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Rapid $1 Covid-19 tests exist. Why can’t we get them?

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A sign advertising a rapid coronavirus test on the new Abbott ID Now machine at a ProHEALTH center in Brooklyn, New York, on August 27. | Spencer Platt/Getty Images

A new testing strategy prioritizes infectiousness instead of infections.

To get the US pandemic under control, a growing number of health and medical experts are making a clarion call for an additional testing approach to Covid-19.

What we need, they argue, are at-home rapid tests that look for antigens, proteins the live virus makes. These kits would allow anyone to test themselves for the coronavirus any time (and anywhere) for between $1 and $5, and get results in about 15 minutes. No doctors, labs, expensive machines, or special chemicals required.

“I see these [antigen] tests as a solution that’s literally sitting in front of us,” says Michael Mina, an epidemiologist at the Harvard T.H. Chan School of Public Health, who has led an effort to get these rapid tests authorized by the Food and Drug Administration. “We could be getting massive outbreaks down to nothing. … It’s a no-brainer to me.”

Back in April, Deborah Birx, the White House coronavirus response coordinator, actually called for just this sort of solution in an interview on Meet the Press. “We have to have a breakthrough innovation in testing,” she said. “We have to be able to detect antigen.”

Several small companies have been developing these simple tests, and the conglomerate 3M is working with MIT on another one. (The new BinaxNOW test from Abbott, authorized August 26, is different — it requires a health professional to administer it, and the patient must have symptoms to get a prescription.)

And some of these at-home tests are ready to go. But they have been sitting on the shelf, unused, for months. Why?

 Spencer Platt/Getty Images
People line up on August 13 to take a Covid-19 test in the Sunset Park neighborhood in Brooklyn, New York, which has seen a spike in coronavirus cases.

The holdup is that rapid, over-the-counter antigen tests are not nearly as sensitive to the coronavirus as the molecular PCR (polymerase chain reaction) tests currently used for most Covid-19 testing. In fact, by PCR standards, some at-home antigen tests might catch only half or a third of people who test positive on a PCR test.

But that’s because they’re looking for different things in different ways. A PCR test, designed to diagnose an individual with infection, can catch very low levels of viral material before or after a person spreads the virus. An over-the-counter antigen test, meanwhile, relies on high levels of the virus to be able to detect it. These high levels, though, also happen to coincide with when a person is most likely to transmit the virus to others.

“The antigen test is maximally sensitive at the same time that you are maximally infectious,” says David Paltiel, a professor of public health and health policy at the Yale School of Public Health. “The antigen test is picking up the infections I want. Because I don’t care about infections, I care about infectiousness.”

Since at-home antigen tests would be fast and cheap, they could allow people to test themselves regularly. Currently, PCR testing is relatively expensive (about $100) and often experiences processing delays that hamstring efforts to stop transmission.

PCR tests’ sensitivity, however, is the current benchmark by which the FDA judges new tests for emergency authorization.

This pre-pandemic framework, Mina and others argue, is a problem as we look for the most effective tools to fight the coronavirus right now. So they are calling for a new way to evaluate these tests, one based in public health terms rather than individual diagnostic ones — in other words, widely accessible tests that are well tuned to find those who are most likely to spread the virus.

Let’s take a look at how and why this potential solution has gotten sidelined in the pandemic battle — and what might be done to get these tests off companies’ shelves and out to the public.

A test to find infectiousness, not infection

To understand the stalemate around antigen tests, it’s helpful to first understand what they are, how they differ from classic PCR tests, and the trajectory of coronavirus infections.

First: An antigen test looks for a particular protein from a live virus. (Not to be confused with an antibody test, which finds immune cells your body has made after mounting a defense against the virus.) These tests need a lot of viral material to generate a positive result.

Second: A PCR test looks for the virus’s genetic material — its RNA — making copies of itself until it reaches a detectable level. As a result, it has a fairly low (although not perfect) false-negative rate, or the proportion of time it would tell someone who has the virus that they don’t.

Finally: One of this new coronavirus’s superpowers is its ability to spread from people before they start to experience symptoms. In fact, people tend to carry the most live virus the day or so before they begin feeling sick, and the amount tends to quickly trail off in the several days after symptom onset.

So proponents of at-home antigen testing say that PCR tests, while useful in determining whether an individual is infected with Covid-19, are actually a poor tool in finding people who are most likely to spread the virus. That’s because PCR tests are so sensitive, they are excellent at picking up traces of the virus even after someone has beat it back and is no longer infectious.

Thomas Tsai, a health policy expert at the Harvard T.H. Chan School of Public health, compares the two types of testing this way: PCR tests are reactive tests, usually used for people who either have symptoms, a close contact with the virus, or other reason to think they are likely to have caught it. Rapid, widespread antigen tests are proactive tests, designed to find cases before they spread the virus more widely.

And as the Center for Evidence-Based Medicine noted earlier this month, “while an infectious stage may last a week or so because inactivated RNA degrades slowly over time, it may still be detected many weeks after infectiousness has dissipated.”

