Here is the entire problem with all the testing at the moment — it is because people are totally uninformed (likely because of internet idiocy and panic that the government is fomenting). In order to have a valid test you have to know what you are testing for. You also have to know how the tests work.
So briefly:
1. Omicron is a URI not an LRI like wild type and delta. That means that the upper respiratory tract should be assayed to have the highest possibility of a valid test. The upper respiratory tract is the most distal part of the nares or the throat (upper respiratory). Although somewhat paradoxical deep nasal swabs are more considered indicative of the lower respiratory tract because deep swabs are beyond the initial immunological structures of the upper airway
2. Because of this — it is entirely likely that home swabs where people are not actually really getting into the nasopharynx (it is very uncomfortable) are getting upper respiratory swabs where you would find omicron. So going and getting a deep swab may infect be negative. Its not where the virus is.
3. We would have to go to the source of the tests for the home tests to examine the (+) predictive value and the (-) predictive value of the test to determine how it is skewed from a bayesian statistical inference. My guess is the home assays and antigenic assays are probably pretty sensitive — meaning that they will preferentially not miss a positive in exchange for a false positive rate that is higher — but that is just a guess
4. As for the PCR, there is a lot of incorrect information that it returns false positives. It returns true positives (either the RNA is there and amplified or not), but the (+) may simply not be all that clinically significant. As I and others have said, PCR (+) at 12 weeks occurs a lot as there are dead partial virons still being cleared. Those particles have amplifiable RNA and therefore turn the test (+). But so what? That is the question that has gotten away from us. It is not exactly a difference without distinction — it is not truly a false positive, it is an irrelevant positive.
5. Testing because of panic has become a total nightmare. Why in the world are we testing for a disease that as we evolve knowledge at the same time is 3x more contagious, but causing 2/3 less hospitalization. In other words a ninefold decrease in severity. And I think that is an underestimate. In the hospital where I work I have had 10 or 11 (+) tests for a procedure where the patient was admitted for something else and shocked to find they had Omicron. The question becomes — so what?
6. We are essentially now able to name a common cold syndrome and have known forever that corona viridae cause URI as well as LRI — so we can name the URI. Because it appears to be entirely self limited — who cares? The only reason to get a medical test is to alter a treatment pathway. This is not why people are being manically tested for Omicron — its about the fear.
Looking back historically in the last H1N1 when Obama was president and Biden was VP, they simply stopped testing (I think it was around 2010) and that ended the worry and the clamor. H1N1 was particularly nasty and caused a lot of problems for Middle Aged adults and the younger set. But the political environment necessitated that the conversation be stopped. Now the democrats in power are governing based on the usual liberal ideas of fear and control, so there is no way this will stop — at least until rational people finally start asking why the hell we are testing like this — who cares?
It seems me that the decoupling of fear and information is occurring — we have over half a million cases, the power set are trying to drive a control theory, and people are not biting. Consider the Chicago Teacher Union — they are stopping school, but being criticized for the same. Something that is very rare for a liberal union in a liberal city.
People are slowing coming around. But we must and should be guided by what is instead of what we would like to be.
Great post. I especially like this part:
“ at least until rational people finally start asking why the hell we are testing like this — who cares?”
I have said this from the very beginning. The only numbers that ever mattered to me were hospitalizations and deaths, not case numbers, and especially when testing asymptomatic people. That has never made any sense other than the politics of it. It may have made sense in January or February of 2020, and maybe even March, but once it was really in the wild, the contact testing was uncalled for.
Thanks for the information.
Personally, if I was sick, I’d like to know what I’m dealing with. I’d probably treat myself differently knowing I had Covid vs the Flu. So I’m not against testing or home tests.
I read and I think Dr. John Campbell (UK) addressed this as well, that nasal swabs are testing negative but throat swabs are testing postive with Omicron.
There is also some speculation that Omicron is triggering other illnesses or conditions to become more severe. Reports of people with Diabetes being pushed into Ketoacidosis. Not sure how valid that is. But it’s something that needs to be looked at.
In June 2020 when things were opening up and the numbers were going down, I wish that Trump had also just said …. stop testing.