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

Abstract

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.

Examining the association between reported COVID-19 symptoms and testing for COVID-19 in Canada: a cross-sectional survey

“…However, the results indicate that compared with females, males have lower likelihood of testing for COVID-19. Our result mirrors that of a related study from Canada 21 that showed that males had significantly lower odds of seeking COVID-19 test compared with females. The observed gender differences in COVID-19 testing could be explained by the risk perception and health seeking behaviour of males.…”

“…The observed gender differences in COVID-19 testing could be explained by the risk perception and health seeking behaviour of males. 21 22 In a multicountry study, which included the UK, USA, Australia, Germany, Spain, Italy, Sweden, Mexico, Japan and South Korea, it was revealed that males display significantly lower risk perception about COVID-19 compared with females. 23 Such low-risk perception tends to adversely affect males’ health-seeking behaviour including their uptake of COVID-19 testing, thus making males less likely to go for COVID-19 testing.…”

Gender Differences on Psychosocial Factors Affecting COVID-19 Preventive Behaviors

“…In general, women carry out hygiene behaviors more frequently [48] and tend to seek medical help more quickly when faced with a health concern [49]. A recent study conducted in Canada analyzing cases of COVID-19 showed that it was women who sought testing promptly to determine whether they were infected by the virus [50].…”

SARS-CoV-2 testing and COVID-19 related primary care use among people with citizenship, permanent residency, and temporary immigration status in British Columbia: Cross-sectional analysis of population-based administrative data

“…More positive tests among people marked as “M” with temporary status and permanent residency, combined with lower access to primary care may suggest gendered facets of COVID-19 management, though we cannot measure gender directly due to the way the health system collects this data. Similarly, lower testing rates but higher rates of laboratory confirmed COVID-19 infection, as well as delayed testing were observed among presumed males in Ontario (33,34). In our study, higher testing and visits for COVID-19 related primary care among people with temporary status in rural/remote settings may reflect targeted testing and outreach in agricultural workplaces where people in the Temporary Foreign Worker Program are employed.…”