This comparative analysis of SARS-COV-2 NAAT using the m2000, Simplexa, Xpert and ID NOW trials showed that significant performance deficits were detected in the ID NOW trial when tested in a mixed population of patients with NP and nose samples. Based on a CRS, use of m2000, Xpert, and Simplexa Assays for NP samples in VTM are likely to have a similar performance in clinical practice and the choice of implementation can be made based on considerations of passing time, flow, workflow and costs. On the other hand, despite the assertion of ID NOW and the demonstration of THE analytical results of LOD (differences <1 log10) compared to other tests tested, the lower detection rate of the NOW ID from nose samples should be taken into account when selecting a case of use. By limiting our data set to an acute population of ED patients and comparing the results of the same sample type (NP in VTM), the performance of ID NOW was improved, but the performance of ID NOW was even lower than the other tests tested, perhaps due to 14 times the dilution stage, when the sample is transferred to the ID NOW elucidation chamber before the trial. However, the relatively small sample size of 88 patients, or 25 positive for SARS-CoV-2, is a restriction in our study that prevents analysis of the results from assigning statistical significance. Although this significant lack of compliance by the ID NOW is not a new finding in the literature (Harrington et al., 2020; Mitchell and George, 2020; Moore et al., 2020; Smithgall et al., 2020), we believe that our work refers to the type of sample and patient population as key components that contribute to the lack of performance of ID NOW. We assert that in situations where the 5-15-minute duration of the ID NOW test may bring obvious benefits to the supply, there is a critical need for an analysis of the most appropriate sample type, the appropriate patient population and the need to confirm NAAT tests prior to clinical use. In order to determine a percentage agreement between the methods, we have established, in at least 2 of the 4 NAAT results, a composite reference standard within the meaning of the SARS CoV-2 outcome agreement. The agreement for each trial was compared to this standard. The nose smears tested directly on the ID NOW test had positive support at 48% compared to the SIR, while Seulexa had 88%, m2000 96% and Xpert had a favorable opinion of 100% (Table 1a). While the deficit in positive percentage of approval (AEA) seen in the results of the ID NOW tests is consistent with other early exit studies in the scientific literature (Cradic et al., 2020; Harrington et al., 2020; Mitchell and George, 2020; Moore et al., 2020; Rhoads et al., 2020; Smithgall et al., 2020; Zhen et al., 2020), is surprising given the ID NOW LOD claim of 125 genomic equivalents/ml, which claims 250 copies/ml of Xpress and 242 copies/ml of Simplexa, as do the 100 copies/ml under the m2000 method. To illustrate this apparent discrepancy, a direct assessment of the analytical sensitivity of all trials was conducted in this comparison using dilutions of the inactivated SARS CoV-2 virus (ZeptoMetrix). In this limited study of the LOD, we found that each trial had IDCs comparable to the LOD data recorded in its notice, including the LOD of the ID NOW test, as shown in Table 2.