ABSTRACT
Testing for SARS-CoV-2 internationally has focused on COVID-19 diagnosis among symptomatic individuals using reverse transcriptase polymerase chain reaction (PCR) tests. Recently, however, SARS-CoV-2 antigen rapid lateral flow tests (LFT) have been rolled out in several countries for testing asymptomatic individuals in public health programmes. Validation studies for LFT have been largely cross-sectional, reporting sensitivity, specificity and predictive values of LFT relative to PCR. However, because PCR detects genetic material left behind for a long period when the individual is no longer infectious, these statistics can under-represent the sensitivity of LFT for detecting infectious individuals, especially when sampling asymptomatic populations. LFTs (intended to detect individuals shedding SARS-CoV-2 antigens) validated against PCR (intended to diagnose infection) are not reporting against a gold standard of equivalent measurements. Instead, these validation studies have reported relative performance statistics that need recalibrating to the purpose for which LFT is being used. We present an approach to this recalibration. We derive a formula for recalibrating relative performance statistics from LFT vs PCR validation studies to give likely absolute sensitivity of LFT for detecting individuals who are shedding shedding SARS-CoV-2 antigens. We contrast widely reported apparent sensitivities of LFT with recalibrated absolute sensitivity for detecting individuals shedding SARS-CoV-2 antigens. After accounting for within-individual viral kinetics and epidemic dynamics within asymptomatic populations we show that a highly performant test for SARS-CoV-2 antigen should show LFT-to-PCR relative sensitivity of less than 50% in conventional validation studies, which after re-calibration would be an absolute sensitivity of more than 80%. Further studies are needed to ascertain the absolute sensitivity of LFT as a test of infectiousness in COVID-19 responses. These studies should include longitudinal series of LFT and PCR, ideally in cohorts sampled from both contacts of cases and the general population.
ABSTRACT
The COVID-19 pandemic in China in the winter-spring of 2019-2020 has decreased and even stopped many human activities. This study investigates whether there were any changes in the water quality of the Lower Min River (China) during the lockdown period. The time-series remote sensing images from November 2019 to April 2020 was used to examine the dynamics of the river's total suspended solids (TSS) concentrations in the period. A new remote sensing-based prototype was developed to recalibrate an existing algorithm for retrieving TSS concentrations in the river. The Nechad and the Novoa algorithms were used to validate the recalibrated algorithm. The results show that the recalibrated algorithm is highly consistent with the two algorithms. All of the three algorithms indicate significant fluctuation in TSS concentrations in the Lower Min River during the study period. February (COVID-19 lockdown period) has witnessed a 48% fall in TSS concentration. The TSS in March-April showed a progressive and recovery back to normal levels of pre-COVID-19. The spatiotemporal change of TSS has worked as a good indicator of human activities, which revealed that the decline of TSS in the lockdown period was due largely to the substantially-reduced discharges from industrial estates, densely-populated city center, and river's shipping. Remote sensing monitoring of the spatiotemporal changes of TSS helps understand important contributors to the water-quality changes in the river and the impacts of anthropogenic activities on river systems.