Improvements in SARS-CoV-2 Testing Cascade in the US: Data from Serial Cross-sectional Assessments.


There were significant improvements in access and turnaround times across US states; yet barriers to testing remained consistent across states underscoring the importance of a continued focus on testing, even amidst mass vaccination campaigns.

In February 2021, across 10 US states, 11% (895) of respondents reported wanting a diagnostic test in the prior 2 weeks, 63% of whom got tested with limited variability across states. Almost all (97%) who got tested received their results; 56% received their results within 2 days. In MD, FL, and IL where serial data were available at four time points, 56% were tested the same day they wanted/needed a test in February 2021 compared to 28% in July 2020, and 45% received results the same day as opposed to 17% in July 2020. Wanting a test was significantly more common among younger, non-white respondents and participants with a history of symptoms or exposure. Logistical challenges including not knowing where to go were the most frequently cited barriers.

SARS-CoV-2 testing is critical for monitoring case counts, early detection and containment of infection, clinical management, and surveillance of variants. However, community-based data on the access, uptake, and barriers to testing have been lacking.

We conducted serial cross-sectional online surveys covering demographics, COVID-19 symptoms, and experiences around SARS-CoV-2 diagnostic testing to characterize the SARS-CoV-2 testing cascade and associated barriers across 10 US states (California, Florida, Illinois, Maryland, Massachusetts, Nebraska, North Dakota, South Dakota, Texas, and Wisconsin), between July 2020 to February 2021.

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