Improvements in SARS-CoV-2 Testing Cascade in the US: Data from Serial Cross-sectional Assessments.

Clipman, Steven J; Wesolowski, Amy; Mehta, Shruti H; Cobey, Sarah; Cummings, Derek A T; Solomon, Sunil S

BACKGROUND SARS-CoV-2 testing is critical for monitoring case counts, early detection and containment of infection, clinical management, and surveillance of variants. However, community-based data on the access, uptake, and barriers to testing have been lacking. METHODS We conducted serial cross-sectional online surveys covering demographics, COVID-19 symptoms, and experiences around SARS-CoV-2 diagnostic testing to characterize the SARS-CoV-2 testing cascade and associated barriers across 10 US states (California, Florida, Illinois, Maryland, Massachusetts, Nebraska, North Dakota, South Dakota, Texas, and Wisconsin), between July 2020 to February 2021. RESULTS In February 2021, across 10 US states, 11% (895) of respondents reported wanting a diagnostic test in the prior 2 weeks, 63% of whom got tested with limited variability across states. Almost all (97%) who got tested received their results; 56% received their results within 2 days. In MD, FL, and IL where serial data were available at four time points, 56% were tested the same day they wanted/needed a test in February 2021 compared to 28% in July 2020, and 45% received results the same day as opposed to 17% in July 2020. Wanting a test was significantly more common among younger, non-white respondents and participants with a history of symptoms or exposure. Logistical challenges including not knowing where to go were the most frequently cited barriers. CONCLUSIONS There were significant improvements in access and turnaround times across US states; yet barriers to testing remained consistent across states underscoring the importance of a continued focus on testing, even amidst mass vaccination campaigns.