Article Text
Abstract
The UK government has put lateral flow antigen tests (LFATs) at the forefront of its strategy to scale-up testing in the coronavirus pandemic. However, evidence from a pilot trial using an LFAT to identify asymptomatic infections in the community suggested that the test missed over half of the positive cases in the tested population. This raises the question of whether it can be ethical to use an inaccurate test to guide public health measures. We begin by explicating different dimensions of test accuracy (sensitivity, specificity and predictive value), and why they matter morally, before highlighting key data from the Liverpool pilot. We argue that the poor sensitivity of the LFAT in this pilot trial suggests that there are important limitations to what we can expect these tests to achieve. A test with low sensitivity will provide false-negative results, and in doing so generate the risk of false assurance and its attendant moral costs. However, we also suggest that the deployment of an insensitive but specific test could identify many asymptomatic carriers of the virus who are currently being missed under existing arrangements. Having outlined ways in which the costs of false reassurance could potentially be mitigated, we conclude that the use of an insensitive LFAT in mass testing may be ethical if (1) it is used predominantly to identify positive cases, (2) it is a cost-effective method of achieving that goal and (3) if other public health tools can effectively prevent widespread false reassurance.
- allocation of healthcare resources
- COVID-19
- interests of health personnel/institutions
- Policy Guidelines/Inst. Review Boards/Review Cttes
- public policy
Data availability statement
(1) The data cited in this study are available in the cited publically available documents.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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- allocation of healthcare resources
- COVID-19
- interests of health personnel/institutions
- Policy Guidelines/Inst. Review Boards/Review Cttes
- public policy
Data availability statement
(1) The data cited in this study are available in the cited publically available documents.
Footnotes
Twitter @Neonatalethics
Contributors JP conceived and drafted the initial version of the manuscript. JS and DW redrafted and added additional material to later drafts.
Funding DW was supported for this work by a grant from the Wellcome trust 203132/Z/16/Z. JS was supported for this work by a grant from the Wellcome trust WT203132JP DW and JS received funding from the UKRI.
Disclaimer The funders had no role in the preparation of this manuscript or the decision to submit for publication.
Competing interests JP’s research on on this paper was funded by the UK Pandemic Ethics Accelerator Project. DW received funding from the UK Pandemic Ethics Accelerator Project and the Wellcome Trust. JS received funding from the UK Pandemic Ethics Accelerator Project, the Wellcome Trust, and through his involvement with the Murdoch Children’s Research Institute, received funding through from the Victorian State Government through the Operational Infrastructure Support (OIS) Program.
Provenance and peer review Not commissioned; externally peer reviewed.
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