The more tests, the less basic

rights... Statistics for advanced

users
translated by Corona InvestigativeAugust 28, 2020

Update 29.07.2020: And again, the RKI provides a prime example

for a (formulated in a value-free manner) not unproblematic handling
of the numbers generated by himself - Lothar Wieler is "concerned
about rising infection numbers" (DLF 28.07.2020), which we still do
not know in Germany. Also Wieler only knows the numbers of positive
test results - they are actually increasing, but so is the number of tests
performed, and they are increasing massively (see below)... .
The portion of positive test results of their total number rose in the
week 30 nevertheless slightly, lies thereby in addition, only so highly,
as before approximately 4 weeks and measured at international
yardsticks in the ultra-green range...
And the probability that a positive test result actually means an
infection is still low: only about one in five positive tests actually
shows COVID-19 correctly...
(Source: RKI Situation Report 29.07.2020)

Update 23.07.2020:
 With the specificity from the INSTAND interlaboratory comparison
(see below) of 99.3%, it is still not possible to calculate meaningful
figures - a publication from June, in which Christian Drosten, among
others, participated and which examined the specificity of RT-PCR
under conditions of "real" (laboratory) life (Matheeussen 2020),
resulted in a false positive rate of 0.58%. If this is taken as a basis, the
above figures are obtained.
But of course, the same applies to the RKI as the Bavarian LGL freely
admitted: whether testing is done with one or two targets, whether
positive results are cross-checked... All this is not known in Berlin at
the RKI as well as in Erlangen at the LGL.
________________________________________________
Update 28.06.2020: Meanwhile, the total positive test results of RT-
PCR are regionally so low that they cannot be brought into agreement
with the specificity of the INSTAND interlaboratory test (99.3%) -
what can be the reason for this?
RT-PCR can in principle detect two different gene sequences
("targets") for SARS-CoV-2 and, if both sequences are detected in one
sample, achieves specificities of almost 100%.
However, in a publication of March 19, 2020, the WHO has decreed
for regions affected by the pandemic that the detection of only one of
the targets is sufficient for the sample to be found "positive": "In areas
where COVID-19 virus is widely spread a simple algorithm might be
adopted in which, for example, screening by rRT-PCR of a single
discriminatory target is considered sufficient. (WHO 19.03.2020) This
results - due to the missing double determination - naturally in a
significantly lower specificity and thus a significantly higher rate of
false-positive results.
 This generous offer of the WHO was of course accepted by numerous
laboratories (fewer determinations means: less costs), the MVZ
Augsburg even got an article in an Austrian newspaper (Wochenblick
17.05.2020) via its blog entry of 03.04. (the entry has been deleted
from the laboratory's blog in the meantime, but was definitely still
there on 18.05.)
It is not known how many laboratories issue positive results for the
detection of one target, how many determine both targets from the
beginning and how many at least positive tests with one target are
then checked with the other (retesting as described in the article of the
NZZ below) - this double determination or retesting obviously
increases the specificity relevantly beyond 99.3%.
To which value? Here RKI, PEI & Co are silent... .
________________________________________________
Update 15.06.2020: Here you can download a small Excel-calculator
to calculate the number of false-positive test results from the RKI's
figures on tests and positive test results and see how other values for
sensitivity and specificity affect these figures. You can then also see
(via the PPW) how low the significance of a positive test result is at
present.
And here - from minute 13:10 - you can see that the (very obviously
difficult) topic has meanwhile even reached the Federal Ministry of
Health:

You ask - Federal Minister of Health Spahn answers | Follow-up report

from
Berlin_______________________________________________
_
Update 12.06.2020: Applying the considerations on PCR tests listed
below to the test numbers currently reported by the RKI results in the
following picture:

This calculation (which, for methodological reasons, only indicates

orders of magnitude) is based on the following assumptions:

 An average specificity of the tests of 99.3% (Zeichhardt 2020)

 An average sensitivity of the test of 70% (Kucirka 2020 - this work

finds during the symptomatic phase of COVID-19 (and in this
phase is tested in Germany) sensitivities of PCR tests of 60-80%)
Interesting aspects of the calculation are (KW 24):

 With 330,000 performed tests of suspected cases of COVID-19 (i.e.

a pre-selected population group) only about 1 of 300 tested
persons was actually ill. This would correspond to a prevalence in
this group (!) of about 0.31%.

 It can definitely be assumed that this rate is significantly lower in

the normal population.

 The overwhelming majority of positive test results are false-

positive, i.e. they are found in people who are actually healthy.

