posts: 31529

{
    "id": "wp-31529",
    "slug": "untitled-reusable-block-204",
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                "text": [
                    {
                        "text": "The importance of testing",
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                ],
                "type": "heading",
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                        "text": "Testing is our window onto the pandemic and how it is spreading. Without testing we have no way of understanding the pandemic.",
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                        "text": "It is one of our most important tools in the fight to slow and reduce the spread and impact of the virus. Tests allow us to identify infected individuals, guiding the medical treatment that they receive. It enables the isolation of those infected and the tracing and quarantining of their contacts.{ref}Hellewell et al. (2020) discuss factors that influence the success of isolation, testing and contact tracing on COVID-19 outbreaks. Hellewell et al. \u2018Feasibility of controlling COVID-19 outbreaks by isolation of cases and contacts\u2019, ",
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                        "children": [
                            {
                                "text": "The Lancet Global Health",
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                            }
                        ],
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                    },
                    {
                        "text": ", volume 8, issue 4. Available ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(20)30074-7/fulltext",
                        "children": [
                            {
                                "text": "here",
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                        ],
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                    {
                        "text": ".{/ref} And it can help allocate medical resources and staff more efficiently.{ref}As described by health researchers in ",
                        "spanType": "span-simple-text"
                    },
                    {
                        "url": "https://www.theatlantic.com/health/archive/2020/03/next-covid-19-testing-crisis/609193/",
                        "children": [
                            {
                                "text": "this article",
                                "spanType": "span-simple-text"
                            }
                        ],
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                    },
                    {
                        "text": " in The Atlantic.{/ref}",
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                        "text": "In addition, testing for COVID-19 also informs our understanding of the pandemic and the risks it poses in different populations.",
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                        "text": "This knowledge is important if we are to properly assess the interventions that should be implemented, including very costly interventions such as social distancing and the shutdown of entire regions and industries.",
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                "text": [
                    {
                        "text": "Why data on testing is needed",
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                        "text": "Without data on COVID-19 we cannot possibly understand how the pandemic is progressing.",
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                        "text": "Without data we cannot respond appropriately to the threat; neither as individuals nor as a society. Nor can we learn where countermeasures against the pandemic are working.\u00a0",
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                "value": [
                    {
                        "text": "The number of confirmed cases is what informs us about the development of the pandemic.",
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                        "text": "But the confirmation of a case is based on a test. The World Health Organization defines a confirmed case as \u201ca person with laboratory confirmation of COVID-19 infection\u201d.{ref}See any Situation Report by the WHO \u2013 for example report 71 ",
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                    },
                    {
                        "url": "https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200331-sitrep-71-covid-19.pdf?sfvrsn=4360e92b_4",
                        "children": [
                            {
                                "text": "here",
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                    {
                        "text": ".{/ref}",
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                        "text": "Reliable data on testing is therefore necessary to assess the reliability of the data that informs us about the spread of the pandemic: the data on cases and deaths.",
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                "text": [
                    {
                        "text": "Different types of tests for COVID-19",
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                        "text": "There are many different technologies for COVID-19 testing, some currently available and some still in development. Trackers of the development, regulatory status and commercial release of different types of COVID-19 test are being compiled by ",
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                    },
                    {
                        "url": "https://www.centerforhealthsecurity.org/resources/COVID-19/serology/Serology-based-tests-for-COVID-19.html",
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                            {
                                "text": "Johns Hopkins University",
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                            }
                        ],
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                    },
                    {
                        "text": " and the medical industry news website, ",
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                    },
                    {
                        "url": "https://www.360dx.com/coronavirus-test-tracker-launched-covid-19-tests",
                        "children": [
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                                "text": "360Dx",
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                    {
                        "text": ".",
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                        "text": "Broadly, we can divide these different tests into two kinds:",
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                                "text": "those that test for the presence of the virus, aiming to establish whether an individual is currently infected. The most common way of performing a test of the first type is with a \u2018PCR\u2019 test.{ref}Here you can find",
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                            },
                            {
                                "url": "https://www.youtube.com/watch?v=tgyzdgf66eM",
                                "children": [
                                    {
                                        "text": " a video",
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                                ],
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                            {
                                "text": " that explains how this kind of test works.{/ref}",
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                        "type": "text",
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                            {
                                "text": "those that test for the presence of antibodies, aiming to establish whether an individual has been infected at some point in the past.",
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                                "text": "Currently, we aim to include only these PCR tests in our dataset",
