Adherence to the test, trace and isolate system: results from a time series of 21 nationally representative surveys in the UK (the COVID-19 Rapid Survey of Adherence to Interventions and Responses [CORSAIR] study)
Abstract
Objectives
To investigate rates of adherence to the UK’s test, trace and isolate system over time.
Design
Time series of cross-sectional online surveys.
Setting
Data were collected between 2 March and 5 August 2020.
Participants
42,127 responses from 31,787 people living in the UK, aged 16 years or over, are presented (21 survey waves, n≈2,000 per wave).
Main outcome measures
Identification of the key symptoms of COVID-19 (cough, high temperature / fever, and loss of sense of smell or taste), self-reported adherence to self-isolation if symptomatic, requesting an antigen test if symptomatic, intention to share details of close contacts, self-reported adherence to quarantine if alerted that you had been in contact with a confirmed COVID-19 case.
Results
Only 48.9% of participants (95% CI 48.2% to 49.7%) identified key symptoms of COVID-19. Self-reported adherence to test, trace and isolate behaviours was low (self-isolation 18.2%, 95% CI 16.4% to 19.9%; requesting an antigen test 11.9%, 95% CI 10.1% to 13.8%; intention to share details of close contacts 76.1%, 95% CI 75.4% to 76.8%; quarantining 10.9%, 95% CI 7.8% to 13.9%) and largely stable over time. By contrast, intention to adhere to protective measures was much higher. Non-adherence was associated with: men, younger age groups, having a dependent child in the household, lower socioeconomic grade, greater hardship during the pandemic, and working in a key sector.
Conclusions
Practical support and financial reimbursement is likely to improve adherence. Targeting messaging and policies to men, younger age groups, and key workers may also be necessary.
WHAT IS ALREADY KNOWN ON THIS TOPIC
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Test, trace and isolate systems are one of the cornerstones of COVID-19 recovery strategy.
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The success of the test, trace and isolation system depends on adherence to isolating if symptomatic, getting a test if symptomatic, passing on details of close contacts if infection is confirmed, and quarantining of contacts.
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Rates of adherence to test, trace and isolate behaviours in the UK need to be systematically investigated.
WHAT THIS STUDY ADDS
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Self-reported adherence to test, trace and isolate behaviours is low; intention to carry out these behaviours is much higher.
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Identification of COVID-19 symptoms is also low.
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Practical support and financial reimbursement are likely to improve adherence to test, trace and isolate behaviours.
Article activity feed
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SciScore for 10.1101/2020.09.15.20191957: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:This study also has limitations. First, we used quota sampling to ensure that participant characteristics were representative of the UK adult population. While we cannot be sure that survey respondents are representative of the …
SciScore for 10.1101/2020.09.15.20191957: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
No key resources detected.
Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:This study also has limitations. First, we used quota sampling to ensure that participant characteristics were representative of the UK adult population. While we cannot be sure that survey respondents are representative of the general population,(41, 42) online quota sampling is a pragmatic approach when a large, demographically representative sample must be obtained in a very short time frame during a crisis.(14, 43) Second, data were self-reported, and so could have been influenced by social desirability and recall gaps and bias. Although self-reported adherence to protective measures for COVID-19 such as social distancing is associated with real-world behaviour,(44) it is likely that rates reported here are overestimates of adherence. Third, data are cross-sectional, therefore we cannot infer causality. Fourth, although we asked participants if they had left home at all since developing COVID-19 symptoms, technically it is permissible to leave home under some circumstances, including to attend a medical appointment, get a test or if you receive a negative test result. Given that only 12% of people with symptoms reported requesting a test, we do not believe this explanation accounts for more than a small fraction of the non-adherence that we observed. Fifth, while we had a large overall sample size, numbers of participants included in analyses investigating requesting an antigen test and quarantining after being alerted were smaller, and skewed outcome responses resulted i...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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Our take
Test, trace, and isolate protocols are a crucial part of the UK COVID-19 response. In this large survey, available as a preprint and thus not yet peer reviewed, knowledge of COVID-19 symptoms was fairly poor, and there was a large gap between stated intentions and actual behaviors with respect to test, trace, and isolate guidelines. This gap has remained relatively unchanged from March to August, 2020. Lower adherence was associated with male sex, younger age, lower economic status, and less COVID-19 knowledge, but not with risk perception. The authors suggest that financial assistance might improve outcomes, but this conclusion is speculative.