To look a little bit deeper at how this works, an August 7 preprint report which hasn’t been peer reviewed proposes that people with 10,000 copies of the virus detected in their airways are unlikely to spread the virus to someone else, even with sustained contact (according to their models, it would happen about 0.002 percent of the time). Once that viral load climbs to 10 million copies (which happens quickly, potentially in about a day), they have about a 40 percent chance of transmitting it to a close contact — and about 80 percent chance at 100 million viral copies (it’s worth noting that when they first reach this level they still might not have any symptoms).

By the time someone has had Covid-19 symptoms for several days (which might currently be about the time they receive results from a PCR test), however, the amount of virus in their system has likely waned to the point of actually being less transmissible. As the authors of the study note, “transmission after the first week of infection is quite rare.”

At that point, says Mina, it’s more likely that “they just have residual [virus] RNA hanging about.” So although many of these people would get a positive PCR test — and a negative at-home antigen test — they are much less likely to transmit the virus than someone who feels fine now but will develop symptoms in a day or two.

“The PCR is being fooled all the time,” Paltiel says. “The PCR is just picking up strands of viral junk.” If your goal is to slow an outbreak, he notes, this sort of data is not actually that useful. “Outbreak control is all about figuring out who’s actually spreading this stuff.”

This could also help explain why so many people continue to get positive PCR test results weeks after getting over most of their symptoms. One small JAMA study, for example, found that one in six former Covid-19 patients with no symptoms tested positive for the virus via PCR test four to 24 days after being discharged from the hospital. As an author of a commentary about that paper noted about these long-tail positive test results, “the clinical significance and infectivity are minimal. These PCR tests likely are responding to noninfective RNA fragments and do not represent detection of viable virus.”

Antigen tests, however, need a much higher level of the virus to register a positive result because they don’t rely on multiplying their target.

This, experts argue, make them well matched for finding people with Covid-19 at precisely their most infectious points rather than potentially long after symptoms have arrived and infectiousness has faded, as is more likely now with the long delays in PCR results and contact tracing. As Paltiel describes it, the concept is pretty simple: “The more viruses around your airway, the more likely you are to be a risk to others.”

According to an analysis from the June preprint (on which Mina was a co-author), this crucial time period is precisely where the antigen test is most sensitive: detecting viral load at around 10,000 copies, which is just before someone’s infectiousness skyrockets. PCR tests, on the other hand, can pick up about 1,000 copies of the virus, which gives them about a day’s head start at finding the virus. Although with a lag of more than a day in returning results, that benefit is lost.

To put it in other terms, these tests could be “superspreading detectors,” Mina says, locating many of those who would otherwise go on to unknowingly infect many other people before they know they have the virus.

“Their whole goal is to capture the 90 percent of people who might be transmitting the virus,” Mina says. So if they were to be evaluated in this population — those with high levels of the virus — he says, the sensitivity for these tests would soar from 30 or 50 percent (as measured against PCR) up to 95 percent. (They also have very low false-positive rates, in which they would tell someone they had the virus when they actually didn’t.)

Another selling point to antigen tests, proponents argue, is that they would give people their results much faster than PCR tests. Since delays of more than a day or so in getting PCR results back make containment and tracing much less effective, being able to have results back in 15 minutes or so would be a vast improvement.

Because these tests would be fast and affordable, people could also test frequently, which could help overcome worry about the tests being less sensitive than PCR — especially in the very small window early in an infection when a PCR test might catch the virus but an antigen test wouldn’t.

And such frequent testing would be far superior to the still relatively rare PCR testing that we’re currently doing, Paltiel says. “Of all the variables that we control, the frequency of screening is the most important,” he says. Even if the antigen-based test only caught half of all cases (regardless of infectiousness level), he says, if it’s “between a test that is missing 50 percent [but rapid and easy] and a test that is getting everyone that is so expensive or so cumbersome or has such a long turnaround time that it takes a week, I’ll take what’s behind door No. 1.”

In the June preprint study, the researchers found the sensitivity of a test made little difference in the rate at which it could bring viral transmission down. For example, running either of these tests, PCR or at-home antigen testing, on a population weekly could lower the spread of the virus by about 60 percent, they posit.

We can bring this pandemic under control within weeks

Without shutting down the economy

With technology we have now

Cheaply

But we won’t

Because of @US_FDA backward thinking about tests

Watch @j_g_allen video. Then, don’t get mad. Let’s act.#dailyquicktest https://t.co/dWYCE8JpNA

— Ashish K. Jha (@ashishkjha) August 17, 2020

So, Mina suggests, we shouldn’t just be asking what level of sensitivity a test has, but rather, what it’s sensitive to. PCR tests are great at finding traces of the coronavirus but, he says, “it’s going to have a 0 percent sensitivity to detect elephants.” And if what we want is to start finding elephants — or people who are most infectious — we should look for new testing options, he argues.

The FDA’s job is to help keep us safe, but it might lack a pandemic public health protocol

One of the FDA’s essential responsibilities is to make sure dangerous medications, ineffective vaccines, or misleading diagnostic tests don’t make it to US consumers. So it applies rigorous standards to make sure new products are reliable before they are allowed on the market.

And the FDA has applied this same rubric when it has evaluated new tests for the coronavirus this year.