 Under these assumptions, a positive predictive value of only 24%

results - i.e. the probability that a test result that is positively
collected in week 23 actually still indicates COVID-19 disease is
less than 25%, the probability that it is a false positive result is
over 75%.
  This value, too, is - since the absolute number of false-positive
tests is included in its calculation - strongly dependent on the
number of tests: the higher the number of tests (with the same
proportion of positive results), the lower the significance of the
positive result/ PPV.
________________________________________________
If you use a test to search for a disease or pathogen in a population,
there are two goals:

1. The test should reliably find all those who are really ill/infected,
i.e. not to overlook anyone - this is called the sensitivity of a
test.
2. The test should reliably find only those who are really ill, i.e. who
are not positive in anyone who is not ill/infected - this is called the
specificity of a test.
The sensitivity and specificity of a test are its characteristics and are
usually documented and published (at least to a professional
audience) as part of the regulatory approval process.
All test procedures suffer from two dilemmas:

 No test is perfect - the values for sensitivity and/or specificity are

never 100%, that is: - each test overlooks a part of the really
ill/infected people, i.e. it shows negative test results in people
where these should have been positive ("false negative results" the
sensitivity is always < 100%) - each test shows positive test results
in people where these should have been negative because these
people are not ill/infected ("false positive results" - the specificity
is always < 100%)

 Sensitivity and specificity are in a tense relationship to each other -

the more sensitive a test is, the lower its specificity is usually, and
vice versa.
A decisive question in testing is of course how reliably a positive test
result actually indicates the presence of a disease - this is described by
the so-called positive predictive value/PPV. A PPV of 100% would
mean that all those who tested positive are actually ill - the further the
value is below 100%, the greater the probability that a positive test is
false positive.
All three values: sensitivity, specificity or the PPV are either given in %
or as part of 1 - a PPV of 24% can therefore also be expressed as a PPV
of 0.24, for example].
This also applies to such highly specialized tests as the so-called RT-
PCR swab tests, millions of which (not only) have been performed in
Germany for months and whose results - nicely colorfully packaged in
lines, columns or pies - have been wrongly sold to us for months as a
number of "new infections" and have been used as the basis for
unprecedented restrictions of basic rights.
According to papers distributed by the RKI (Zeichhardt 2020), the
SARS-CoV-2-PCR tests have - and this is where it gets exciting - a
specificity of at best 99.3% (average value - which in itself is not bad!)
- but this means no more and no less than that at least 0.7% of the test
results are false positive.
What does that mean?
It means that if 100,000 tests are performed on safely healthy, non-
infected persons, 700 of these tests are (falsely) positive - in other
words, they "prove" the presence of a disease that does not (no longer)
exist in this frequency.
Now, in the last documented 20th calendar week, only 1.7% of the
tests in Germany are positive anyway - i.e. 1700 of 100,000.
If I subtract the 700 that are false positive from this number, the
remaining 1000 - or 1%.
It is also important to keep in mind that these 1.7% positive test
results in no way mean that 1.7% of the tested persons tested were
positive - "It should be noted that the number of tests does not equal
the number of tested persons, as the figures may include multiple tests
of patients. (RKI 20.05.2020); on the one hand, this means that the
recommended swabs of the nose and throat are partly (in contrast to
the recommended) carried out with separate tests (then makes two
tests for one tested person) and partly also control tests during the
course of a disease - the systematic control of positive test results is
not provided by the RKI (see below).
What else does that mean?
It means that as long as we do PCR testing on this scale, there will
always be enough false-positive results to make the pandemic
immortal - there are still enough "new infections"... second wave and
all...
And what does that also mean?
It means that the number of supposedly "new infections found" in the
late phase of the pandemic (i.e. now when there are almost no more
"true new infections") depends practically only on the number of tests
performed.
This in turn means that the number of positive results can be
controlled by the number of tests performed: in district XY,
demonstrations are to be banned again and the limit is 50 new
infections/100,000 inhabitants? No problem: with 7200
tests/100,000 inhabitants the desired result is guaranteed... .
Against this background, the demand for "more and more tests",
repeated like a prayer wheel by politicians, gets a completely new
connotation...
And how can the problem be solved?
The simplest solution to the problem of false positive test results
would be to consistently test every single person tested with a positive
result immediately a second time - this is routinely done in Swiss
laboratories, for example (NZZ dated 14.05.2020).
 (Source: NZZ of 14.05.2020)

One waits in vain for a corresponding recommendation from the

RKI.....

Test result calculator shown in this page can be downloaded from

here.

Translated & reblogged Version - Original here

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