COVID-19 at-home test takers may not adhere to guidelines
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People taking at-home COVID-19 tests may not follow CDC quarantine recommendations when they test negative, findings from a randomized clinical trial showed.
“Our findings suggest that many at-home COVID-19 self-test users will draw false reassurance from a negative result, ignoring conditions that pose a high risk of infection,” Steven Woloshin, MD, MS, professor of medicine, community and family medicine at The Dartmouth Institute for Health Policy and Clinical Practice, said in a press release.
For the study, Woloshin and colleagues assessed three cohorts of people given different directions for taking at-home COVID-19 tests. They randomly assigned 360 participants in a 1:1:1 ratio to receive either FDA-authorized instructions for the at-home tests, instructions of a similar length that were designed using decision science principles, or no instructions at all.
At the time of the study, the FDA-authorized instructions said that a negative test result meant that the person did not need to quarantine unless they had symptoms and recent contact with a person showing COVID-19 symptoms.
The intervention instructions designed for the study provided the same recommendations as the FDA-authorized instructions but were designed to give the test-takers step-by-step decisions. For example, if they tested negative but had symptoms within the last 10 days, they should stay at home.
Currently, the CDC recommends that people who have had contact with a symptomatic person someone and test negative should wear a mask around the home and in public for at least 10 days afterward. The guidance notes that negative test results do not rule out the possibility of infection.
Of the 360 participants included in the study, 22 were excluded. The 338 remaining had a mean age of 38 years (interquartile range [IQR], 31-48), and were primarily men (54%). Among them, 64% had a college degree or some form of higher education.
Among participants with a positive test result, 95% chose to quarantine (95% CI, 0.92-0.97).
Among participants in a group given a high pretest probability of infection, 33% of participants in the FDA instructions group failed to quarantine appropriately compared with 14% in the intervention group — a 19 percentage point difference (95% CI, 6-31). Among those who received no instructions, 24% failed to quarantine with a negative test, a 9 percentage point difference from the first group (95% CI, –4 to 23).
Given a scenario in which they had COVID-19 symptoms and came in close contact with someone who had COVID-19, the proportion of participants choosing not to quarantine despite a recommendation to was higher among those given the authorized instructions (36%) than those given the revised instructions (4%), for a difference of 32 percentage points (95% CI, 13%-51%). Among those receiving no instructions, 21% reported that they would not quarantine, a 14 percentage point difference from the first group (95% CI, –9% to 38%).
“I think our results show how fundamentally important it is to design and pilot-test instructions to ensure that they can be understood by as many users as possible — to increase the benefits and reduce the harms from at-home self-test kits,” Woloshin said.
References:
CDC. Quarantine & Isolation. https://www.cdc.gov/coronavirus/2019-ncov/your-health/quarantine-isolation.html. Accessed Feb. 7, 2022.
Dartmouth study assesses how consumers interpret and act on results from at-home COVID-19 self tests. https://geiselmed.dartmouth.edu/news/2022/dartmouth-study-assesses-how-consumers-interpret-and-act-on-results-from-at-home-covid-19-self-tests/. Published Jan. 31, 2022. Accessed Feb. 8, 2022.
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