“Tests are still being considered first and foremost as diagnostic tools,” Mina says. This is evident in how the FDA has required antigen tests to perform at PCR-levels in detecting traces of the virus in people’s systems, he notes. For example, a new test might need to detect the virus in 80 or 90 percent of emergency room patients who’ve received a positive PCR test.

So when you compare the numbers and see a test that catches half or a third of the positive cases a PCR test does, it makes sense for the FDA to worry about a huge number of Covid-19-positive people thinking they are negative.

And Mina says he gets that. “If I’m a doctor, which I am, and I have a patient in front of me, I would want the absolute best and most sensitive molecular test to make sure I don’t miss something,” he says.

But he is also an epidemiologist. “For public health, it’s totally different. It requires a really different type of thinking.” One that targets minimizing spread of the virus among people.

“Unfortunately, the FDA just doesn’t have that,” he says. “They don’t even have a lens with which to think about it.”

And so, he says, they’re still evaluating at-home antigen tests as individual medical diagnostic tools rather than “as a virus control tool at the population level.”

The FDA has already authorized four antigen-based tests, including ones from Quidel (in May), BD Veritor (in July), LuminaDX (in August), and the new one from Abbott. To meet the FDA’s current sensitivity standards, however, the first three of these use proprietary machines to read results. (Some of these machines are now being allocated by the Centers for Medicare & Medicaid Services to nursing homes around the country.)

But an over-the-counter antigen test, the sort that Mina and others are advocating for, simply can’t be authorized under the current standards.

This gets at the essential tension between the FDA’s individual-based medical diagnostic framework and the broader public health needs of the pandemic. And, says Tsai, “We really need to shift gears.”

Concerns remain about at-home antigen testing

Beyond the sensitivity question, the FDA and others also have hesitations about these sorts of tests being done outside of the health care setting.

Current Covid-19 tests require a health care professional to order them and provide the results, allowing for them to give patients medical advice. If people are taking these tests on their own at home or before entering a business, a nurse won’t be on hand, for example, to advise them to isolate if necessary or take other steps to prevent spread.

“Due to the lack of healthcare professional supervision, FDA believes it is important for over-the-counter non-lab diagnostic tests to have a low rate of false negative results,” Emma Spaulding, a spokesperson for the FDA wrote to Vox in an email. “For example, an individual with a false negative result from an OTC diagnostic test may be less likely to quarantine despite symptoms, putting others in the community at risk,”

This is one reason they are recommending such tests catch 90 percent of the PCR-positive cases, she says. They would lower this to 80 percent if the tests required a prescription and were done under the supervision of a health care worker (such as via telemedicine).

Others worry about individual compliance. Rebecca Lee Smith, an epidemiologist at the University of Illinois, notes that this sort of testing would probably be most readily adopted by people who are already putting in the most effort to avoid catching and spreading Covid-19, such as those regularly wearing masks and practicing physical distancing.

“But the people who aren’t concerned about the virus may not choose to do at-home testing — they’re also the people who are not taking the precautions. So the same people we would absolutely want to be checking for the virus, then, would be the people less likely to do it at home.”

She also has concerns about at-home tests being used to clear people for work, school, or other activities. If someone needed to produce a negative test result, they could theoretically get someone else to take the test for them but still gain entry to, say, their college classes for the day. That was a point of discussion at her university, where they eventually opted for supervised (rather than collected-at-home) saliva-based PCR testing. “We decided that it was more important that we know, for sure, that the person who checked in for testing is the person giving the sample,” she says.

Administering these tests out in the community as a way to enter a workplace or a restaurant, for example, could also help alleviate this issue — as well as the concern about those with higher chances of contracting the virus not taking the test.

The newly approved Abbott test, BinaxNOW, is a step toward more accessible antigen testing. It doesn’t require a machine to read the results — and still, according to data presented to the FDA, has a 97 percent specificity level compared with PCR tests. It is also $5 for one test, and the company says they will be able to ship 50 million of them a month this fall.

The downside is it is only available with a prescription, and it needs to be given by a health care professional or other trained individual (such as a pharmacist or workplace health specialist). The test requires a nasal swab and a small amount of specialized chemicals known as reagents. And it is only to be used for people who developed Covid-19 symptoms within the past week, making it inapplicable for broader population-wide screening.

With an over-the-counter test, we might also lose a lot of important public health disease surveillance data. If people are testing positive at home — or even in a public setting — and not following up with a health care worker or public health department, their case might not get counted or their contacts traced. “You would need to have a link back to public health,” Smith says. They would also want to get information on the test that was performed so they could properly interpret the results.

This is where our existing PCR testing capacity could run backup. Smith explains that a positive antigen test result could be a trigger to get a PCR test to confirm the infection. It could also possibly reduce the number of PCR tests that are run, potentially speeding up delivery of those results as well.

“In a perfect world,” Smith says, “we would have this cheap, at-home test that anybody could take, as frequently as they want, that would give them a quick result. If there is a reason — if they have symptoms, if they’ve been exposed, or the at-home test comes back positive — then they report for PCR.”

Tsai agrees PCR tests would still be important. “It’s really thinking about how we use the pros and cons of all the different tests in a more comprehensive strategy,” he says. “Let’s put these pieces together.”

