Despite widespread public health messaging about the importance of COVID-19 testing and the frequency of asymptomatic spread, huge disconnects still exist between public understanding and scientific reality.
Almost a year into a pandemic that has killed more than 2.4 million people worldwide, a new online survey (sponsored by Thermo Fisher Scientific) of more than 3,000 residents of the United States and the United Kingdom reveals that many people are still uncertain about the differences among tests, when they should be tested and the implications of new COVID-19 strains.
The online survey took place in early February against the backdrop of the approaching milestone in the U.S. of half a million COVID-19 deaths and a month-long national lockdown in the U.K., prompted by the emergence of a more transmissible variant of the virus. The U.S. has suffered the highest number of COVID-19-related deaths in the world, while the U.K. has been the fifth hardest hit country in terms of mortality.
The Importance of Continued Testing
For many people in both countries, testing is still not a priority. Only two out of five Americans (40%) and a third (33%) of Britons report having been tested since the pandemic began, despite the fact that widespread testing is a critical tool for containing transmission and judging when it’s safe to relax restrictions. Testing has increased slightly in the U.S. since late last year, when an earlier survey found only 36% of Americans had been tested.
When people do seek testing, it is primarily driven by the fact that they have experienced symptoms (33% of respondents in the U.K. and 25% in the U.S.), because of possible exposure (22% in the U.K. and 28% in the U.S.) or because it was required for their jobs (25% in both countries).
A sizable percentage of people in both countries have a false sense of security about their infection precautions as they relate to testing, with 44% of Americans and 30% of Britons saying they don’t need to get tested if they do things like wear a mask. Despite persistent messaging about the prevalence of asymptomatic infection and spread, 70% of Britons and 67% of Americans report they haven’t been tested simply because they have not been ill.
“Non-pharmaceutical protective measures such as masks are very important and we have to follow them scrupulously,” said Stephen Morse, Ph.D., Professor of Epidemiology at the Columbia University Medical Center. “But the problem is there is no such thing as perfection. We’re never going to be able to reduce the risk completely to zero. We all make mistakes. We all forget to put on our masks, forget to wash our hands, maybe don’t put our masks on properly. So there is no substitute for testing. In reality, it’s the only way to really be sure that you’re not infected. The confusion is really unfortunate, because we should be testing much more widely.”
“I’m concerned that this second survey has revealed that people still don’t understand that widespread testing continues to be an important part of our COVID-19 containment strategy,” added Manoj Gandhi, M.D., Ph.D, senior director of medical affairs, Genetic Sciences, Thermo Fisher Scientific. “Even as more of us are getting vaccinated, testing will continue to be an important public health tool. We still need to identify those who are infected — and as we’ve seen, some people are declining vaccination. Additionally, testing will help us understand whether the vaccines protect against COVID-19 transmission and how well.”
Confusion about Tests and Accuracy
Although it has been widely reported that PCR-based tests are more accurate than rapid antigen tests, only 36% of Americans and 32% of Britons know the difference between the two types of tests. Misconceptions about testing options are common, with the majority of people (60% in the U.K. and 56% in the U.S.) believing all test are equally accurate.
“Antigen tests are very good at detecting if there’s a large amount of virus; and we know that those who are producing large quantities of virus are the most infectious. These tests look for the presence of virus proteins in the sample and can be very fast, but not as sensitive as PCR,” explained Morse. “The polymerase chain reaction, or PCR molecular test, is still the gold standard for sensitivity. We’ve used it for many years and with many infections and it’s really the baseline against which we compare others. It’s very sensitive and very accurate.”
Despite scientists’ continued assertions that PCR provides a definitive answer as to whether an individual has the virus in their body, an astounding 58% of Americans believe tests can be wrong as much as half the time. The survey shows educational efforts may have been more impactful in the U.K., where only 40% of people agree with the statement that tests can be wrong as much as half the time.
While confusion remains on test accuracy and types of tests available, Americans and Britons (69% and 75%, respectively) agree that confidence in test results is the most important criteria when choosing a test. Only 18% of Americans and 14% of Britons say they would choose a test that delivered faster results if those results might not be accurate.
New Strains Cause Concerns
As new strains of coronavirus have emerged — a seemingly more infectious variant first appeared in England in December — most people in the U.S. (70%) and U.K. (72%) voice heightened concerns. Interestingly, the emerging variants have provoked a greater response in the U.S., perhaps because reports of the new strains have only more recently made headlines. Because of the reported mutations, about a third (31%) of Americans have been tested for the first time (compared to 20% in the U.K.) and 35% have been getting tested more regularly (compared to 22% in the U.K.).
While the new strains have prompted more testing in some cases, 42% of Americans and 24% of Britons say they have heard these variants may not be identified with current tests and are therefore less likely to get tested. It appears that the general public is not aware that some of these tests, including Thermo Fisher’s TaqPath COVID-19 assay, are designed to target multiple areas of the virus genome so they can identify positive cases even when mutations arise.
Vaccine Hesitancy is More Common in the U.S.
The survey illustrates perceptions toward COVID-19 testing as vaccine rollouts are underway across the globe. Equal percentages of respondents in both countries (23%) reported being vaccinated at the time of the survey, but attitudes toward vaccinations diverged widely. Alarmingly, one in four (21%) Americans say they do not plan on being vaccinated, compared to only 7% of Britons.
Vaccination rates will continue to increase over the coming months, but testing will still be critical to preventing future outbreaks, said Morse. “Testing is going to be important to determine whether the vaccine protects against transmission. If the vaccine protects against the disease but not transmission, we’ll be testing for quite a while, until everyone has the vaccine to protect them.”
Morse added: “Later on, testing will still be needed to find out how effective the vaccine is in the long-term. And if someone has a respiratory infection, we need to be able to identify what it is so we can treat it appropriately. So there’s always a role for testing.”
The survey was conducted online by Regina Corso Consulting on behalf of Thermo Fisher Scientific between February 4 and 8, 2021 among 2,017 U.S. residents and 1,030 U.K. residents ages 18 and older. Samples were balanced by age, gender, region, education and income to be representative of both countries as a whole. The earlier U.S. survey (also by Regina Corso Consulting on behalf of Thermo Fisher) was conducted between Nov. 23 and 25, 2020.