Covid-19 Testing: Patient perspectives

"This collaboration between M3 and the University of Birmingham provides an unprecedented global insight into the opinions of health care professionals regarding the emerging diagnostic landscape for COVID-19. This project explores preference for different diagnostic test options and how these might be deployed in local clinical practice. The pipeline of antigen and antibody tests is evolving rapidly and the perspective of the patient community is essential to guiding this development"
Dr.Alex Richter
University of Birmingham, April 2020

Overview

This research study investigated how 3,272 members of the general public, in ten countries, feel about SARS-CoV-2 antigen and antibody assays. We explore questions around choice of test, type of test, and how likely they would be to use each of these, to inform the development of new options.

Methodology

A 5-minute online quantitative survey was conducted with a random sample. Recruitment was via email to members of M3 Global Research’s proprietary patient panel, and in China via partner panel Holden.

The sponsor was not named at any point in the research, and there was no incentive for taking part. Fieldwork for this study was conducted between 24 April-1 May 2020, on the Confirmit platform.

Data were analysed based on all respondents, at country level, and also considered the impact of self-disclosed comorbidities on response.

Importance of Test

As a cohort, the general public feel strongly about the importance of both antigen and antibody tests in controlling the COVID-19 pandemic. 94% of respondents believe that the antigen test is critically, or very, important (compared to 91% of HCPs). By contrast, 89% of respondents think that the antibody test is critically, or very, important (compared to 79% of HCPs).

Being at a potentially greater risk of developing a more serious case of COVID-19 (i.e. respondents with high BMI, underlying health conditions) did not affect support for either test, but this may be because support was fairly unequivocal.

How important is the test? - Antigen tests
Antigen tests
How important is the test? - Antibody tests
Antibody tests

Accuracy of tests

43% of respondents preferred a widely available and ‘somewhat accurate’ test compared to 38% who only wanted very accurate tests, although there are differences at country level.

This is most stark in China, where 62% of respondents would prefer a widely available and somewhat accurate test. A widely available test is also particularly favoured in Brazil (58%).By contrast 45% of respondents in the USA, and 43% in the UK would prefer a very accurate test.

Deference to medical professionals’ opinion on test choice is most pronounced in Sweden (27%), and Canada (24%).

Likelihood of test usage

In stark contrast to the HCP survey, patient respondents are much more likely to use the tests if offered to them, with even support for the antibody and antigen tests (81% of respondents were extremely or very likely to take both tests). There is a slight preference for the antigen test when you look at ‘extremely likely’ (i.e. ‘top one’) in isolation. Support remains even when considering ‘top three’ options and including ‘somewhat likely’, with 92% each.

Support for the antibody test is lowest in China, with only 74% of respondents extremely or very likely to take a test. Only 51% of Swedish respondents would be likely to take an antigen test.

Respondents potentially more at risk of developing a more serious case of COVID-19 were not significantly more likely to be more predisposed to testing than respondents with a BMI of <25 and / or no pre-existing health conditions.

Accuracy vs speed

High accuracy is the most important factor for respondents in deciding how likely they would be to take a particular type of test offered to them, followed by speed of results.

The questionnaire asked respondents to choose between tests taken at home, at mobile testing centres, and at a doctor’s office or pharmacy. These options were then combined with offering highly accurate or less accurate tests, and immediate or slightly delayed results, to understand preferred combinations.

Testing combinations

The most popular testing combination across all options was the highly accurate in-home test, with immediate results.

This was least popular in China, with only 41% of respondents ‘extremely likely’ to take this option if offered, although it was still the highest rated combination for Chinese respondents. However, Chinese respondents were the most cautious about testing combinations in general, consistent with the data on p10-11 which shows they are the least positive aboutboth antigen and antibody tests.

The next most popular combination was a highly accurate home test where results would be received several days later. Both less accurate test options had little support. Preference for an ‘in-home’ test suggests convenience is paramount.

The top choices for test combinations are shown here, based on the percentage of respondents who were ‘extremely likely’ to choose that test profile.

In-home tests

Drive through tests

Pharmacy/Doctor tests

Type of test

In very similar results to the same question on the HCP survey, saliva was the preferred type of test, at 42% (45% of HCPs).

As with the HCP survey there were clear geographical preferences, with high preference for saliva tests in Canada, China, Germany, and the USA, all matching the HCP responses.

In the UK and Brazil, finger prick tests were preferred by 46% and 52% of respondents respectively, with similar levels of support to the HCP survey (45% and 39% respectively). France was the only market where a blood sample test was the preferred option (47%), whereas 54% of French HCPs would prefer a finger prick test.

Impact of Testing

There is very little divergence between the expected impact of the two types of tests for the respondents. For both, confidence in interacting with family and friends takes priority over other considerations.

In a reversal of the HCP survey results, confidence in returning to work is second. The general public also place more importance on being less concerned about social distancing than use of public transport than the HCP group.

Less concern with PPE and hand-washing was consistent with the HCP survey.

Conclusions

The ‘patient’ cohort’s enthusiasm for testing for COVID-19 is clear, as are the benefits; respondents will feel more confident spending time with their friends and family following positive antigen and antibody tests, but critically, for the economy, they will also feel more confident returning to work, and getting back to ‘normal’.

Respondent feedback on type of test supports the findings from the equivalent HCP survey, with saliva the preferred serology, and respondents happy with home testing, providing accuracy can be assured. Speed of testing results is important to them, but is secondary to accuracy of results.

However, availability of testing plays a large part, and the patient cohort will be acutely aware of media interest in this angle. Given the importance of accuracy to respondents, it was interesting to see opinion split on whether a widely available less accurate test would be preferred to a highly accurate test.

Perhaps surprisingly, looking specifically at the respondents who might be more likely to contract a severe case of COVID-19 due to their weight or other comorbidities, there is little divergence from the overall picture. This may reflect a lack of awareness of their relative threat risk, and should be considered as part of patient education around relaxing lockdown restrictions. If they do not consider themselves particularly vulnerable they may not take appropriate protective measures, although this is of course subject to ongoing research into the relative impact of comorbidities on COVID-19 patient outcomes.

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