How could at-home antigen tests get authorized?

With over-the-counter antigen tests at a regulatory stalemate in the FDA’s current authorization system, experts are spitballing alternative routes to getting these tests to the public.

First and foremost, says Mina, government involvement in authorizing new tests is essential to make sure that those that do reach the market work in the way they are supposed to.

One route for this, he proposes, is a new standard by which the FDA could authorize tests, setting a different benchmark for test sensitivity at levels of the virus that are most likely to be transmissible rather than at very low detectable levels. In other words, he notes, the FDA could adjust their language from looking at sensitivity to the virus broadly to “sensitivity during peak infection.”

The FDA could also reframe the way it characterizes these tests, he says. Instead of being evaluated as an individual diagnostic test, he says, “it would essentially be indicated as a transmission-detecting test … [or] a public health diagnostic test, where the real reason of doing that diagnostic test is one of public health.”

Another option would be to designate these tests as surveillance tools rather than diagnostic tests. Under that category, they fall outside the FDA’s purview and would more likely be overseen by the CDC and local health departments.

This plan has a big hitch, though. Surveillance test results are aggregated and are not shared back with the individual taking the test. Diagnostic tests, on the other hand, are those which have results given back to the individual so that they might take a specific action. The latter is, of course, the goal here (to let people know, for example, if they need to start self-isolating).

“It’s this awful catch-22 that could easily be changed if there was a will,” Mina says. “There just doesn’t seem to be much of a will.” Or a regulatory framework for thinking about things differently — even in the midst of a pandemic, he says.

The FDA has recently conceded that they would consider authorizing a less sensitive test if it were part of a high-frequency testing plan, with each person being tested multiple times (which they call “serial testing”), Spaulding says.

This, to Mina and others, seems like a step in the right direction, and he is hoping the FDA will provide more detailed guidance on what this would look like in practice.

But the FDA also notes that it would require an application for this sort of serial testing to “include the capacity to manufacture a sufficient supply of tests with which to conduct multiple tests per person,” Spaulding says.

Mina suggests that this is an arbitrary ask. For other authorized tests, like those using PCR or machine-based antigen detection, the agency has not required makers to show manufacturing capacity — or even the supply chain to turn results around in a certain amount of time (which is a key aspect to slowing transmission of Covid-19). “They’re perfectly fine approving tests that might take a year to return results, but that’s a 100 percent useless test,” Mina says.

Mina also worries that as some of these companies with at-home antigen tests wait for the government to greenlight them, they will decide to make them more complex to meet the current (PCR-based) requirements for diagnostic viral detection.

He calls this going from the sort of “instant coffee model” of testing (where anyone can take a test, cheaply, pretty much anywhere) to the “Nespresso model” (where you need access to a specialized machine to get a result).

And slowdowns in rolling out these machine-based antigen tests are already happening. Both BD and Quidel, two companies making rapid antigen tests, are now facing supply chain issues as they try to fulfill orders for their machines and tests, the Wall Street Journal reported.

Tsai notes that public health officials in Florida have been advised to use the Quidel antigen tests only for symptomatic, older adults. Which, he says, makes sense in targeting those most at-risk for complications from the virus, but “in some ways also defeats the purpose of the frequent testing strategy.”

 Chandan Khanna/AFP via Getty Images
Cars line up at a rapid antigen coronavirus testing site at Hard Rock Stadium near Miami, Florida, on August 5.

Mina has been challenging those who are still on the fence about rapid, at-home antigen testing to say whether, in hindsight, it would have been good to have five months ago.

“Almost all of them say, ‘yes, that would have been great.’ Compared to what has happened, of course it would have been great.” Now, he says, “we’re in an almost worse spot today, we’re hitting up against September and October, when coronaviruses can start spreading like crazy. We have to cut our losses and say, ‘okay, we didn’t do it five months ago, but we can do it today.’”

Like the old tree-planting aphorism: The best time to plant a tree may have been 20 years ago, but the second-best time is now. “We could potentially save ourselves from ourselves in the fall. But I don’t know if it’s going to happen, frankly,” he says.

Part of that reason, he notes, has to do with our general national mindset. “I think Americans, including policymakers, are having a hard time coming to terms with the idea that there’s actually something bad happening to us.”

Just adding this new type of testing on its own, however, won’t be enough to get us out of the pandemic. “We can’t test our way out of it,” Smith says. “We also need masks, we need distancing.”

But, she says, many presymptomatic and asymptomatic cases are not being detected with our current testing strategy. “And those people are able to spread the infection further without knowing it. If we can’t identify these cases, we are never going to get out of this.”

Katherine Harmon Courage is a freelance science journalist and author of Cultured and Octopus! Find her on Twitter at @KHCourage.


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World

All the products we found to be the best during our testing this year

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(CNN) —  

Throughout the year, CNN Underscored is constantly testing products — be it coffee makers or headphones — to find the absolute best in each respective category.

Our testing process is rigorous, consisting of hours of research (consulting experts, reading editorial reviews and perusing user ratings) to find the top products in each category. Once we settle on a testing pool, we spend weeks — if not months — testing and retesting each product multiple times in real-world settings. All this in an effort to settle on the absolute best products.