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                        "text": ".",
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                        "text": "We do this for the following reasons:",
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                                "text": "Our focus is on using testing data to help properly interpret the data we have on confirmed cases and deaths. Case confirmation is generally based on a positive result from a PCR test, in line with WHO recommendations.{ref}This WHO ",
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                            },
                            {
                                "url": "https://www.who.int/news-room/commentaries/detail/advice-on-the-use-of-point-of-care-immunodiagnostic-tests-for-covid-19",
                                "children": [
                                    {
                                        "text": "Scientific Brief from 8 April",
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                                "spanType": "span-link"
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                            {
                                "text": " states that PCR tests remain the \u201crecommended method for the identification and laboratory confirmation of COVID-19 cases\u201d.",
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                                "text": "They do not recommend using antibody tests for diagnosis, nor do they yet recommend the use of rapid diagnostic tests based on antigen detection (another kind of test of the first of the two kinds we mention above).{/ref} So including antibody tests in our figures would mean they were less useful for this purpose.",
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                                "text": "Other kinds of test beyond PCR are not yet being widely used. This also means that data on how many of these tests have been conducted is very limited. Including such data in our counts when it is available would reduce the comparability of our data across countries.",
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                                "text": "There are technical differences in how results from these different tests should be interpreted. Current data suggests that other existing testing technologies are subject to very different rates of false positive and false negative results than PCR tests.{ref}As discussed in this WHO ",
                                "spanType": "span-simple-text"
                            },
                            {
                                "url": "https://www.who.int/news-room/commentaries/detail/advice-on-the-use-of-point-of-care-immunodiagnostic-tests-for-covid-19",
                                "children": [
                                    {
                                        "text": "Scientific Brief from 8 April",
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                            {
                                "text": ".{/ref} This is another reason why aggregating the data across these different types of test is not the best way of using testing data to help us understand the epidemic.",
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                "text": [
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                        "text": "Some countries provide clear and helpful data on testing",
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                        "text": "Some countries present comprehensive, detailed and regularly updated data. Iceland (",
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                    {
                        "url": "https://www.covid.is/data",
                        "children": [
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                                "text": "here",
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                        "text": ") is one of these countries. Estonia (",
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                    {
                        "url": "https://www.terviseamet.ee/et/koroonaviirus/koroonakaart",
                        "children": [
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                                "text": "here",
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                    {
                        "text": ") goes even further, showing breakdowns by age, gender and region.",
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                        "text": "For many countries however, available data on testing is either incomplete or else completely unavailable. This makes it impossible for their citizens and for researchers to assess the extent and significance of their testing efforts.\u00a0",
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                        "text": "Our current knowledge of COVID-19 testing \u2013 and more importantly of the pandemic itself \u2013 would be greatly improved if all countries were able to report all the testing data available to them in the way shown by the best examples.\u00a0",
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                "text": [
                    {
                        "text": "We need to understand what the published numbers on testing mean\u00a0",
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                        "text": "Those countries that do publish testing data often do not provide the required documentation to make it clear what the provided numbers precisely mean, and this is crucial for meaningful comparisons between countries and over time.",
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                        "text": "The key questions that any data description on testing data should answer are given in the following checklist. Clear answers to these questions are what is needed to properly interpret and compare published numbers.",
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                        "text": "For citizens to trust and understand the published data and for countries to learn from each other, it is crucial that every country provides the data on testing in a clearly documented way. We hope this checklist offers helpful guidance.",
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                "text": [
                    {
                        "text": "Our checklist for COVID-19 testing data",
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                        "children": [
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                                "text": "1) Is there no data \u2013 or it is just hard to find?",
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                        "text": "Many countries are not yet providing official figures. Others do not do so on a regular basis. The first question to ask, then, is if there is any testing data for a given country.",
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                        "text": "Equally important is to make the available data findable. Currently, the available data is often not easy to find, because some countries are releasing figures at unpredictable intervals in ad-hoc locations (including social media or press conferences).",
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                        "children": [
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                                "text": "2)",
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                        "children": [
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                                "text": "What testing technologies are being used?",
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                        "text": "There are many different technologies for COVID-19 testing, some of which are already implemented, some currently available but not yet rolled out, and some still in development.\u00a0 As we discuss\u00a0",
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                    {
                        "url": "https://ourworldindata.org/covid-testing#different-types-of-tests-for-covid-19",
