Intent to Test for COVID-19 in the Postpandemic Era
Kimberly A. Fisher, Kathleen M. Mazor, Mary T. Antonelli, Caitlin Pretz, Yanhua Zhou, Apurv Soni
TL;DR
This study explores how likely US adults are to get tested for COVID-19 when they suspect they have it, in the years after the pandemic.
Contribution
The study provides updated insights into testing intentions in the postpandemic period using a national survey.
Findings
The study found that a majority of adults intend to get tested if they suspect they have COVID-19.
Demographic and geographic differences in testing intent were observed.
Abstract
This cross-sectional study used an online national survey to examine the intent to test when COVID-19 was suspected among adults in the US between October 2024 and April 2025.
Genes, proteins, chemicals, diseases, species, mutations and cell lines named across the full text — each resolved to its canonical identifier and authoritative record.
| Characteristic | No. (%) | Overall | ||
|---|---|---|---|---|
| Total sample (N = 2009) | Yes would test (n = 1407) | No or not sure would test (n = 602) | ||
| Age, y | ||||
| 18-29 | 396 (19.7) | 248 (62.6) | 148 (37.4) | <.001 |
| 30-44 | 524 (26.1) | 358 (68.3) | 166 (31.7) | |
| 45-59 | 466 (23.2) | 323 (69.3) | 143 (30.7) | |
| ≥60 | 623 (31.0) | 478 (76.8) | 145 (23.2) | |
| Education | ||||
| No high school diploma or GED | 186 (9.3) | 116 (62.3) | 70 (37.7) | .04 |
| High school diploma or GED | 576 (28.7) | 399 (69.2) | 177 (30.8) | |
| Some college or associate’s degree | 526 (26.2) | 367 (69.8) | 159 (30.2) | |
| Bachelor’s degree or higher | 721 (35.9) | 525 (72.8) | 196 (27.2) | |
| Race and ethnicity | ||||
| Black, non-Hispanic | 244 (12.1) | 187 (76.5) | 57 (23.5) | <.001 |
| Hispanic | 361 (18.0) | 279 (77.4) | 82 (22.6) | |
| Other, non-Hispanic or ≥2 races, non-Hispanic | 185 (9.2) | 144 (77.6) | 41 (22.5) | |
| White, non-Hispanic | 1219 (60.7) | 797 (65.4) | 422 (34.6) | |
| Language of survey completion | ||||
| English | 1904 (94.8) | 1324 (69.5) | 580 (30.5) | .04 |
| Spanish | 105 (5.2) | 83 (79.1) | 22 (20.9) | |
| Sex | ||||
| Male | 980 (48.8) | 661 (67.4) | 319 (32.6) | .01 |
| Female | 1029 (51.2) | 746 (72.5) | 283 (27.5) | |
| Marital status | ||||
| Married | 1030 (51.3) | 720 (69.9) | 310 (30.1) | .90 |
| Not married (includes widowed, divorced, separated, and never married) | 979 (48.7) | 687 (70.2) | 292 (29.8) | |
| Household size, No. | ||||
| 1 | 330 (16.4) | 235 (71.2) | 95 (28.8) | .03 |
| 2 | 710 (35.3) | 520 (73.2) | 190 (26.8) | |
| ≥3 | 969 (48.2) | 652 (67.3) | 317 (32.7) | |
| Household income, $ | ||||
| <24 999 | 197 (9.8) | 147 (74.5) | 50 (25.5) | .33 |
| 25 000-49 999 | 287 (14.3) | 211 (73.4) | 76 (26.6) | |
| 50 000-74 999 | 295 (14.6) | 205 (69.6) | 90 (30.5) | |
| 75 000-99 999 | 251 (12.5) | 179 (71.4) | 72 (28.6) | |
| 100 000-149 999 | 388 (19.3) | 264 (68.0) | 124 (32.0) | |
| ≥150 000 | 591 (29.5) | 401 (67.8) | 190 (32.2) | |
| Metropolitan Statistical Area status | ||||
| Nonmetropolitan | 265 (13.2) | 160 (60.3) | 105 (39.7) | <.001 |
| Metropolitan | 1744 (86.8) | 1247 (71.5) | 497 (28.5) | |
| Census region | ||||
| Northeast | 345 (17.1) | 242 (70.2) | 103 (29.8) | .02 |
| Midwest | 411 (20.5) | 263 (63.9) | 148 (36.1) | |
| South | 778 (38.7) | 556 (71.5) | 222 (28.5) | |
| West | 475 (23.7) | 346 (72.8) | 129 (27.2) | |
| Employment status | ||||
| Working (full or part time) | 1259 (62.6) | 869 (69.0) | 390 (31.0) | .21 |
| Not working | 750 (37.4) | 538 (71.7) | 212 (28.3) | |
| Have a primary care physician | ||||
| Yes | 1705 (84.9) | 1229 (72.1) | 476 (27.9) | <.001 |
| No | 303 (15.1) | 178 (58.6) | 125 (41.4) | |