So, as we enter peak gifting season, if you’re on the hunt for the perfect gift, we know you’ll find something on this list that they (or you!) will absolutely love.

Coffee

Best burr coffee grinder: Baratza Virtuoso+ Conical Burr Grinder With Digital Timer Display ($249; amazon.com or walmart.com)

Baratza Virtuoso+ Conical Burr Grinder
Baratza Virtuoso+ Conical Burr Grinder

Beginner baristas and coffee connoisseurs alike will be pleased with the Baratza Virtuoso+, a conical burr grinder with 40 settings for grind size, from super fine (espresso) to super coarse (French press). The best coffee grinder we tested, this sleek look and simple, intuitive controls, including a digital timer, allow for a consistent grind every time — as well as optimal convenience.

Read more from our testing of coffee grinders here.

Best drip coffee maker: Braun KF6050WH BrewSense Drip Coffee Maker ($79.95; amazon.com)

Braun KF6050WH BrewSense Drip Coffee Maker
Braun KF6050WH BrewSense Drip Coffee Maker

During our testing of drip coffee makers, we found the Braun KF6050WH BrewSense Drip Coffee Maker made a consistently delicious, hot cup of coffee, brewed efficiently and cleanly, from sleek, relatively compact hardware that is turnkey to operate, and all for a reasonable price.

Read more from our testing of drip coffee makers here.

Best single-serve coffee maker: Breville-Nespresso VertuoPlus ($165; originally $179.95; amazon.com)

Breville-Nespresso VertuoPlus
Breville-Nespresso VertuoPlus

Among all single-serve coffee makers we tested, the Breville-Nespresso VertuoPlus, which uses pods that deliver both espresso and “regular” coffee, could simply not be beat for its convenience. Intuitive and a snap to use right out of the box, it looks sleek on the counter, contains a detached 60-ounce water reservoir so you don’t have to refill it with each use and delivers perfectly hot, delicious coffee with a simple tap of a lever and press of a button.

Read more from our testing of single-serve coffee makers here.

Best coffee subscription: Blue Bottle (starting at $11 per shipment; bluebottlecoffee.com)

Blue Bottle coffee subscription
Blue Bottle coffee subscription

Blue Bottle’s coffee subscription won us over with its balance of variety, customizability and, most importantly, taste. We sampled both the single-origin and blend assortments and loved the flavor of nearly every single cup we made. The flavors are complex and bold but unmistakably delicious. Beyond its coffee, Blue Bottle’s subscription is simple and easy to use, with tons of options to tailor to your caffeine needs.

Read more from our testing of coffee subscriptions here.

Best cold brewer coffee maker: Hario Mizudashi Cold Brew Coffeepot ($25; amazon.com)

Hario Mizudashi Cold Brew Coffeepot
Hario Mizudashi Cold Brew Coffeepot

This sleek, sophisticated and streamlined carafe produces 1 liter (about 4 1/4 cups) of rich, robust brew in just eight hours. It was among the simplest to assemble, it executed an exemplary brew in about the shortest time span, and it looked snazzy doing it. Plus, it rang up as the second-most affordable of our inventory.

Read more from our testing of cold brew makers here.

Kitchen essentials

Best nonstick pan: T-fal E76597 Ultimate Hard Anodized Nonstick Fry Pan With Lid ($39.97; amazon.com)

T-fal E76597 Ultimate Hard Anodized Nonstick Fry Pan With Lid
T-fal E76597 Ultimate Hard Anodized Nonstick Fry Pan With Lid

If you’re a minimalist and prefer to have just a single pan in your kitchen, you’d be set with the T-fal E76597. This pan’s depth gives it multipurpose functionality: It cooks standard frying-pan foods like eggs and meats, and its 2 1/2-inch sides are tall enough to prepare recipes you’d usually reserve for pots, like rices and stews. It’s a high-quality and affordable pan that outperformed some of the more expensive ones in our testing field.

Read more from our testing of nonstick pans here.

Best blender: Breville Super Q ($499.95; breville.com)

Breville Super Q
Breville Super Q

With 1,800 watts of motor power, the Breville Super Q features a slew of preset buttons, comes in multiple colors, includes key accessories and is touted for being quieter than other models. At $500, it does carry a steep price tag, but for those who can’t imagine a smoothie-less morning, what breaks down to about $1.30 a day over a year seems like a bargain.

Read more from our testing of blenders here.

Best knife set: Chicago Cutlery Fusion 17-Piece Knife Block Set ($119.74; amazon.com)

Chicago Cutlery Fusion 17-Piece Knife Block Set
Chicago Cutlery Fusion 17-Piece Knife Block Set

The Chicago Cutlery Fusion 17-Piece Knife Block Set sets you up to easily take on almost any cutting job and is a heck of a steal at just $119.97. Not only did the core knives included (chef’s, paring, utility and serrated) perform admirably, but the set included a bevy of extras, including a full set of steak knives. We were blown away by their solid construction and reliable execution for such an incredible value. The knives stayed sharp through our multitude of tests, and we were big fans of the cushion-grip handles that kept them from slipping, as well as the classic look of the chestnut-stained wood block. If you’re looking for a complete knife set you’ll be proud of at a price that won’t put a dent in your savings account, this is the clear winner.

