Fast results are one thing but accuracy is another.
The Abbott Lab test takes only 15 minutes. But what about accuracy?
Please consider Abbott’s Coronavirus Test Falls Short of Rival Device.
The study involved 101 emergency-room patients who were referred for testing at the hospital during a three-day period. For each patient, two swabs were taken. One swab was tested using a device the NYU lab had already validated, Cepheid’s GeneXpert, which takes about 45 minutes to complete a test. The other swab was taken using Abbott’s recommended method and tested in the ID Now.
The GeneXpert detected 31 positive cases among those samples. By contrast, the Abbott device detected only 16 out of the 31. “The remaining 15 samples were falsely negative,” the authors reported in the study.
In another portion of the study, the authors examined 15 positive specimens that had been stored in a liquid on both devices, finding that the ID Now missed one-third of those cases. Last month, Abbott changed the ID Now’s instructions to warn against using the preservative, which it said had contributed to earlier concerns about test accuracy.
In April, The Wall Street Journal reported that several lab directors said the Abbott ID Now was producing false negative results using samples stored in the preservative as much as 25% of the time.
25% to 50% False Negatives
But consider the advantages.
- ID Now is a very catchy name. GeneXpert? Come on.
- Faster Results – 15 minutes vs 45 minutes
- Fewer Reported Cases
That sounds like triple bragging rights.
Mish
Very informative and fantastic bodily structure of content material , now that’s user friendly .
I had one of these tests. The techs that did the testing had training the day before. I tested negative, imagine that. I am pretty sure that I was negative as I have been vigilant in attempting to not get this virus.
Mish, I have discussed generally our SARS-CoV-2 testing in my department (molecular) through email a few times but this story is very close to my work. I run a Panther Fusion rtPCR assay for Cov2 and it is an excellent assay yet the accuracy comes at a cost in time (about 2.5 hours). However PCR is a standard for viral amplification/detection. Another department used the GeneXpert and it was very good also for a 45 minute test. You need time (cycles) to amplify RNA to a detectable level. That is critical if there is a low dose infection or the source of the collection is sub-optimal. A viral infection can easily be missed just on the collection site and how it is collected (following guidelines by manufacturer of swabs/VTM/UTM). I would not trust any 15 minute test and would expect a lot of missed positive just due to low a cycle times.
As for a catchy name, in a laboratory nobody cares. Cepheid sells analyzers based on performance and probably price. I would still prefer mine done on at least a 2 hour rtPCR (or standard PCR).
Note: I do not disclose my company as the opinions are mine and not those of my employer (so there is no point).
I was curious about the efficacy of Remdesivir now that they are using far more widely for several weeks. I found this story and it gives hope, if the bureaucratic mess in DC can just get out of the way.
To sum it up, Remdesivir is complicated to make, expensive, and toxic beyond relatively low doses, yet, most of it is converted into a compound called GS-441524 in the bloodstream anyway. This article points out that GS-441524 is the precursor to Remdesivir and is already long been shown to be up to 96% effective in animals with other coronaviruses. It is easier/cheaper to make, and can be safely given in doses up to 1,000 times as large as Remdesivir without any side effects or toxicity. And evidence says your body is changing the Remdesivir into GS-441524 anyway. That appears to be the active healing ingredient. While the other factors in Remdesivir are the toxic ones that limit dose.
And so how many more will die before they decide to use it on the population? Well of course the answer is Remdesivir is far more profitable.
NOTE: “The attractive profile of GS-441524 from both manufacturing and clinical perspectives raises this question: Why hasn’t Gilead opted to advance this compound to the clinic? We would be remiss for not mentioning patents, and thus profits. The first patent on GS-441524 was issued in 2009, while the first patent for remdesivir was issued in 2017.”