| Self-rated health | ||||
| Excellent | 222 (11.1) | 135 (61.0) | 87 (39.0) | <.001 |
| Very good | 722 (36.2) | 481 (66.6) | 241 (33.4) | |
| Good | 756 (37.9) | 559 (74.0) | 197 (26.0) | |
| Fair | 254 (12.8) | 193 (75.8) | 61 (24.2) | |
| Poor | 42 (2.1) | 29 (69.4) | 13 (30.6) | |
| Trust in health care | ||||
| Do not trust at all | 140 (7.1) | 51 (36.4) | 89 (63.6) | <.001 |
| Trust a little | 534 (26.8) | 321 (60.0) | 213 (40.0) | |
| Trust somewhat | 907 (45.6) | 680 (74.9) | 227 (25.1) | |
| Trust a great deal | 410 (20.6) | 344 (83.8) | 66 (16.2) | |
| Depend on numbers and statistics to make decisions about health | ||||
| Strongly agree | 296 (15.0) | 234 (79.0) | 62 (21.0) | <.001 |
| Somewhat agree | 880 (44.5) | 644 (73.2) | 236 (26.8) | |
| Somewhat disagree | 474 (24.0) | 317 (66.9) | 157 (33.1) | |
| Strongly disagree | 327 (16.5) | 191 (58.5) | 136 (41.5) | |
| Heard of COVID-19 medications, such as Paxlovid | ||||
| Yes | 1394 (70.1) | 1022 (73.3) | 372 (26.7) | <.001 |
| No | 596 (30.0) | 375 (62.8) | 221 (37.2) | |
| Have done a home test for COVID-19 | ||||
| Yes | 1416 (70.9) | 1157 (81.7) | 259 (18.3) | <.001 |
| No | 582 (29.1) | 242 (41.6) | 340 (58.4) | |
| Characteristic | Odds ratio (95% CI) | |
|---|---|---|
| Age, y | ||
| 18-29 | 1 [Reference] | NA |
| 30-44 | 1.37 (0.97-1.92) | .07 |
| 45-59 | 1.32 (0.93-1.86) | .12 |
| ≥60 | 2.14 (1.51-3.01) | <.001 |
| Education | ||
| No high school diploma or GED | 1 [Reference] | NA |
| High school diploma or GED | 1.63 (1.06-2.51) | .03 |
| Some college or associate’s degree | 1.23 (0.80-1.91) | .34 |
| Bachelor’s degree or higher | 1.23 (0.80-1.90) | .35 |
| Race and ethnicity | ||
| White, non-Hispanic | 1 [Reference] | NA |
| Black, non-Hispanic | 2.64 (1.79-3.90) | <.001 |
| Hispanic | 2.21 (1.58-3.10) | <.001 |
| Other, non-Hispanic or ≥2 races, non-Hispanic | 2.21 (1.41-3.46) | <.001 |
| Census region | ||
| Northeast | 1 [Reference] | NA |
| Midwest | 0.93 (0.65-1.35) | .72 |
| South | 1.39 (0.99-1.95) | .06 |
| West | 1.23 (0.85-1.79) | .28 |
| Self-rated health | ||
| Excellent | 1 [Reference] | NA |
| Very good | 1.01 (0.69-1.48) | .97 |
| Good | 1.74 (1.18-2.56) | .01 |
| Fair | 2.23 (1.37-3.62) | .001 |
| Poor | 2.54 (1.11-5.83) | .03 |
| Trust in health care | ||
| Do not trust at all | 1 [Reference] | NA |
| Trust a little | 1.64 (1.03-2.59) | .04 |
| Trust somewhat | 3.14 (2.00-4.90) | <.001 |
| Trust a great deal | 5.65 (3.39-9.41) | <.001 |
| Depend on numbers and statistics to make decisions about health | ||
| Strongly agree | 1 [Reference] | NA |
| Somewhat agree | 0.84 (0.58-1.21) | .36 |
| Somewhat disagree | 0.62 (0.42-0.93) | .02 |
| Strongly disagree | 0.46 (0.30-0.71) | <.001 |
| Have done a home test for COVID-19 | ||
| Yes | 1 [Reference] | NA |
| No | 0.16 (0.12-0.20) | <.001 |
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Taxonomy
TopicsCOVID-19 and healthcare impacts · COVID-19 epidemiological studies · Vaccine Coverage and Hesitancy
Introduction
COVID-19 is a continuing health threat, with the Centers for Disease Control and Prevention estimating 28 000 to 46 000 deaths and 230 000 to 390 000 hospitalizations due to COVID-19 in the US between October 2024 and April 2025.^1^ Early identification of infection enables prompt care and steps to reduce spread. Timely initiation of oral antiviral medications is associated with lower hospitalizations, deaths, and long-COVID incidence among adults at high risk.^2^ Although motivation to self-test for COVID-19 was high during the pandemic,^3^ COVID-19 fatigue and inertia may lessen motivation to test. We conducted a national survey to examine current intent to test for COVID-19.
