Balance of Risk in COVID-19 Reveals the Extreme Cost of False Positives
COVID-19 public health responses, including lockdowns and diagnostic testing strategies, have had consequences. Economic costs (see the CHD paper in this issue) could reach $16 trillion dollars, 90% of the US annual GDP. While harm to small businesses, unemployment, worsening poverty, death from cancer, increased suicides, social isolation, and restriction of freedom all increase the perceived need for drastic responses from the top, flawed measures are costly. A diagnostic assay of tests for COVID-19 depends for its validity on its sensitivity and specificity assessed in terms of the true positive rate (TPR), false positive rate (FPR), true negative rate (TNR), and false negative rate (FNR) of the assays. In this pandemic, Real Time — Polymerase Chain Reaction (RT-PCR) testing has been relied on for drastic top-down responses (as in shutting down the economy of whole nations or the entire world). Here I focus on false positive results where RT-PCR testing suggests many infections by SARS-CoV-2 where there are none. I show by mathematical modeling how reporting positive results of RT-PCR testing, ones known to be false in a measurable percentage of instances, is at least 40 times more impactful (in a detrimental way) than increasing or decreasing the number of tests conducted. To balance the risks of errors in diagnosis, false positive results must be minimized by validating nucleotide sequences and estimates of viremia to avoid flagging individuals as contagious when they are not.
Copyright (c) 2021 James Lyons-Weiler
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
The copyright for materials in this journal, IJVTPR, is owned by the author. The author, however, grants first right of publication to the journal, IJVTPR and assures the editorial staff of the journal that the work submitted has not simultaneously been submitted to any other journal, nor is it under consideration for publication by any other journal. If any portion of the work submitted has appeared elsewhere, the quoted material is properly cited and credit is given to the original publisher. The submitting author (or the principal and corresponding author of the work) also assures the editors of IJVTPR that he or she has obtained all required written permissions from any quoted authors or publishers of quoted materials. The submitting author also agrees to hold IJVTPR and its editorial staff harmless from any infractions of copyright law that may be discovered at any time in the future in the submitted work. The author assures the editorial staff at IJVTPR that none of the work submitted is plagiarized, and that any recycled or precycled material by the author is identified as such with proper credits in the text to any other parties holding a copyright interest in the quoted material.