Drug patents are good for 20 years. Gilead would see the loss of it’s monopoly on GS-441524 in 2029, where the patent on Remdesivir runs till 2037. Folks, they have given cats GS-441524 which was a death sentence for feline covid that attacked hearts and now more than 96% of infected cats recover. Maybe the answer to surviving this pandemic rests with making friends with a Mexican veterinarian.
Awesome choice of title for the post!
Words get thrown around so loosely that one must wonder about the pitchers.
Using “accurate” colloquially: If Mish’s take on the story is accurate, then this test is very accurate. Because we can suppose (for omission reasons) this test doesn’t mislabel someone without C19 as having C19.
“Accuracy” of test such as this has a specific meaning: (tp + tn) / (tp + tn + fp + fn) where “f” is “false” and “t” is “true”.
The WSJ article is behind a paywall, so I can’t see the TP, TN, and FP numbers.
As@Sechel points out, a FN rate of 48% isn’t necessarily a bad thing. It’s not ideal, to be sure. But if TN is 0%, then you may have a very, very useful test – if it’s cheap and/or quick and/or has some otherwise desirable quality, for instance.
The picture at the top of the article is from March 30th but you should know that Trump had the Abbot device up there next to him again just a couple of days ago in his press conference.
Also next to him during the press conference he had a giant sign which read “America leads the world in testing”. This of course is totally misleading because while yes, we may run the most tests in absolute numbers but that statistic is completely and utterly meaningless. What actually counts is per-capita testing in which the US is far behind on.
That was the same press conference BTW where he also told an American journalist of Chinese heritage to send her questions to China rather than him.
Oh my Lord, what a moron he is. Really, it would be good for him to just shut up and not say anything about anything.
Yes, there is some positive CV19 news!
Fear Of Contracting Coronavirus Propels Some Smokers To Quit
May 14, 20205:00 AM ET
I read a study from Europe that suggested that smokers were less likely than non-smokers to catch Covid19, however, if they did catch it, the outcome was much worse. The study suggested that nicotine binds to ACE2 receptors, making them unavailable for SARS-COV2.
Of course. Welcome to the internet where all things exist at all times!
My commute to work has been a very big positive!
Snake oil from the snake oil salesman in chief.
When it gets serious, you have to lie. And with Trump, it’s ALWAYS serious.
Sounds pretty bleak for the false negative rate in the current version of the Abbott test, but I wonder about the false positive rate in the comparator test and the overall rate of positives. If it’s something like a 2% false positive rate and a true 1% COVID prevalence in the sample, then most of the reference test’s positives are false positives. In such a case it would be a mark of a good test if it “missed” those.
Every swab test, from the beginning to the present, has has a high false negative rate. I remember early on cases from China where they tested people 7 times, very certain that they had Covid, before they finally tested positive. That said the Abbott test may be worse, if they have 48% false negatives. 25% is more normal.
The blood tests for antibodies are much more accurate (well, some of them). The antibody test from Quidel claims a 0.7% false positive ratio. Quidel also has a quick test for the swabs, too. I suspect that it has a 25% false negative ratio, just like everyone else.
The Abbott, test, by the way, is the one that Trump uses to test people before he will meet with them.
Faith-based science. Perfectly normal in these Trump-Pence times.
Article fails to mention that the sample acquisition and handling was not in accordance with the test protocol procedure. This should be retracted until the test is performed in accordance with the test procedure instructions.
cheaper to flip a coin almost as accurate
Would’ve expected a lot better from Abbot Labs.
I was charged $49 for a finger stick antibody test that came back negative on May 1st but really question it’s accuracy. I was sick for 15 days in March with what on paper pretty much had to be Covid, and as of last night am sick again, same list of symptoms. This country cannot get it’s collective shit together and we are going to fail to manage this to the point where we will not have to choose between an economic collapse/depression and a major pandemic with needless death and suffering because we are going to get BOTH!
Sorry to hear that.
Get well.
Seconded, sounds terrible. We are Amazon – tons of choice but the quality control is lacking.
Get well soon.
