OBJECTIVES: 

To investigate public use of lateral flow test [LFT] or polymerase chain reaction [PCR] test when experiencing key COVID-19 symptoms.



STUDY DESIGN: 

Two waves of a cross-sectional nationally representative online survey (data collected 1-2 June and 14-15 June 2021; n=3665 adults aged 18 years or over living in England or Scotland).





METHODS: 

We report data investigating which type of test, if any, the public think Government guidance asks people to use if they have COVID-19 symptoms. In people with key COVID-19 symptoms (high temperature, cough, loss of sense of taste or smell), we also describe uptake of testing, if any.



RESULTS: 

10% of respondents thought Government guidance stated that they should take an LFT if symptomatic, while 18% of people thought that should take a PCR test; 60% thought they should take both types of test (12% did not select either option). In people who were symptomatic, 32% reported taking a test to confirm whether they had COVID-19. Of these, 53% reported taking a PCR test and 44% reported taking an LFT.



CONCLUSIONS: 

Despite Government guidance stating that anyone with key COVID-19 symptoms should complete a PCR test, a significant percentage of the population use LFT tests when symptomatic. Communications should emphasise the superiority of, and need for, PCR tests in people with symptoms

Amlȏt, R

Fear, NT

Michie, S

Potts, HWW

Rubin, GJ

Smith, LE

English

UCL Discovery

Journal Pre-proofDo members of the public think they should use lateral flow tests or PCR tests whenthey have COVID-19-like symptoms? The COVID-19 Rapid Survey of Adherence toInterventions and Responses [CORSAIR] studyLouise E. Smith, PhD, Henry WW. Potts, PhD, Professor of Health Informatics,Richard Amlȏt, PhD, Head of Behavioural Science, Nicola T. Fear, DPhil (Oxon),Professor of Epidemiology, Susan Michie, DPhil, Professor of Health Psychology, GJames Rubin, PhD, Assistant DirectorPII: S0033-3506(21)00293-6DOI: https://doi.org/10.1016/j.puhe.2021.07.023Reference: PUHE 4356To appear in: Public HealthReceived Date: 9 July 2021Accepted Date: 20 July 2021Please cite this article as: Smith LE, Potts HW, Amlȏt R, Fear NT, Michie S, Rubin GJ, Do membersof the public think they should use lateral flow tests or PCR tests when they have COVID-19-likesymptoms? The COVID-19 Rapid Survey of Adherence to Interventions and Responses [CORSAIR]study, Public Health, https://doi.org/10.1016/j.puhe.2021.07.023.This is a PDF file of an article that has undergone enhancements after acceptance, such as the additionof a cover page and metadata, and formatting for readability, but it is not yet the definitive version ofrecord. This version will undergo additional copyediting, typesetting and review before it is publishedin its final form, but we are providing this version to give early visibility of the article. Please note that,during the production process, errors may be discovered which could affect the content, and all legaldisclaimers that apply to the journal pertain.© 2021 Published by Elsevier Ltd on behalf of The Royal Society for Public Health.Do members of the public think they should use lateral flow tests or PCR tests when they have COVID-19-like symptoms? The COVID-19 Rapid Survey of Adherence to Interventions and Responses [CORSAIR] study  Louise E Smith (0000-0002-1277-2564),1,2 PhD, Henry WW Potts (0000-0002-6200-8804),3 PhD, Richard Amlȏt (0000-0003-3481-6588),2,4 PhD, Nicola T Fear (0000-0002-5792-2925),1,5 DPhil (Oxon), Susan Michie (0000-0003-0063-6378),6 DPhil, G James Rubin (0000-0002-4440-0570),1,2 PhD  1 King’s College London, Institute of Psychiatry, Psychology and Neuroscience  2 NIHR Health Protection Research Unit in Emergency Preparedness and Response 3 University College London, Institute of Health Informatics 4 Public Health England, Behavioural Science and Insights Unit 5 King’s Centre for Military Health Research and Academic Department of Military Mental Health  6 University College London, Centre for Behaviour Change  Corresponding author: Louise E Smith, Post-doctoral Researcher. Department of Psychological Medicine, King’s College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ. Email: louise.e.smith@kcl.ac.uk Henry WW Potts, Professor of Health Informatics. Institute of Health Informatics, 222 Euston Road, London, NW1 2DA. Richard Amlȏt, Head of Behavioural Science in the Behavioural Science and Insights Unit at Public Health England. Porton Down, Salisbury, Wiltshire, SP4 0JG. Nicola T Fear, Professor of Epidemiology. Department of Psychological Medicine, King’s College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ. Susan Michie, Professor of Health Psychology. Centre for Behaviour Change, University College London,1-19 Torrington Place, London, WC1E 7HB. G James Rubin, Assistant Director, NIHR Health Protection Research Unit in Emergency Preparedness and Response, King’s College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ. Journal Pre-proofAbstract Objectives: To investigate public use of lateral flow test [LFT] or polymerase chain reaction [PCR] test when experiencing key COVID-19 symptoms.  