campus |
series |
Rambam Maimonides Medical Journal |
issn |
2076-9172 |
publishDate |
2020-07-01 |
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. |
topic |
bayes’ theorem covid-19 diagnostic tests epidemiology flights methods screening |
url |
https://www.rmmj.org.il/issues/46/1117/manuscript |
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