The antibody tests are far more accurate than the swab tests for an active infection. The best ones have a false positive ratio of 1%, and a false negative around 10%. The swab tests are all off by as much as 25%. A person will not test positive for IGG until at least two weeks after they completely clear the infection, however.
I have to be retested this time with a nasal swab at 9 tomorrow and I will keep you all posted.
So, I am certainly sick, had a good day, but now back to being ill. I think that they put in all that fluid and it really helped till the fluids were peed out. I just can’t stay hydrated nearly well enough. But whatever I am sick with is miserable in it’s own right. And whatever I was sick with in March had me in bed for 15 days as well. So, in the midst of a deadly pandemic in two months I have been damn good and sick twice and neither were the virus causing the pandemic. Yet it is documented by the ER I am sick with fever and all.
I must be the luckiest guy alive eh? And STILL vulnerable to a bug I have no immunity to.
Of course the results could be a false negative. If I had something else in March then that negative would be accurate. I can’t believe we are pinning our safety onto such flawed tests that by the way are making several company’s shareholders obscenely rich.
Good luck. I hope it’s negative, but based on your description, it very well may be positive. If it is positive, at least you’ll know, and you can get treatment for it, and hopefully kick it for good.
Thanks Carl, but if they are using the Abbot Labs ID test there is at least a 30% chance the result will be wrong if I do have it. That is really not comforting, a negative result can bar you from getting the early needed treatment.
Just out of curiosity, now that they have been using remdesivir for a while what is the consensus as to its efficacy? Is it actually helping? There was a lot of noise about it a few weeks ago but now they have been using it for a while I have heard nothing about the promise they were braying about and which sent the Dow 3,000 points higher.
All the swab tests have a 25% false negative rating, unfortunately. I think it has to do with the swab process more than the actual test. Sometimes the swab hits the jackpot, and sometimes it doesn’t.
As for Remdesivir, the one study that was positive was barely positive. It showed a decrease in the time to recover of 3 days, but no significant decrease in the death rate. The current regimen seems to be an antiviral while the symptoms are mild, and moving to anti-inflammatory, antioxidant, and anti-coagulant if the symptoms are more advanced. Without a prescription, you will have to do without the antiviral. You can take NAC as an antioxidant and a mild anti-coagulant, if you like. NAC is actually undergoing trials at the moment, and it’s cheap, safe, and readily available.
So Carl, my test results are back, I am negative for Covid, at least I was negative when they tested me, the state of that emergency room was pretty um, well let’s say I have seen cleaner bus stations. It was the IGG rapid.
Antibody testing is very different than the process used for testing active disease. It uses an immunoassay process which generally tends to produce very reliable results (assuming enough time has passed of course for antibodies to show up in the blood).
Carl, my Covid swab has not come back yet but I am pretty sure what I have been sick with is not Covid, because I was in the ER Friday night till 4 in the morning Saturday. Then all day yesterday and last night I had a bad time of it, thought about going to the ER in Tampa. But, I woke feeling much better this morning, still not well but certainly not going to die, so from first throat tickle on Wednesday to having broken the worst of it on Sunday morning can’t be Covid right? I must have some regular flu bug. That is the theory of the ER doctor that discharged me.
Although, if that is the case it is a nasty bug in it’s own right.
And it still leaves me at risk. I should know when the swab comes back tomorrow or the next day.
I know here in Florida it was on the news that Adventist Health (I think they said) is terminating it’s contract with the company that has processed their tests due to unreliable results. This tells me that they found serious enough deficiencies in the handling of the tests that the tests we unreliable, and they had a contract, so that means they would not have backed out without a lot of evidence of the truth of that.
I am also wondering if the strain of Covid on the east coast is not way different from that of the west coast. When I look at the maps showing the cases nationwide it appears that the east coast is far and away more heavily hit than the west coast in spite of the fact that the west coast had circulating cases well before the east coast. Not only a much higher incidence (communicability), but a more severe version with more critically ill and more dead.