Study design: Two waves of a cross-sectional nationally representative online survey (data collected 1-2 June and 14-15 June 2021; n=3665 adults aged 18 years or over living in England or Scotland). Methods: We report data investigating which type of test, if any, the public think Government guidance asks people to use if they have COVID-19 symptoms. In people with key COVID-19 symptoms (high temperature, cough, loss of sense of taste or smell), we also describe uptake of testing, if any. Results: 10% of respondents thought Government guidance stated that they should take an LFT if symptomatic, while 18% of people thought that should take a PCR test; 60% thought they should take both types of test (12% did not select either option). In people who were symptomatic, 32% reported taking a test to confirm whether they had COVID-19. Of these, 53% reported taking a PCR test and 44% reported taking an LFT. Conclusions: Despite Government guidance stating that anyone with key COVID-19 symptoms should complete a PCR test, a significant percentage of the population use LFT tests when symptomatic. Communications should emphasise the superiority of, and need for, PCR tests in people with symptoms. Keywords: antigen testing, lateral flow devices, testing, behaviour, knowledge, COVID-19  Journal Pre-roofMain text Since 18 May 2020, guidance in the UK has been that people with a new onset cough, high temperature, or loss of taste or smell should receive a polymerase chain reaction (PCR) test for COVID-19.1 In addition, since 9 April 2021 everyone in the UK has been able to access free, rapid lateral flow tests (LFTs) for COVID-19 for use when asymptomatic.2 In England and Scotland, it is recommended that all adults should use an LFT twice a week, with any positive LFT results requiring a follow-up PCR test to confirm infection. While the results of all LFTs conducted at home should be reported on a Government website, in practice it is believed that most LFTs go unreported.3 How LFTs should be incorporated into efforts to combat the pandemic has been a source of controversy, with arguments played out across academic journals and the national media.4,5 Often missing from this debate are any data on how tests are used in practice. Many members of the public are uncertain as to the difference between PCR tests and LFTs and, despite warnings from the Government and NHS that people should “…not use a rapid lateral flow test if you have COVID-19 symptoms. Get a PCR test and self-isolate”,6 it is clear that some people do indeed use LFTs to check their symptoms. To assess current public usage of tests, we analysed data from the CORSAIR study (COVID-19 Rapid Survey of Adherence to Interventions and Responses study). This is a series of nationally representative (UK) cross-sectional surveys, conducted by BMG data on behalf of the Department of Health and Social Care.7 This work was conducted as part of service evaluation of the marketing and communications run by the Department of Health and Social Care and, following advice from King’s College London Research Ethics Subcommittee, was exempt from ethical approval. For this study, we used a sample of 3665 adults aged 18 years or over living in England or Scotland from two survey waves, collected 1-2 June and 14-15 June 2021.  Participants were asked what they thought Government advice was if they had symptoms of coronavirus (true/false statements). Only 17·8% of people selected that they should take a PCR test, 10·0% thought they should take an LFT, and 60·0% thought they should take both types of test (Table 1). Twelve percent of people did not select either option. Table 1. Understanding of Government guidance on testing if you have symptoms of COVID-19. The Government has issued advice on how people should help prevent the spread of coronavirus if they have symptoms. If you have symptoms of coronavirus, you: [Total n=3665] Selected “true”, % (95% CI) N Should take a rapid ‘lateral flow’ coronavirus test (results within 30 minutes) 10·0 (9·1 to 11·0) 368 Should take a lab-processed ‘PCR’ coronavirus test (results typically within a day or two) 17·8 (16·5 to 19·0) 651 Selected both options 60·0 (58·4 to 61·6) 2200 Selected neither option 12·2 (11·1 to 13·2) 446  Among people who reported that they had developed cough, high temperature / fever, loss of sense of taste or smell in the last 10 days (n=185), 31·9% (95% CI 25·1% to 38·7%, n=59) reported taking a test to confirm whether they had COVID-19. Of those, 52·5% (95% CI 39·4% to 65·7%, n=31/59) reported taking a PCR test, and 44·1% (95% CI 31·0% to 57·1%, n=26/59) reported taking an LFT. Two people did not know what type of test they took. We did not include a “both” option for this item.  