Read more from our testing of knife sets here.

Audio

Best true wireless earbuds: AirPods Pro ($199, originally $249; amazon.com)

Apple AirPods Pro
Apple AirPods Pro

Apple’s AirPods Pro hit all the marks. They deliver a wide soundstage, thanks to on-the-fly equalizing tech that produces playback that seemingly brings you inside the studio with the artist. They have the best noise-canceling ability of all the earbuds we tested, which, aside from stiff-arming distractions, creates a truly immersive experience. To sum it up, you’re getting a comfortable design, a wide soundstage, easy connectivity and long battery life.

Read more from our testing of true wireless earbuds here.

Best noise-canceling headphones: Sony WH-1000XM4 ($278, originally $349.99; amazon.com)

Sony WH-1000XM4
Sony WH-1000XM4

Not only do the WH-1000XM4s boast class-leading sound, but phenomenal noise-canceling ability. So much so that they ousted our former top overall pick, the Beats Solo Pros, in terms of ANC quality, as the over-ear XM4s better seal the ear from outside noise. Whether it was a noise from a dryer, loud neighbors down the hall or high-pitched sirens, the XM4s proved impenetrable. This is a feat that other headphones, notably the Solo Pros, could not compete with — which is to be expected considering their $348 price tag.

Read more from our testing of noise-canceling headphones here.

Best on-ear headphones: Beats Solo 3 ($119.95, originally $199.95; amazon.com)

Beats Solo 3
Beats Solo 3

The Beats Solo 3s are a phenomenal pair of on-ear headphones. Their sound quality was among the top of those we tested, pumping out particularly clear vocals and instrumentals alike. We enjoyed the control scheme too, taking the form of buttons in a circular configuration that blend seamlessly into the left ear cup design. They are also light, comfortable and are no slouch in the looks department — more than you’d expect given their reasonable $199.95 price tag.

Read more from our testing of on-ear headphones here.

Beauty

Best matte lipstick: Stila Stay All Day Liquid Lipstick ($11, originally $22; amazon.com or $22; nordstrom.com and stilacosmetics.com)

Stila Stay All Day Liquid Lipstick
Stila Stay All Day Liquid Lipstick

The Stila Stay All Day Liquid Lipstick has thousands of 5-star ratings across the internet, and it’s easy to see why. True to its name, this product clings to your lips for hours upon hours, burritos and messy breakfast sandwiches be damned. It’s also surprisingly moisturizing for such a superior stay-put formula, a combo that’s rare to come by.

Read more from our testing of matte lipsticks here.

Best everyday liquid liner: Stila Stay All Day Waterproof Liquid Eyeliner ($22; stilacosmetics.com or macys.com)

Stila Stay All Day Waterproof Liquid Eyeliner
Stila Stay All Day Waterproof Liquid Eyeliner

The Stila Stay All Day Waterproof Liquid Eyeliner is a longtime customer favorite — hence its nearly 7,500 5-star reviews on Sephora — and for good reason. We found it requires little to no effort to create a precise wing, the liner has superior staying power and it didn’t irritate those of us with sensitive skin after full days of wear. As an added bonus, it’s available in a whopping 12 shades.

Read more from our testing of liquid eyeliners here.

Work-from-home essentials

Best office chair: Steelcase Series 1 (starting at $381.60; amazon.com or $415, wayfair.com)

Steelcase Series 1
Steelcase Series 1

The Steelcase Series 1 scored among the highest overall, standing out as one of the most customizable, high-quality, comfortable office chairs on the market. At $415, the Steelcase Series 1 beat out most of its pricier competitors across testing categories, scoring less than a single point lower than our highest-rated chair, the $1,036 Steelcase Leap, easily making it the best bang for the buck and a clear winner for our best office chair overall.

Read more from our testing of office chairs here.

Best ergonomic keyboard: Logitech Ergo K860 ($129.99; logitech.com)

Logitech Ergo K860
Logitech Ergo K860

We found the Logitech Ergo K860 to be a phenomenally comfortable keyboard. Its build, featuring a split keyboard (meaning there’s a triangular gap down the middle) coupled with a wave-like curvature across the body, allows both your shoulders and hands to rest in a more natural position that eases the tension that can often accompany hours spent in front of a regular keyboard. Add the cozy palm rest along the bottom edge and you’ll find yourself sitting pretty comfortably.

Read more from our testing of ergonomic keyboards here.

Best ergonomic mouse: Logitech MX Master 3 ($99.99; logitech.com)

Logitech MX Master 3
Logitech MX Master 3

The Logitech MX Master 3 is an unequivocally comfortable mouse. It’s shaped to perfection, with special attention to the fingers that do the clicking. Using it felt like our fingers were lounging — with a sculpted ergonomic groove for nearly every finger.

Read more from our testing of ergonomic mice here.

