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

BackgroundMinimizing 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. MethodsWe 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. FindingsAmong 27,198 COVID-19 cases from January 25 2020 to July 19 2020, 28{middle dot}7% had timely test seeking, 40{middle dot}2% had timely test turnaround, and 75{middle dot}5% had timely reporting. Male gender had lower odds of timely test seeking (adjusted odds ratio [aOR] 0{middle dot}79 [95% CI: 0{middle dot}74-0{middle dot}85]) compared to females. Healthcare worker status (aOR 2{middle dot}77 [95% CI: 2{middle dot}52-3{middle dot}05] compared to non-healthcare workers), and age [≥]80 years (aOR 1{middle dot}59 [95% CI: 1{middle dot}33-1{middle dot}91] compared to 40-59 year olds) were associated with timely test seeking. Specimen collection on Fridays and Saturdays (aOR 0{middle dot}88 [95% CI: 0{middle dot}79-0{middle dot}98], aOR 0{middle dot}83 [95% CI: 0{middle dot}74-0{middle dot}92] respectively, compared to Wednesdays) had lower odds of timely test turnaround. Urban areas (aOR 1{middle dot}55 [95% CI: 1{middle dot}41-1{middle dot}70] compared to rural areas) were associated with timely test turnaround. Urban areas (aOR 0{middle dot}79 [95% CI: 0{middle dot}70-0{middle dot}89] compared to rural areas) were less likely to have timely reporting. InterpretationIndividual, 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. FundingThis study was funded by Public Health Ontario. Research in ContextO_ST_ABSEvidence before this studyC_ST_ABSWe 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 studyOur 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 evidenceNumerous 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.