Rapid antigen testing for COVID-19: Decreasing diagnostic reliability, potential detrimental effects and a lack of evidence to support continued public funding of community-based testing.

Rapid antigen testing continues to be broadly recommended across the world for the prevention of transmission of SARS-CoV-2. We explore existing recommendations in the United States, evidence of decreasing diagnostic reliability of individual tests and potential benefits and harms of non-targeted testing. Recent research has found multiple commonly-used rapid antigen tests to now have diagnostic sensitivities below 30%, with sensitivities at or near 0% the first 48 hours of infection, using polymerase chain reaction (PCR) test positivity as the gold standard. Reliance on tests with low sensitivity could paradoxically increase transmission risk through false assurance. Furthermore, widespread testing has substantial direct and indirect costs, while its effectiveness for diminishing COVID-19 disease burden or improving overall community health is unclear. Because benefit has not been demonstrated with high-quality evidence, we argue against 1. The continued recommendations for and 2. Public funding of widespread community-based rapid antigen testing

The importance of falsification endpoints in observational studies of vaccination to prevent severe disease: A critique of a harm-benefit analysis of BNT162b2 vaccination of 5- to 11-year-olds.

We explore one systematic review and meta-analysis of both observational and randomized studies examining COVID-19 vaccines in 5- to 11-year-olds, which reported substantial benefits associated with vaccinating this age group. We discuss the limitations of the individual studies that were used to estimate vaccination benefits. The review included five observational studies that evaluated vaccine effectiveness (VE) against COVID-19 severe disease or hospitalization. All five studies failed to adequately assess differences in underlying health between vaccination groups. In terms of vaccination harms, looking only at the randomized studies, a significantly higher odds of adverse events was identified among the vaccinated compared with the unvaccinated. Observational studies are at risk of overestimating the effectiveness of vaccines against severe disease if healthy vaccinee bias is present. Falsification endpoints can provide valuable information about underlying healthy vaccinee bias. Studies that have not adequately ruled out bias due to better health among the vaccinated or more vaccinated should be viewed as unreliable for estimating the VE of COVID-19 vaccination against severe disease and mortality. Existing systematic reviews that include observational studies of the COVID-19 vaccine in children may have overstated or falsely inferred vaccine benefits due to unidentified or undisclosed healthy vaccinee bias

Analysis of tweets discussing the risk of Mpox among children and young people in school (May-October 2022): a retrospective observational study.

OBJECTIVE: To determine the number of tweets discussing the risk of Mpox to children and young people in school and (1) determine accuracy, (2) for inaccurate tweets, determine if risk was minimised or exaggerated and (3) describe the characteristics of the accounts and tweets which contained accurate versus inaccurate information. DESIGN: Retrospective observational study. SETTING: Twitter advanced search in January 2023 of tweets spanning 18 May 2022-19 September 2022. PARTICIPANTS: Accounts labelled as: MD, DO, nurse, pharmacist, physical therapist, other healthcare provider, PhD, MPH, Ed. degree, JD, health/medicine/public policy reporter (including students or candidates) who tweeted about the risk of Mpox to children and young people in school. EXPOSURES: Tweets containing the keywords school and mpox, pox, or monkeypox from May to October 2022. MEASURES: (1) The total and ratio of accurate versus inaccurate tweets, the latter further subdivided by exaggerating or minimising risk, and stratified by account author credential type. (2) The total likes, retweets and follower counts by accurate versus inaccurate tweets, by month and account credentials. (3) Twitter user exposure to inaccurate versus accurate tweets was estimated. RESULTS: 262 tweets were identified. 215/262 (82%) were inaccurate and 215/215 (100%) of these exaggerated risks. 47/262 (18%) tweets were accurate. There were 163 (87%) unique authors of inaccurate tweets and 25 (13%) of accurate tweets. Among healthcare professionals, 86% (95/111) of tweets were inaccurate. Multiplying accuracy by followers and retweets, Twitter users were approximately 974× more likely to encounter inaccurate than accurate information. CONCLUSION: Credentialed Twitter users were 4.6 times more likely to tweet inaccurate than accurate messages. We also demonstrated how incorrect tweets can be quickly amplified by retweets and popular accounts. In the case of Mpox in children and young people, incorrect information always exaggerated risks