Factors Associated with Timely Test Seeking, Test Turnaround, and Public Reporting of COVID-19: a retrospective analysis in Ontario, Canada

Joh, E.; Buchan, S. A.; Daneman, N.; Paul, L. A.; Brown, K. A.

Background Minimizing delays in disease identification and reporting improves the timeliness of surveillance data, and can reduce transmission of COVID-19. Our study investigates factors associated with timely testing and reporting of COVID-19 during the first pandemic wave in one province of Canada. Methods We identified all persons with confirmed SARS-CoV-2 infection residing in private households across the largest province of Canada, Ontario from the date of the first confirmed case in Ontario (January 25) to July 19, 2020. Our primary outcomes consisted of: (1) specimen collection within 1 day of symptom onset (test seeking), (2) test result reported to local public health within 1 day of specimen collection (test turnaround), and (3) entry of case data into the provincial database within 1 day of reporting test results (reporting). We examined 14 covariates including eight case characteristics, and six neighborhood characteristics. In addition to descriptive measures, logistic regression models were fitted. Unadjusted models included the covariate alone, while adjusted models included age, gender, month, and region. Findings Among 27,198 COVID-19 cases from January 25 2020 to July 19 2020, 28.7% had timely test seeking, 40.2% had timely test turnaround, and 75.5% had timely reporting. Male gender had lower odds of timely test seeking (adjusted odds ratio [aOR] 0.79 [95% CI: 0.74-0.85]) compared to females. Healthcare worker status (aOR 2.77 [95% CI: 2.52-3.05] compared to non-healthcare workers), and age [≥]80 years (aOR 1.59 [95% CI: 1.33-1.91] compared to 40-59 year olds) were associated with timely test seeking. Specimen collection on Fridays and Saturdays (aOR 0.88 [95% CI: 0.79-0.98], aOR 0.83 [95% CI: 0.74-0.92] respectively, compared to Wednesdays) had lower odds of timely test turnaround. Urban areas (aOR 1.55 [95% CI: 1.41-1.70] compared to rural areas) were associated with timely test turnaround. Urban areas (aOR 0.79 [95% CI: 0.70-0.89] compared to rural areas) were less likely to have timely reporting. Interpretation Individual, neighborhood, and administrative factors are associated with timely testing and reporting of SARS-CoV-2 infections. These findings present considerations for developing targeted strategies to minimize delays and improve timely testing and reporting of SARS-CoV-2 infections.