Methods
We conducted a cross-sectional online national survey between October 31 and November 7, 2024, using the Ipsos KnowledgePanel, which uses probability-based sampling to provide a nationally representative sampling frame for US adults. We asked about intent to conduct a home test if COVID-19 was suspected; respondents answering “no” or “not sure” were asked for reasons for not testing. Additional items assessed related attitudes and experiences (eAppendix in Supplement 1). This study followed the AAPOR reporting guideline.
All analyses used sample weights based on sex, age, race and ethnicity, census region, education, and household income. Ipsos collected demographic data, including race and ethnicity, via self-report to ensure sample representativeness. We used χ^2^ statistics to examine bivariate associations between intent to test and respondent characteristics and attitudes. We used forward stepwise selection to create a multivariate logistic regression model, starting with variables with P < .20 in bivariate analyses and retaining variables with P < .10. Analyses were conducted from November 14, 2024, to April 16, 2025, using SAS, version 9.4 (SAS Institute Inc). The UMass Chan Medical School institutional review board reviewed and approved this study and granted a waiver of written documentation of informed consent because the study activities involved no more than minimal risk and met the criteria for documentation not required outside of the research context. The Wald χ^2^ test was used to calculate 2-sided P values, with P = .05 the level used to indicate significance.
Results
Of 2009 respondents to the question on COVID-19 self-testing, 1029 (51.2%) were female, and 244 (12.1%) were non-Hispanic Black; 361 (18.0%) were Hispanic; 185 (9.2%) were other, non-Hispanic or 2 or more races, non-Hispanic; and 1219 (60.7%) were non-Hispanic White, with mean (SD) age of 51.5 (18.4) years (Table 1). The survey completion rate was 63.4% (2016 of 3182).
Most respondents (70.0% [1407 of 2009]) would test if they suspected COVID-19. Several variables were associated with intent to test in bivariate analyses (Table 1). On multivariate analysis (Table 2), age older than 60 years; identifying as non-Hispanic Black, Hispanic, or other or multiple races, non-Hispanic; reporting other than excellent health (good, fair, or poor); having higher trust in the health care system; strongly agreeing they depend on numbers to make decisions about health; and having previously completed a COVID-19 home test were all associated with being more likely to test.
The percentage of respondents endorsing each reason for not or possibly not testing were not seeing a reason to test (53.6%), believing it would not be helpful to know if COVID-19 positive (30.1%), not trusting test results (20.7%), anticipating it would not or might not occur to one to test (19.4%), preferring not to know (9.1%), not knowing where to get a test (5.8%), being unable to afford a test (4.9%), and “other” (8.3%).
Discussion
Nearly one-third of US adults would not or might not test for suspected COVID-19, largely because they do not see value in testing. Test hesitancy may delay oral antiviral initiation and could result in missed opportunities to limit transmission. Efforts are needed to increase awareness of the value of testing. Limitations of this study include that respondents’ reported intent to self-test may vary from their actual behavior and we may not have captured the full set of reasons why respondents may not self-test.
The reference list from the paper itself. Each links out to its DOI / PubMed record.
- 1Preliminary estimates of COVID-19 burden for 2024-2025. Centers for Disease Control and Prevention. December 6, 2024. Accessed April 15, 2025. https://www.cdc.gov/covid/php/surveillance/burden-estimates.html
- 2Hammond J, Leister-Tebbe H, Gardner A, ; EPIC-HR Investigators. Oral nirmatrelvir for high-risk, nonhospitalized adults with Covid-19. N Engl J Med. 2022;386(15):1397-1408. doi:10.1056/NEJ Moa 2118542 35172054 PMC 8908851 · doi ↗ · pubmed ↗
- 3Bien-Gund C, Dugosh K, Acri T, . Factors associated with US public motivation to use and distribute COVID-19 self-tests. JAMA Netw Open. 2021;4(1):e 2034001. doi:10.1001/jamanetworkopen.2020.34001 33471114 PMC 7818126 · doi ↗ · pubmed ↗