Undertesting of patients with febrile illness may have contributed to COVID-19 surge
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A study of more than 2,600 U.S. adults found “generally low rates” of COVID-19 testing among participants reporting onset of febrile illness through late October 2020, according to results published in JAMA Network Open.
“We cannot know for certain what the impact of more effective targeting of coronavirus testing would be on disease transmission in the United States, how it might have blunted the third wave that recently swept through the U.S., or how it might be used to reduce transmission of new coronavirus variants,” Mark J. Pletcher, MD, MPH, professor of epidemiology and biostatistics at the University of California, San Francisco School of Medicine, and colleagues wrote. “However, it is clear that countries such as China and South Korea have a much more aggressive targeted approach to testing and appear to have substantially lower community transmission rates.”
Pletcher and colleagues analyzed patient data from 2,679 individuals aged 18 years or older who had new-onset febrile illness from April to October of 2020 via the COVID-19 Citizen Science Study. They reviewed data from each patient’s survey related to COVID-19 symptoms and testing, and designated receipt of a coronavirus test results within 7 days of febrile illness onset as the study’s primary outcome.
In total, 3,865 new febrile illness episodes occurred between April 2, 2020, and Oct. 23, 2020. A total of 12% of participants indicated on a survey given during the 14 days after fever onset that they had a test result delivered.
Time-to-event modeling performed by the researchers estimated that 7 days after febrile illness onset, 20.5% (95% CI, 19.1%-22%) of patients had received a test result. This percentage spiked from 9.8% (95% CI, 7.5%-12%) early in the COVID-19 outbreak to 24.1% (95% CI, 21.5%-26.7%) by the end of July. However, testing rates did not significantly increase after July, and the rate by late October was 25.9% (95% CI, 21.6%-30.3%), the researchers reported.
The researchers said they were unable to determine whether testing disparities contributed to disparities in COVID-19 outcomes. Black participants had lower rates of testing, but the difference did not reach statistical significance due to a low number of Black participants in the study population.
“This cohort study’s results suggest systematic underuse of coronavirus testing in patients with febrile illness. Whether this is because of lack of testing availability, knowledge about how to get a test, understanding about the importance of testing, or active avoidance (eg, to avoid economic hardships associated with isolation and quarantine of contacts if one tests positive) is unclear,” Pletcher and colleagues wrote.
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