Had it just been New York you could ascribe the disparity to population density, but it is not just New York and the greater mega urban region from DC to Boston. The whole eastern seaboard from New Hampshire to Miami is now much more affected, with a huge case load and
enormous increase in the southeast, Georgia is very hard hit.
If you recall the early development of the pandemic in America you know that it started in the Seattle/Vancouver BC region. One thing you should know about that area (especially BC in Canada) is there is an out sized number of Chinese property investors, Canada has encouraged such investment way more than the US has with much more lax immigration rules. Most of those Chinese investors were absentee, but they have bought in BC because it is their form of fall back prepper property investing in case of a Chinese crisis, mostly they were thinking political crisis when they bought up half the city of Vancouver, but this will work too. A lot of wealthy Chinese bugged out for Canada after Wuhan was shut down but before North America placed it’s minimal restriction on their arrivals. Statistically some had to have brought virus directly from China.
On the other hand, the start of the spread of CD19 on the east coast was from Italy and the Alps where travelers brought it from Europe. The first identified cases in New York were travelers who had vacationed in Italy/Alps. That bug along the way had gone through among other places Iran and other ME nations. While they all had the same origin there could be just enough mutation they picked up along the way that they are for all intents two different epidemics. I think it is possible that the blood antibody tests for Covid are missing some (perhaps a lot) of west coast cases. So it is not that the west coast version is a lot less contagious or that west coast people are a lot better at avoiding the bug, but that when they are tested their version just is not being picked up by the test nearly as much as in the east.
Our blood has a lot of antibodies in it, so tests for finding one antibody has to be by nature very specific and very sensitive to exactly the one they are looking for. And we already know that the design of those early tests were both rushed and flawed. The early original tests were testing for three different bugs and one of them was such a disaster that the tests were missing a majority of positives. They then came out with a new test in a matter of just a few weeks. Could it not also be flawed? Picking up positive results on the east coast but missing a lot of positives from the west?
I was sick for about 15 days in March on the west coast in Oregon with SOMETHING that on paper reads like a textbook case of Covid. But I was tested in early May for antibodies in Florida. It came back negative which really threw me for a loop. It meant I was still at risk and had to tighten up my defensive measures. Then I got really sick again last week and thought oh shit. But now I seem to be mending. Maybe I got it twice but one a west coast version and one east. There are cases of people who are documented as having it twice already though the time has been short and I think they suppress such stories because they want the public to think once you had it you are immune. It gives people hope and allows for reopening the economy when people think they have immunity.
Yesterday the Navy reported that more than a dozen people known to have had the bug and were completely recovered by rigorous standards which included two negative Covid tests are now testing positive again and that is aboard just one ship, the USS Theodore Roosevelt. “The Navy has since confirmed to NPR that an additional eight sailors have retested positive for coronavirus, bringing the total to 13.”
So, maybe I did have it twice, once out west, and now once in Florida, and while the second was worse than the first is was also beaten back quicker. Possibly because my immune system is not some government flawed lab test. Maybe my immune system allowed a second infection to get in but then recognized it much more quickly than the original version. After all, part of what made this pandemic so dangerous was that the virus was utterly new and nobody had any immunity to it. But once you have had it the bug is no longer new to you. You have some immunity to it. For the same reason you can get colds twice in a year (or more), or the flu a dozen times in your life, your immune system does not perfectly block out all virus the moment it gets in. It does however mount a defense once it stumbles upon something it recognizes before that has a chance to kill you. But they do still get in and start replicating before the response removes it. Otherwise flu, maybe even colds would kill people. If a cold or flu virus was completely unknown to any immune system it would likely result in a deadly pandemic as well. In fact that is probably what happened in the Spanish flu in 1918. It was a flu, but just different enough that people had little protection.