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                                "text": "here",
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                        "text": ", these different tests are used with different objectives in mind, and there are technical differences in how results from these different testing technologies should be interpreted.\u00a0",
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                        "text": "It\u2019s critical that\u00a0governments provide a detailed and explicit account of the technologies that are being implemented as they get rolled out, disaggregating the test results accordingly. For citizens to trust and understand the published data, and for epidemiologists to incorporate the data into the models that inform public policy, it is crucial that every country provides the data on testing in a clearly documented way.",
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                        "children": [
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                                "text": "3) Do numbers refer to \u2018performed tests\u2019 or \u2018individuals tested\u2019?",
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                        "text": "The number of tests performed is different to the number of individuals tested. The reason for this is that it is common for COVID-19 testing that the same person is tested more than once.",
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                        "text": "Some countries report tests performed, while others report the number of individuals tested.",
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                "value": [
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                        "text": "The source description should state clearly what is counted.",
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                        "children": [
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                                "text": "4) Are negative results included? Are pending results included?",
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                        "text": "It needs to be clear whether or not figures for the total number of tests performed, or the number of people tested, include negative test results, as well as the number of tests that are pending results.",
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                        "text": "Many sources report the number of individuals who are 'suspected' or have been \u2018ruled out\u2019. To be reliably included in test counts, it needs to be explicit whether such categories reflect the number of people who are awaiting test results or have tested negatively.",
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                                "text": "5) Do the figures include all tests conducted in the country, or only some?\u00a0",
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                        "text": "Figures reported by countries may only be partial if not all laboratories are reporting to the central authority.",
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                        "text": "The scope of testing data should be made explicit by the source. For instance, the ",
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                    {
                        "url": "https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/testing-in-us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Ftesting-in-us.html",
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                                "text": "US CDC",
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                        "text": " make it clear that their figures do not include tests conducted in private labs.",
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                        "children": [
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                                "text": "6) Are all regions and laboratories within a country submitting data on the same basis?",
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                        "text": "Answers to the questions above may vary from region to region. In order to assess the reliability of aggregate testing data, it needs to be clear if heterogenous data is being summed together.",
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                        "text": "The ",
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                    {
                        "url": "https://covidtracking.com/data/",
                        "children": [
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                                "text": "US COVID Tracking Project",
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                        "text": ", for instance makes it clear that their US totals combine data for tests performed and individuals tested, depending on which is reported by individual states.",
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                        "children": [
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                                "text": "7) What period do the published figures refer to?",
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                        "text": "Cumulative counts of the total number of tests should make clear the date from which the count begins. The key question that needs to be answered is whether the figures published at some date (attempt to) include all tests conducted up to that date.",
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                        "text": "Because the reporting of tests can take several days, for some countries figures for the last few days may not yet be complete. It needs to be made clear by the source if this may be the case. The ",
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                        "url": "https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/testing-in-us.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Ftesting-in-us.html",
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                                "text": "US CDC",
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                        "text": ", for instance, makes this clear.",
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                        "children": [
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                                "text": "8) Are there any issues that affect the comparability of the data over time?",
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                        "text": ", for instance, makes it clear that not all labs were included in national estimates from the start. As new labs get included, their past cumulative total gets added to the day they begin reporting, creating spikes in the time series.",
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                                "text": "10) Might any of the information above be lost in translation?",
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                        "text": "People accessing data published in a language in which they are not fluent may misinterpret the data by mistranslating the provided text, which often includes technical terms.",
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                        "text": "Many countries report testing data in multiple languages \u2013 this helps disseminate the information to a broader audience, whilst helping prevent misinterpretations.",
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                        "text": "We have started with this effort and will expand it in the coming days.",
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                        "text": "At the end of this document you find descriptions of the data for each country. But in many cases sources do not yet provide the detailed descriptions of the data we would like. All the details we have been able to find so far are provided below.",
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                        "text": " we make our full testing dataset, alongside detailed source descriptions, available ",
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