COVID-19 Testing Rates Low Among Symptomatic Americans

(Reuters Health) – Sick Americans appear to be passing up opportunities to get tested for coronavirus and thus are likely unknowingly spreading the infection throughout their communities, new research shows.

Only one quarter of participants in the COVID-19 Citizen Science Study ( reported receiving a test result within a week of experiencing fever, a cardinal sign of coronavirus infection, in late October, the JAMA Network Open study found.

“It’s shocking to me that when people have a fever they’re still not getting tested,” said lead author Dr. Mark Pletcher, professor of epidemiology, biostatistics and medicine at the University of California at San Francisco.

“Tests are easy to come by,” he told Reuters Health in a phone interview. “People might have coronavirus, might be spreading it to their friends and neighbors, and they’re not getting tested.”

More than 37,000 adults across the U.S. enrolled in the study, a smartphone app survey, between March 26 and October 23, 2020. Nearly 2,700 of them reported at least one episode of febrile illness, defined as fever and chills or a temperature of 100.4 degrees Fahrenheit (38 degrees Celsius).

But fewer than 26% reported receiving a coronavirus test result within seven days of the onset of illness.

Black participants were about half as likely to report receiving a result than other participants. Because only 41 participants identified as Black, though, the study lacked statistical power to draw conclusions about the disparity.

Previous studies have shown lower testing rates, fewer testing sites and longer travel times to testing sites in New York City neighborhoods with a higher proportion of minority residents.

At first, researchers found that people with coronavirus symptoms were likelier to get tested for COVID-19 as tests became more accessible. At the beginning of April 2020, less than 10% of survey participants reporting febrile illness received test results within a week. By late July, the number reporting fever and getting tested increased to 24.1%.

Throughout the summer and fall, as tests became easier to find, however, the number of sick participants who reported getting tested remained flat. By late October, only 25.9% reported receiving a test result within a week of febrile illness.

“The testing didn’t get higher than 26% at its best – which is really stunning,” said Dr. H. Nina Kim, associate professor of medicine at the University of Washington School of Medicine. An infectious disease specialist, she was not involved with the study.

In a phone interview, Kim described the study participants as “savvy,” educated smartphone users who signed up to advance a public health initiative. The number of people who had chills and fever but failed to get tested for COVID-19 was especially “disappointingly low” in a cohort in which three-quarters of participants were college educated, she said.

“Even they didn’t get a test result within a reasonable timeline,” she said. “That’s what’s so damning about this study.”

“People need to understand that we are in the midst of a pandemic. If you have a fever, if you feel ill, you should get tested for COVID,” she said. “Testing is the key to knowledge. We want you to know because it changes people’s behavior.”

Pletcher agreed that his study probably paints a picture rosier than the actual number of sick Americans getting tested for COVID-19. “It’s got to be even worse than what it looks like in our study,” he said.

The importance of coronavirus testing in curbing the pandemic could be getting lost in the current vaccine push, Pletcher said.

“All the messaging is on vaccinations,” he said. “I do think continuing to test is quite important, particularly as we start opening things up again.”

The study raises more questions than it answers about why, given the widespread availability of tests, people who feel ill fail to get tested, Kim said.

The study authors could not determine if the obstacle to testing stemmed from lack of access, knowledge about how to get a test, understanding about the importance of testing or active avoidance because of a need or desire to continue working.

“How can we do testing and make it easy, convenient and not a horrible disaster for your family if you do get a positive test?” Pletcher asked.

When someone feels feverish and achy and gets a test, can they work or attend classes while waiting for a result? If they test positive, can they afford to remain home and isolated?

“How do we align the incentives so that people want to know that they’re infected?” Pletcher asked. “You want to have society not penalize you for getting tested.”

SOURCE: JAMA Network Open, online May 3, 2021.

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