Adherence to the test, trace, and isolate system in the UK: results from 37 nationally representative surveys

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To investigate rates of adherence to the UK’s test, trace, and isolate system over the initial 11 months of the covid-19 pandemic.


Series of cross sectional online surveys.


37 nationally representative surveys in the UK, 2 March 2020 to 27 January 2021.


74 699 responses from 45 957 people living in the UK, aged 16 years or older (37 survey waves, about 2000 participants in each wave).

Main outcome measures

Identification of the main symptoms of covid-19 (cough, high temperature or fever, and loss of sense of smell or taste), self-reported adherence to self-isolation if symptoms were present and intention to self-isolate if symptoms were to develop, requesting a test for covid-19 if symptoms were present and intention to request a test if symptoms were to develop, and intention to share details of close contacts.


Only 51.5% of participants (95% confidence interval 51.0% to 51.9%, n=26 030/50  570) identified the main symptoms of covid-19; the corresponding values in the most recent wave of data collection (25-27 January 2021) were 50.8% (48.6% to 53.0%, n=1019/2007). Across all waves, duration adjusted adherence to full self-isolation was 42.5% (95% confidence interval 39.7% to 45.2%, n=515/1213); in the most recent wave of data collection (25-27 January 2021), it was 51.8% (40.8% to 62.8%, n=43/83). Across all waves, requesting a test for covid-19 was 18.0% (95% confidence interval 16.6% to 19.3%, n=552/3068), increasing to 22.2% (14.6% to 29.9%, n=26/117) from 25 to 27 January. Across all waves, intention to share details of close contacts was 79.1% (95% confidence interval 78.8% to 79.5%, n=36 145/45 680), increasing to 81.9% (80.1% to 83.6%, n=1547/1890) from 25 to 27 January. Non-adherence was associated with being male, younger age, having a dependent child in the household, lower socioeconomic status, greater financial hardship during the pandemic, and working in a key sector.


Levels of adherence to test, trace, and isolate are low, although some improvement has occurred over time. Practical support and financial reimbursement are likely to improve adherence. Targeting messaging and policies to men, younger age groups, and key workers might also be necessary.

Article activity feed

  1. 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 Statementnot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot 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.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. 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


    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.


    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.