SARS-CoV-2 Testing Behavior in Symptomatic Adults and the Role of Exposure Risk, Susceptibility and Healthcare Access in a U.S. National Cohort (2020–2023)

TL;DR

This study explores how U.S. adults with symptoms tested for SARS-CoV-2 from 2020–2023, finding that factors like exposure risk, health susceptibility, and healthcare access influenced testing frequency.

Contribution

The study identifies demographic and socioeconomic factors associated with infrequent SARS-CoV-2 testing among symptomatic individuals during the pandemic.

Findings

Infrequent testers were more likely to be female, Hispanic or Black/non-Hispanic, and have lower income or education.

Testing frequency was positively linked to vaccination, trust in public health, and willingness to take antivirals.

Those with higher exposure risk, susceptibility, or healthcare barriers were less likely to use at-home tests or request free tests.

Abstract

The COVID-19 pandemic highlighted the critical role of diagnostic testing for managing transmission and reducing the risk of serious illness. This study examines SARS-CoV-2 testing behavior patterns, including at-home and laboratory tests, among adults with COVID-like symptoms from 2020–2023. We explore characteristics associated with testing frequency and assess the impact of SARS-CoV-2 exposure risk, susceptibility to COVID-19 complications, and barriers to healthcare access on frequency of testing when ill.

The CHASING COVID Cohort study comprises a diverse sample of U.S. adults, with data collected quarterly from March 2020 to December 2023. We categorized participants with COVID-like symptoms reported 2+ times (N = 3,929) as ‘frequent testers’ if they tested ≥ 66% of the time when symptomatic, ‘occasional testers’ if they tested > 33% and < 66% of the time, and ‘infrequent testers’ if they tested ≤ 33% of the time. Informed by the Blumenshine Pandemic Disease Framework, we examined the impact of SARS-CoV-2 exposure risk, susceptibility to COVID-19 complications if infected, and barriers to healthcare access on testing frequency using crude and adjusted log-binomial regression models.

Infrequent testers were more likely to be female, Hispanic or Black/non-Hispanic, have an annual household income <$35,000, have fewer years of education, have children in the household, reside in a rural area or southern state. Testing frequency was positively correlated with COVID-19 vaccination, willingness to take antivirals, trust in public health agencies and healthcare providers for COVID-19 vaccine information. Those with more (versus less) exposure risk (aOR 1.14, 95% CI [1.01, 1.26]), COVID-19 susceptibility (aOR 1.17, 95% CI [1.05, 1.30]), no insurance (aOR 1.52, 95% CI [1.37, 1.70]), and no regular healthcare provider (aOR 1.32, 95% CI [1.19, 1.46]) were more likely to test infrequently. Those with more (versus less) exposure risk, susceptibility, and barriers to healthcare were less likely to have purchased SARS-CoV-2 at-home tests and to have requested freely available tests from covidtests.gov.

Initiatives to increase testing uptake should prioritize reaching those with greater risk of SARS-CoV-2 exposure, susceptibility to severe COVID-19, and for those with barriers to healthcare access.