Best ring light: Emart 10-Inch Selfie Ring Light ($25.99; amazon.com)

Emart 10-Inch Selfie Ring Light
Emart 10-Inch Selfie Ring Light

The Emart 10-Inch Standing Ring Light comes with a tripod that’s fully adjustable — from 19 inches to 50 inches — making it a great option whether you’re setting it atop your desk for video calls or need some overhead lighting so no weird shadows creep into your photos. Its three light modes (warm, cool and a nice mix of the two), along with 11 brightness levels (among the most settings on any of the lights we tested), ensure you’re always framed in the right light. And at a relatively cheap $35.40, this light combines usability and affordability better than any of the other options we tested.

Read more from our testing of ring lights here.

Home

Best linen sheets: Parachute Linen Sheet Set (starting at $149; parachute.com)

Parachute Linen Sheets
Parachute Linen Sheets

Well made, luxurious to the touch and with the most versatile shopping options (six sizes, nine colors and the ability to order individual sheets), the linen sheets from Parachute were, by a narrow margin, our favorite set. From the satisfying unboxing to a sumptuous sleep, with a la carte availability, Parachute set the gold standard in linen luxury.

Read more from our testing of linen sheets here.

Best shower head: Kohler Forte Shower Head (starting at $74.44; amazon.com)

Kohler Forte Shower Head
Kohler Forte Shower Head

Hands down, the Kohler Forte Shower Head provides the best overall shower experience, offering three distinct settings. Backstory: Lots of shower heads out there feature myriad “settings” that, when tested, are pretty much indecipherable. The Forte’s three sprays, however, are each incredibly different and equally successful. There’s the drenching, full-coverage rain shower, the pulsating massage and the “silk spray” setting that is basically a super-dense mist. The Forte manages to achieve all of this while using only 1.75 gallons per minute (GPM), making it a great option for those looking to conserve water.

Read more from our testing of shower heads here.

Best humidifier: TaoTronics Cool Mist Humidifier (starting at $49.99; amazon.com)

TaoTronics Cool Mist Humidifier
TaoTronics Cool Mist Humidifier

The TaoTronics Cool Mist Humidifier ramped up the humidity in a room in about an hour, which was quicker than most of the options we tested. More importantly, though, it sustained those humidity levels over the longest period of time — 24 hours, to be exact. The levels were easy to check with the built-in reader (and we cross-checked that reading with an external reader to confirm accuracy). We also loved how easy this humidifier was to clean, and the nighttime mode for the LED reader eliminated any bright lights in the bedroom.

Read more from our testing of humidifiers here.

Video

Best TV: TCL 6-Series (starting at $579.99; bestbuy.com)

TCL 6-Series
TCL 6-Series

With models starting at $599.99 for a 55-inch, the TCL 6-Series might give you reverse sticker shock considering everything you get for that relatively small price tag. But can a 4K smart TV with so many specification standards really deliver a good picture for $500? The short answer: a resounding yes. The TCL 6-Series produces a vibrant picture with flexible customization options and handles both HDR and Dolby Vision, optimization standards that improve the content you’re watching by adding depth to details and expanding the color spectrum.

Read more from our testing of TVs here.

Best streaming device: Roku Ultra ($99.99; amazon.com)

Roku Ultra
Roku Ultra

Roku recently updated its Ultra streaming box and the 2020 version is faster, thanks to a new quad-core processor. The newest Ultra retains all of the features we loved and enjoyed about the 2019 model, like almost zero lag time between waking it up and streaming content, leading to a hiccup-free streaming experience. On top of that, the Roku Ultra can upscale content to deliver the best picture possible on your TV — even on older-model TVs that don’t offer the latest and greatest picture quality — and supports everything from HD to 4K.

Read more from our testing of streaming devices here.

Travel

Best carry-on luggage: Away Carry-On ($225; away.com)

Away Carry-On
Away Carry-On

The Away Carry-On scored high marks across all our tests and has the best combination of features for the average traveler. Compared with higher-end brands like Rimowa, which retail for hundreds more, you’re getting the same durable materials, an excellent internal compression system and eye-catching style. Add in smart charging capabilities and a lifetime warranty, and this was the bag to beat.

Read more from our testing of carry-on luggage here.

Best portable charger: Anker PowerCore 13000 (starting at $31.99; amazon.com)

Anker PowerCore 13000
Anker PowerCore 13000

The Anker PowerCore 13000 shone most was in terms of charging capacity. It boasts 13,000 mAh (maH is a measure of how much power a device puts out over time), which is enough to fully charge an iPhone 11 two and a half times. Plus, it has two fast-charging USB Type-A ports so you can juice a pair of devices simultaneously. While not at the peak in terms of charging capacity, at just $31.99, it’s a serious bargain for so many mAhs.

Read more from our testing of portable chargers here.

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Trump’s misleading tweet about changing your vote, briefly explained

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Searches for changing one’s vote did not trend following the recent presidential debate, and just a few states appear to have processes for changing an early vote. But that didn’t stop President Trump from wrongly saying otherwise on Tuesday.

In early morning posts, the president falsely claimed on Twitter and Facebook that many people had Googled “Can I change my vote?” after the second presidential debate and said those searching wanted to change their vote over to him. Trump also wrongly claimed that most states have a mechanism for changing one’s vote. Actually, just a few states appear to have the ability, and it’s rarely used.