Study design
cross-sectional;other
Study population and setting
This study used polling services to conduct a series of nationally representative …
Our take
Test, trace, and isolate protocols are a crucial part of the UK COVID-19 response. In this large survey, available as a preprint and thus not yet peer reviewed, knowledge of COVID-19 symptoms was fairly poor, and there was a large gap between stated intentions and actual behaviors with respect to test, trace, and isolate guidelines. This gap has remained relatively unchanged from March to August, 2020. Lower adherence was associated with male sex, younger age, lower economic status, and less COVID-19 knowledge, but not with risk perception. The authors suggest that financial assistance might improve outcomes, but this conclusion is speculative.
Study design
cross-sectional;other
Study population and setting
This study used polling services to conduct a series of nationally representative surveys regarding COVID-19 knowledge, behaviors, and intentions of 31,787 adults (16 years or older) living in the UK between March 2 and August 5, 2020. Surveys were conducted on a weekly or every other weekly basis, with ~2,000 participants per survey round (21 rounds in all). Some people were surveyed in multiple rounds; there were a total of 42,127 responses. Most questions remained the same throughout the survey, while some questions were added in later survey rounds. Participants were asked to identify the most common COVID-19 symptoms, and were deemed to have done so correctly if they identified fever, cough, and loss of taste or smell. They were also asked whether they had experienced any of those symptoms. Those reporting symptoms within the past 7 days were asked if they had self-quarantined and/or requested an antigen test. In addition to self-reported behaviors, the survey also asked about intentions to self-quarantine, to request an antigen test, and to disclose symptoms to close contacts if participants should become symptomatic. Participants were also asked about their knowledge and beliefs regarding a range of COVID-19 topics, including protective measures, isolation protocols, testing eligibility, government guidance, perceived risk, perceived efficacy of protective measures, and government credibility. Finally, demographic characteristics were obtained via self-report. The study used logistic regression to examine differences in responses by demographic categories (e.g. age, gender, region, employment, etc.).
Summary of main findings
Among all respondents, only 49% identified cough, high temperature/fever and loss of sense of smell or taste as the most common symptoms of COVID-19. There was a large gap between intended and self-reported behaviors. While ~70% of people indicated that they intended to self-isolate should they have symptoms in the future, only 18% of people with symptoms within the past 7 days indicated that they had self-isolated. The most common stated reasons for not self-isolating were going to the grocery store or pharmacy (18%), improvement of symptoms (16%), and attending to non-COVID-19 medical needs (15%). There were similar differences between intended and actual behavior for seeking a SARS-CoV-2 test upon experiencing symptoms (~40% vs. 12%) and self-quarantining after being notified by the National Health Service contact tracing program (~65% vs. 11%). Responses to these questions, and the gaps between intended and reported behaviors, remained relatively constant over time. Those who were male, younger, of lower economic status, and less knowledgeable about COVID-19 were, on average, less likely to be adherent to the test, trace, and isolate guidelines. Perceived risk was not associated with adherence behaviors.
Study strengths
The study included a large and representative population, using well-established polling services to conduct the research. The main survey methodology was straightforward and well-designed, and data were reported relatively clearly. The repetition over time using the same methodologies allows examination of changing knowledge and behaviors.
Limitations
Data were almost entirely self-reported; both self-reported behaviors and intentions may be overestimated due to social desirability and related biases. Response rates were not reported, nor were details of how participants were selected and how they were contacted. Knowledge of COVID-19 symptoms was not disaggregated by individual symptoms, and the binary outcome variable incorporating three common symptoms may not be a good proxy for general awareness of COVID-19 symptoms. Associations between COVID-19 knowledge and behaviors are cross-sectional, and no causality can be inferred. The claim that financial support would improve outcomes is largely speculative and not meaningfully tested in the study itself.
Value added
Little evidence has emerged to date about adherence to test, trace, and isolate procedures. This study adds relatively robust, nationally representative data from the UK regarding knowledge, intentions, and behaviors with respect to test, trace, and isolate guidelines over time.
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