Some epidemiologists believe that is what happened with HIV as well. HIV enters and hides out the same way bubonic plague does. And some studies indicated that a minority, but statistically significant sector of the population has had immunity to HIV because they are descendants of survivors of the Black Death. That there is a mutation in the pathway the two infections used that blocked both. Some people not only seemed immune to the plague they actually got sick with it and survived, that specific antibodies have been passed down through the subsequent generations. Mothers do pass on antibodies in breast milk. Particularly the first few feedings in which the milk is full of colostrum which is thought to be the primary pathway for immunities. My mother could not feed me because of a kidney infection and I have suffered ear infections all my life because of it, one of the known effects of not breastfeeding. But I also did not get AIDS when all around me my community was in the late seventies and eighties, and I was a healthcare worker with known exposure, yet still did not get the virus. I think it had to do with the legacy of immunity dating back to the plague since my family is from the British Isles going back more than a thousand years. It would have only taken one ancestor (female anyway) to impart that immunity to all (most of) her descendants.
So, the upshot is we still have an encyclopedia worth of knowledge to yet learn about immunity and infections.
This is very depressing. China is testing 11 million people in Wuhan this week and we can’t get tests that work and we still lack testing supplies. A killer virus is paralyzing our society with fear and our economy will never recover while the virus is still spreading. We have already spent Trillions on this virus and we still lack testing. My friend tried to get a test yesterday and was told she can’t unless she has severe symptoms or is a front line worker.
And Chinese tests may be no more accurate. How do we know? Why the constant jump to foreign good domestic bad? This stuff ain’t easy, otherwise I’d be doing it in my garage.
You can be pretty confident Chinese tests are more than “50% accurate.” The whole country of a billion and a half, would look like Wuhan in March otherwise.
Of course, “American” tests are also a lot more “accurate” than this one.
It’s not like American labs can’t perform proper tests. Rather, it’s an issue of leadership; instead of doing hard, useful work; mindlessly promoting speculative (at best..) silliness and hype.
It’s not just Trump, either. Rather, it is a result of the sort of people who rise to the top, in purely financialized dystopias like the current US: Mediocre yahoos promising and selling mindless hype. Where people are indoctrinated to blindly believe, that if only some illiterate “billionaire” somewhere, grandstands and promises to “invest” in something neither he nor anyone else understand one lick of, it will just magically appear and somehow work.
It’s what is bound to happen in a system arranged such that the downright stupider you are, the more wealth, and hence influence and decision making power over how resources are deployed, you are handed. America in the DumbAge is smart people working FOR idiots. Scientists working for illiterate “investors.” Engineers working for ambulance chasers and politicians. And everyone paying usury rent to straight up retards, who “invested” in falling down shacks which would be torn down and rebuilt into 10x their current size, and quality; were it not for a totalitarian junta banning people from doing so.
Everything is hyped, yet nothing turns out to work. And the latter doesn’t matter one iota to the idiots making the decisions. Since, after all, they are paid by way of forced wealth transfers from those more competent than themselves. Undertaken by The Fed and Government. Not by their success at doing something requiring even minimal levels of competence.
Trump is just the tip of that Iceberg of undifferentiated celebration of self promoting incompetence.
Chinese tests were reported to have a 25-40% false negative rating as well.
Judging by the current official infection stats out of China, I suppose the testing protocol they are using now is close to 100% false negative!
Simple question- do you believe the US is doing enough testing? Do you think we are the best in the world at it? Just the facts please as to why you think we are doing so well?
st peoof ths.
My state keeps emailing me offers to come in and get tested, even though i tell them I feel fine, have no symptoms, and have no known exposure. If you want to know if your state is doing enough testing, look at the percentage of deaths to cases. If deaths are over 2-3%, they are not doing enough testing.
Modern technology has its limits. Are we asking too much? Expectations too high?
Choices are few but I still wouldn’t buy it if I were in charge.
Wouldn’t buy a car or toaster oven that didn’t work 25-50% of the time either.
Embarrassing and pathetic.
