Disparities in Covid-19 Testing Are Highly Problematic

Summary

The United States is facing significant challenges with COVID-19 testing, including long wait times, testing backlogs, and disparities in access to testing, particularly affecting communities of color and lower-income neighborhoods.

Abstract

The U.S. is grappling with persistent issues in COVID-19 testing, even several months into the pandemic. There are reports of individuals waiting two weeks or more for their test results due to backlogs. Testing rates have declined in 24 states, with a concerning test positivity rate of 12.6% in these areas, indicating that many cases are likely being missed. Health experts, such as Ashish K. Jha, are critical of the current testing approach, emphasizing that states with high positivity rates need to increase testing. Natalie Dean points out the importance of testing high-risk groups effectively. An analysis by ABC News and partners reveals that white neighborhoods have better access to testing sites, while communities of color face higher demand and longer wait times. Economic disparities also affect testing accessibility, with fewer resources in lower-income areas. Experts advocate for a more targeted testing strategy that focuses on high-risk populations to better understand and control the spread of the virus. There is a push for rapid, at-home tests to quickly identify infectious individuals, and a group of governors has formed a compact to acquire more tests, marking the first coordinated testing strategy in the nation.

Opinions

Ashish K. Jha believes that states with declining testing and high positivity rates are under-testing and likely missing a significant number of cases.
Natalie Dean suggests that the current testing approach may be flawed if it fails to prioritize high-risk groups, and that test positivity rates alone can be misleading without context.
Experts argue that testing capacity must be increased, especially in communities of color and lower-income neighborhoods, to address the disparities in testing access and to obtain a clearer picture of virus transmission.
There is a growing consensus among health experts that rapid, at-home tests should be utilized more widely, despite their lower effectiveness, to quickly identify those with the virus at their most infectious stage.
The recent compact formed by seven governors to procure more coronavirus antigen tests reflects a belief in the need for a coordinated national testing strategy.

Long wait times and backlogs are crippling the U.S. response

Los Angeles, California. Photo: Mario Tama/Getty Images

Despite the fact that the United States is in its sixth month of dealing with the coronavirus pandemic (and other countries began combatting the virus months before that), the country is still dealing with testing backlogs. In some cases, people are waiting two weeks or longer to get their results.

As Ashish K. Jha, MD, MPH, the incoming dean of the Brown University School of Public Health shared on Twitter on Tuesday, testing is down in 24 states and is lower now than it was two weeks ago. A decline in testing is okay for states that have high testing rates and a low test positivity rate. For example, New York currently has around a 1% positivity rate that puts its transmission rates at South Korea levels (if these numbers are accurate of course — testing delays make it harder to get a clear picture).

But a decline in tests in states that are hard hit by the virus is problematic. As Jha shares, in 24 states where testing is down, the test positivity rate is 12.6%. “This is abysmal,” he said.

“These states need to be doing a lot more than they are,” Jha added in his thread. “They are likely missing 70–80% of cases. They are not over-testing — they are under-testing. Yet their test numbers are declining Why? Long wait times and long turn around times means people are just giving up.”

Health experts are also questioning whether the country is doing enough to test the right people. “We could test lots of low risk people and have low positivity, but we’re failing if high risk groups can’t access testing,” Natalie Dean, PhD, assistant professor of Biostatistics at the University of Florida, recently shared on Twitter.

The long wait times are a barrier to getting tested, and data is showing that these wait times are not distributed evenly. A recent analysis of testing sites by ABC News, FiveThirtyEight, and ABC-owned television stations found that white neighborhoods have more access to testing sites and that testing sites in communities of color in many U.S. cities face higher demand. “The result of this disparity is clear: People of color, especially Blacks and Latinos, are more likely to experience longer wait times and understaffed testing centers,” reports ABC News.

The analysis also found economic disparities in testing, with testing resources being more scarce in lower income neighborhoods where there are fewer sites and the sites available are located further away. “And the disparity could be even higher in real life, considering wealthier people could also get tested by private practitioners who are less likely to be reflected in our analysis,” reports ABC.

Testing lots of people at low risk for the virus isn’t the best approach. “When access to testing is divorced from risk, the numbers lose their meaning and can mask failure,” Dean shared. “This is why disaggregating even further (race, neighborhood, occupation, symptom status, etc) is needed.”

While positivity rates may suggest improvements — for some states or cities — a better understanding is needed of what spread is like among groups or communities that are at a higher risk of getting the virus or of having severe outcomes from the infection. This kind of data is difficult to come by for both logistical and privacy reasons.

Increasing testing capacity overall is a critical need. A growing group of health experts are pushing for the use of rapid, at-home tests that may not be as effective, but can more quickly identify people with the virus at their most infectious stage. Earlier this week seven governors formed a compact to pressure test makers to ramp up test production. Specifically, the states are pursuing a deal with the Rockefeller Foundation to obtain 3.5 million coronavirus antigen tests. It’s the nation’s first coordinated testing strategy plan.