Why People With COVID-19 Symptoms Aren’t Getting Tested

Many people who self-report as symptomatic for COVID-19 neglect to get tested, largely citing not knowing where to go for a test as the reason.

With the Omicron variant’s (B.1.1.529) unprecedented ability to cause breakthrough infections in fully vaccinated individuals, COVID-19 testing is vital. However, some people are reluctant to get tested, even if they are symptomatic for COVID-19.

A recent study, published in PLOS Global Public Health, examined testing rates among symptomatic individuals and reported reasons for not testing.

The United Kingdom-based study utilized data from the UK Zoe COVID Symptom Study. Participants enrolled in the study used a smartphone app to self-report any COVID-19 symptoms or test results. At the end of 2020, the investigators sent follow-up surveys via SurveyMonkey to 4936 participants who had reported COVID-19 symptoms but neglected to be tested.

In the follow-up survey, only 42.1% of respondents recalled experiencing 1 or more test-qualifying symptom in the last month. Among those who recalled being symptomatic, 54.7% recognized their symptom(s) as qualifying them for a COVID-19 test. The participants who recognized themselves as having test-qualifying symptoms were significantly more likely to get tested (85.6%).

The investigators found that testing among symptomatic Zoe participants increased over time, from under 20% in April 2020 to over 70% in January 2021. The odds of a symptomatic person not getting tested were higher for those who reported just 1 symptom (27.1%) than those who reported multiple symptoms (14.6%). Women with test-qualifying symptoms were less likely to get tested than men (26.2% versus 19.7%).

The study found that 40.4% of survey respondents could not name all 3 test-qualifying symptoms; test-qualifying symptoms followed the UK National Health Service criteria of high temperature, new but continuous cough, and loss or alteration of sense of taste or smell.

Among symptomatic respondents who indicated wanting to test, not knowing where to go was the most cited reason (32.4%) for neglecting to get tested. This response increased with every 10 years of age and with every 4 fewer years of education. Other reasons for not getting COVID-19 tested despite being symptomatic included: “I am unable to travel to a testing location” (29.1%), “I tried to get a test but was not able to get one” (25.6%), “I am worried about bad things happening to me or my family (including discrimination, government policies, and social stigma)” (18.4%), “I can’t afford the cost of the test” (17.9%), and “I don’t have time to get tested”(13.3%).

The investigators concluded that COVID-19 education, specifically regarding test-qualifying symptoms and testing locations, is sorely lacking and warrants improvement. They also acknowledged the significance of testing barriers, like the cost of tests or lack of transportation to testing sites.

The study authors noted, “Not only are greater efforts needed to educate the UK public, it is likely that comparable efforts to mind the knowledge gap will be needed in countries with regionally varying testing criteria or methods of accessing testing.”