Sidenote on Spanish figures, a very rough overview:
270 000 PCR cases
27 000 fatalities (all the above cases not closed) giving CFR of somewhere 10 to 15 %
2 000 000 (something over that amount) estimated to have been infected after immunological study, which is 5% of population.
That gives an IFR of 1 to 2 %
These are rough figures subject to all the usual errors, and without segregating age or any other parameter which might provide a better understanding. They just narrow down the frame of reference somewhat to what is occuring.
Same in Spain?
Wirepoints analysis reveals 92 percent of Cook County COVID-19 victims had pre-existing conditions – Wirepoints
May 11, 2020
A Wirepoints analysis of COVID-19 deaths from the Cook County Medical Examiner’s office reveals that 92 percent of victims from the virus had pre-existing medical conditions.*
The medical examiner’s database showed COVID-19 as the primary cause of death for 2,303 people. Of those, 2,112 were shown to have at least one underlying condition as a secondary cause of death. Those conditions, also known as comorbidities, included hypertension, diabetes, obesity and heart disease. There were no secondary causes reported for 191 deaths.
….
I’m not up to date for that in Spain, but I know those who are weak in whatever way make up the main part. So a quick search shows 90% of fatalities over 70yrs of age in Spain, for example.
It is a muddled subject , of or with the virus , or sequelae etc.
There is a fraction of people also who are young or fit (some old people are fit) , who had no reason at all to succumb to the virus (because it works both ways, comorbidity doesn’t just mean someone was waiting to catch a flu or something) , if we put that all at 10% that gives an IFR for “averagely well people” of say 0.1% to 0.2% (it could easily be higher for various reasons, maybe double or even triple that range) , how that is viewed depends on the person I guess.
Then there is what is unknown of the virus, immunity, sequelae etc. to factor in.
Not trying to say one thing or another really… protect older people or infirm , be sensible because the virus is still dangerous to others, not worth catching or spreading etc.
That is as far as is known to now, I’m more cautious even, because the way the virus acts on people (it can attack them in various ways) means it has a potential to become more dangerous.
There is only so much any person can do to avoid catching and spreading the virus, depending on their circumstance, but I don’t see anything wrong with measures that don’t much infringe on the main facets of our own freedom. Had people over 70 been isolated, fatalities would be a tenth of what they are, but it would have been called cruel I suppose.
It’s a no win reality, an obstacle course, that we have to work our way through now, with or without measures and restrictions. Even if someone is now immune they are going to find the society they live in in a disturbed state for quite a while.
This seems to be increasingly common world wide. Whether ventilators that do more harm than good (apparently sleep apnoea machines are often more useful) or dodgy PPE. Now we have this machine giving false results yet still out in the marketplace. Could it be relaunched as a machine for testing ‘snake oil’?
I have been questioning in my own mind the wisdom of ventilators to bump up O2 levels in these patients, at least till they are at the point of death without them. My father was on O2 with COPD and he was so scared to sleep that he might not wake he was a mess. They gave him Ambien (not sure but he was on a sleeper) which he refused to take because he was so scared to sleep and never wake up. When they found his body he was partially undressed and had turned up his O2 tank full blast and that in turn shut down his body’s natural breathing impulse, if you get an over supply of oxygen this can happen, your body says I have more O2 than I can use so it stops taking in more, it shuts off your breathing. For my father the cause of death was respiratory failure, but what caused it was his oxygen machine at an inappropriate level.
I am so sad for that outcome, Herkie. May you find comfort and peace.
Thanks, by the time he died we were not really friends. In fact we had a small short row a few days prior in which I asked him if was THAT miserable why doesn’t he just hurry up and die. Of course he straight away told my toxic evil sister and she made sure the whole county knew it. According to her my last words were why don’t you hurry up and die, entirely out of context. That is okay, we cannot control what others say or think, but we can isolate ourselves from those toxic infectious people we do not want poisoning our lives.
It’s not called The Age of Incompetence for nothing.