Twitter did not attach a label to Trump’s recent tweet.
Twitter

Trump’s claim about what was trending on Google after the debate doesn’t hold up. Searches for changing one’s vote were not among Google’s top trending searches for the day of the debate (October 22) or the day after. Searches for “Can I change my vote?” did increase slightly around the time of the debate, but there is no way to know whether the bump was related to the debate or whether the people searching were doing so in support of Trump.

It was only after Trump’s posts that searches about changing your vote spiked significantly. It’s worth noting that people were also searching for “Can I change my vote?” during a similar period before the 2016 presidential election.

Google declined to comment on the accuracy of Trump’s post.

Trump also claimed that these results indicate that most of the people who were searching for how to change their vote support him. But the Google Trends tool for the searches he mentioned does not provide that specific information.

Perhaps the most egregiously false claim in Trump’s recent posts is about “most states” having processes for changing your early vote. In fact, only a few states have such processes, and they can come with certain conditions. For instance, in Michigan, voters who vote absentee can ask for a new ballot by mail or in person until the day before the election.

The Center for Election Innovation’s David Becker told the Associated Press that changing one’s vote is “extremely rare.” Becker explained, “It’s hard enough to get people to vote once — it’s highly unlikely anybody will go through this process twice.”

Trump’s post on Facebook was accompanied by a link to Facebook’s Voting Information Center.
Facebook

At the time of publication, Trump’s false claims had drawn about 84,000 and 187,000 “Likes” on Twitter and Facebook, respectively. Trump’s posts accelerated searches about changing your vote in places like the swing state of Florida, where changing one’s vote after casting it is not possible. Those numbers are a reminder of the president’s capacity to spread misinformation quickly.

On Facebook, the president’s post came with a label directing people to Facebook’s Voting Information Center, but no fact-checking label. Twitter had no annotation on the president’s post. Neither company responded to a request for comment.

That Trump is willing to spread misinformation to benefit himself and his campaign isn’t a surprise. He does that a lot. Still, just days before a presidential election in which millions have already voted, this latest episode demonstrates that the president has no qualms about using false claims about voting to cause confusion and sow doubt in the electoral process.

Open Sourced is made possible by Omidyar Network. All Open Sourced content is editorially independent and produced by our journalists.


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Nearly 6,000 civilian casualties in Afghanistan so far this year

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From January to September, 5,939 civilians – 2,117 people killed and 3,822 wounded – were casualties of the fighting, the UN says.

Nearly 6,000 Afghan civilians were killed or wounded in the first nine months of the year as heavy fighting between government forces and Taliban fighters rages on despite efforts to find peace, the United Nations has said.

From January to September, there were 5,939 civilian casualties in the fighting – 2,117 people killed and 3,822 wounded, the UN Assistance Mission in Afghanistan (UNAMA) said in a quarterly report on Tuesday.

“High levels of violence continue with a devastating impact on civilians, with Afghanistan remaining among the deadliest places in the world to be a civilian,” the report said.

Civilian casualties were 30 percent lower than in the same period last year but UNAMA said violence has failed to slow since the beginning of talks between government negotiators and the Taliban that began in Qatar’s capital, Doha, last month.

An injured girl receives treatment at a hospital after an attack in Khost province [Anwarullah/Reuters]

The Taliban was responsible for 45 percent of civilian casualties while government troops caused 23 percent, it said. United States-led international forces were responsible for two percent.

Most of the remainder occurred in crossfire, or were caused by ISIL (ISIS) or “undetermined” anti-government or pro-government elements, according to the report.

Ground fighting caused the most casualties followed by suicide and roadside bomb attacks, targeted killings by the Taliban and air raids by Afghan troops, the UN mission said.

Fighting has sharply increased in several parts of the country in recent weeks as government negotiators and the Taliban have failed to make progress in the peace talks.

At least 24 people , mostly teens, were killed in a suicide bomb attack at an education centre in Kabul [Mohammad Ismail/Reuters]

The Taliban has been fighting the Afghan government since it was toppled from power in a US-led invasion in 2001.

Washington blamed the then-Taliban rulers for harbouring al-Qaeda leaders, including Osama bin Laden. Al-Qaeda was accused of plotting the 9/11 attacks.

Calls for urgent reduction of violence

Meanwhile, the US envoy for Afghanistan, Zalmay Khalilzad, said on Tuesday that the level of violence in the country was still too high and the Kabul government and Taliban fighters must work harder towards forging a ceasefire at the Doha talks.

Khalilzad made the comments before heading to the Qatari capital to hold meetings with the two sides.

“I return to the region disappointed that despite commitments to lower violence, it has not happened. The window to achieve a political settlement will not stay open forever,” he said in a tweet.

There needs to be “an agreement on a reduction of violence leading to a permanent and comprehensive ceasefire”, added Khalilzad.

A deal in February between the US and the Taliban paved the way for foreign forces to leave Afghanistan by May 2021 in exchange for counterterrorism guarantees from the Taliban, which agreed to sit with the Afghan government to negotiate a permanent ceasefire and a power-sharing formula.

But progress at the intra-Afghan talks has been slow since their start in mid-September and diplomats and officials have warned that rising violence back home is sapping trust.

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