Factors Associated with Timely Test Seeking, Test Turnaround, and Public Reporting of COVID-19: a retrospective analysis in Ontario, Canada
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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.
Funding
This study was funded by Public Health Ontario.
Research in Context
Evidence before this study
We searched PubMed and medRxiv up to November 30 2020 to identify studies examining the impact of delays in the disease reporting process on the public health response to COVID-19. We used the search terms (“2019-nCoV” OR “COVID-19” OR “SARS-CoV-2”) AND (“delays” OR “timely” OR “reporting” OR “test” OR “turnaround”), and reviewed reference lists of any relevant articles in the original search. Numerous modeling studies have highlighted the importance of timely testing and reporting to effectively control the spread of COVID-19. Additional studies have also identified delays of only 1 day in testing were associated with increased risk of secondary transmission within households. However no study has described the multiple delays in the disease reporting process of COVID-19 and examined factors associated with timely disease reporting using a large population cohort.
Added value of this study
Our study described timely test seeking, test turnaround, and reporting for laboratory-confirmed COVID-19 cases in Ontario, Canada and identified associated individual, neighbourhood, and administrative factors. To the best of our knowledge, this study is the first to describe detailed delays in the disease reporting process of COVID-19 and identified associated factors using a large population cohort.
Implications of all the available evidence
Numerous individual, neighborhood, and administrative characteristics are associated with timely testing and reporting of COVID-19. These identified factors may be used to develop strategies such as broadened test access, prioritization of vulnerable populations, and increased testing capacity to reduce delays in testing and reporting and improve the effectiveness of public health response to COVID-19.
Article activity feed
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SciScore for 10.1101/2021.02.22.21252219: (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:Our study has limitations as this cohort was generated from cases arising from the first wave of COVID-19 in Ontario, and these associations may not be generalizable to other populations/jurisdictions or subsequent time …
SciScore for 10.1101/2021.02.22.21252219: (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:Our study has limitations as this cohort was generated from cases arising from the first wave of COVID-19 in Ontario, and these associations may not be generalizable to other populations/jurisdictions or subsequent time periods. There may be a degree of misclassification with index and secondary cases within households if members were not tested or if secondary cases had been infected outside of the home. Another limitation is that our outcomes of interest had incomplete data, specifically the test seeking and test turnaround delays. While the delay from symptom onset is likely a reasonable proxy of infection onset to test seeking for symptomatic patients, the delay in test seeking could not be measured relative to the start of true infectiousness among asymptomatic infections. Delays in timely test seeking were likely influenced by changes in test access, testing criteria, and laboratory capacity during our study period. Further, missing information on specimen collection led to incomplete test seeking and test turnaround outcomes. The large reporting error in June likely resulted in decreased timely test turnaround in our analysis. Changes in required data entry fields over our study period may have also impacted timely reporting. However the strengths of our study include a large population-based cohort; an examination of multiple delays in the disease reporting process; and a large number of individual, structural, and neighbourhood characteristics, including the identifi...
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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