EPftF: Testing Characteristics
Jun. 7th, 2020 09:23 am![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
walkitoutThe school system is made up of people who play multiple roles. Any given participant (other than the kids) partakes of one or more of: parent, teacher, not-a-teacher-but-staff, taxpayer. There is always some amount of conflict between these roles. Testing amplifies this conflict. The teacher who wants kids tested may also be a parent who does not want her child subjected to regular nasopharyngeal swab testing, a taxpayer who has zero interest in paying for the testing directly or indirectly and a voter who does not want any level of government to take on further levels of debt to pay for that testing. Her job might be at risk of being cut to be able to pay for the testing, or she might have friends or family members whose jobs might be cut to pay for testing, or she might object to her child having fewer specialist teachers (music, art, special ed aides, etc.) who might be cut to pay for testing. Teachers are also union members, who will support union goals, and they are voters, who will have opinions expressed in elections and on referenda / questions / initiatives and other ballot items.
I think basically this is what we all want: free, frequent, comprehensive, accurate and painless. We will take Paid For By Someone Else instead of Free subject to the role conflicts (which can be internal to an individual) described above. Testing would not need to be frequent, if a single test could show immunity forever (so, serology testing one time would be fine, if it was accurate and if immunity was lasting). Comprehensive is a dodgy goal, as many people are expected to resist having to be tested themselves / have their children tested.
Currently, we do not know whether or not immunity is lasting. We also are not sure if our tests for immunity are accurate at all. We cannot currently plan based on a future one-time test for lasting immunity; we might never get that, and we do need to educate our children before they become adults.
Other tests (antigen and molecular) are prone to false negatives in people who have newly become ill, and false positives in people who have recovered, which is, basically, exactly what you do not want. It means testing errors let infectious people wander around thinking they are not infected and stop people from returning to their New Normal lives even after they are not infectious any more. Currently, antigen testing is not accurate enough for use as anything other than a screening test; that might change before the fall, but I think it would be unwise to plan based on that assumption.
All tests are currently expensive (at the time I am writing this, it seems like $40/test is the cheap end of things for PCR; I expect this to continue to drop).
Price can be reduced by pooling samples.
The negative experience of testing (desire for “painless”) can be addressed by testing waste or saliva, instead of swab based tests.
Accuracy is going to take some time for the science to improve; we can plan based on current accuracy and price points and assume that in the fall, the accuracy will be better AND the price will be lower. As long as we do not plan for a particular degree of improvement, we can be certain those surprises will be good ones.
Given the woeful shortfall between what we want from testing and what we have currently, and the total uncertainty associated with what might be possible with testing in the future, I think it is worth taking a step back and considering what purpose is served by testing.
I think basically this is what we all want: free, frequent, comprehensive, accurate and painless. We will take Paid For By Someone Else instead of Free subject to the role conflicts (which can be internal to an individual) described above. Testing would not need to be frequent, if a single test could show immunity forever (so, serology testing one time would be fine, if it was accurate and if immunity was lasting). Comprehensive is a dodgy goal, as many people are expected to resist having to be tested themselves / have their children tested.
Currently, we do not know whether or not immunity is lasting. We also are not sure if our tests for immunity are accurate at all. We cannot currently plan based on a future one-time test for lasting immunity; we might never get that, and we do need to educate our children before they become adults.
Other tests (antigen and molecular) are prone to false negatives in people who have newly become ill, and false positives in people who have recovered, which is, basically, exactly what you do not want. It means testing errors let infectious people wander around thinking they are not infected and stop people from returning to their New Normal lives even after they are not infectious any more. Currently, antigen testing is not accurate enough for use as anything other than a screening test; that might change before the fall, but I think it would be unwise to plan based on that assumption.
All tests are currently expensive (at the time I am writing this, it seems like $40/test is the cheap end of things for PCR; I expect this to continue to drop).
Price can be reduced by pooling samples.
The negative experience of testing (desire for “painless”) can be addressed by testing waste or saliva, instead of swab based tests.
Accuracy is going to take some time for the science to improve; we can plan based on current accuracy and price points and assume that in the fall, the accuracy will be better AND the price will be lower. As long as we do not plan for a particular degree of improvement, we can be certain those surprises will be good ones.
Given the woeful shortfall between what we want from testing and what we have currently, and the total uncertainty associated with what might be possible with testing in the future, I think it is worth taking a step back and considering what purpose is served by testing.