Journal Pre-proofOur findings suggest that intended and actual testing behaviours in the public are out of step with Government recommendations. Our previous work has suggested that only 20% of people with COVID-19-like symptoms requested a test for COVID-19 in the UK 7, although among those who have reason to believe they have been exposed to infection this percentage is likely to be higher.8 The easy accessibility of LFTs, 30 minute turnaround time, and lack of compulsion to formally register the test with the Government (and hence self-isolate if the result is positive) probably make LFTs a more attractive option than PCR for some people. What the net effect of this is on rates of transmission is unclear. If LFTs are used instead of PCR by symptomatic people who would otherwise have requested a PCR test, their lower sensitivity reduces the chances of an accurate diagnosis.4 On the other hand, if LFTs are used by people who would not otherwise have sought a test, and a positive result leads to a reduction in behaviours associated with transmission, then this would be a beneficial outcome. The use of an LFT among symptomatic people who have already requested a PCR test is unclear. At present adherence to self-isolation among people who seek a PCR test tends to be weakest in the period between symptom onset and receiving a test result.9 If a positive LFT result during this period encourages more people to self-isolate, this may reduce transmission. Conversely a false negative result at this point may reduce adherence in some, offsetting this impact, though findings from elsewhere suggest reduced adherence as a result of false reassurance is relatively uncommon.10  Modelling is required to quantify the impact of testing behaviours. Until then, good communication with the public emphasising the superiority of PCR tests when symptomatic remains important.   Journal Pre-profAuthor contributions All authors conceptualised the study and contributed to survey materials. LS completed analyses and analyses have been verified by HWWP. LS wrote the first draft of the manuscript. All authors contributed to, and approved, the final manuscript. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. Declaration of interests All authors had financial support from NIHR for the submitted work. RA is an employee of Public Health England; HWWP receives additional salary support from Public Health England and NHS England; NTF is a participant of an independent group advising NHS Digital on the release of patient data. All authors are participants of the UK’s Scientific Advisory Group for Emergencies or its subgroups. There are no other financial relationships with any organisations that might have an interest in the submitted work in the previous three years and no other relationships or activities that could appear to have influenced the submitted work. Funding information This work was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme. Surveys were commissioned and funded by Department of Health and Social Care (DHSC), with the authors providing advice on the question design and selection. LS, RA and GJR are supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Emergency Preparedness and Response, a partnership between Public Health England, King’s College London and the University of East Anglia. RA is also supported by the NIHR HPRU in Behavioural Science and Evaluation, a partnership between Public Health England and the University of Bristol. HWWP receives funding from Public Health England and NHS England. NTF is part funded by a grant from the UK Ministry of Defence. The views expressed are those of the authors and not necessarily those of the NIHR, Public Health England, the Department of Health and Social Care or the Ministry of Defence. Role of the funding source NIHR and DHSC had no role in analysis, decision to publish, or preparation of the manuscript. Preliminary results were made available to DHSC and the UK’s Scientific Advisory Group for Emergencies. Ethics This work was conducted as part of service evaluation of the marketing and communications run by the Department of Health and Social Care and, following advice from King’s College London Research Ethics Subcommittee, was exempt from ethical approval.    Journal Pr-proofReferences 1. Department of Health and Social Care. Everyone in the United Kingdom with symptoms now eligible for coronavirus tests. 2020. 2. Department of Health and Social Care. New campaign urges public to get tested twice a week. 9 April 2021 2021. https://www.gov.uk/government/news/new-campaign-urges-public-to-get-tested-twice-a-week (accessed 14 June 2021). 3. National Audit Office. Test and trace in England – progress update, 2021. 4. Dinnes J, Deeks JJ, Berhane S, et al. Rapid, point‐of‐care antigen and molecular‐based tests for diagnosis of SARS‐CoV‐2 infection. Cochrane Database of Systematic Reviews 2021; (3). 5. Josh Halliday. Covid-19: how accurate are lateral flow tests? The Guardian. 25 April 2021. 6. GOV.UK. Order coronavirus (COVID-19) rapid lateral flow tests. 2021. https://www.gov.uk/order-coronavirus-rapid-lateral-flow-tests (accessed 25 June 2021). 7. Smith LE, Potts HWW, Amlôt R, Fear NT, Michie S, Rubin GJ. Adherence to the test, trace, and isolate system in the UK: results from 37 nationally representative surveys. BMJ 2021; 372: n608. 8. Mowbray F, Woodland L, Smith LE, Amlôt R, Rubin GJ. Is my cough a cold or covid? A qualitative study of COVID-19 symptom recognition and attitudes towards testing in the UK. medRxiv 2021: 2021.05.28.21258022. 9. Office for National Statistics. Coronavirus and self-isolation after testing positive in England: 10 May to 15 May 2021. 2 June 2021 2021. https://www.ons.gov.uk/peoplepopulationandcommunity/healthandsocialcare/healthandwellbeing/bulletins/coronavirusandselfisolationaftertestingpositiveinengland/10mayto15may2021 (accessed 25 June 2021). 10. Martin AF, Denford S, Love N, et al. Engagement with daily testing instead of self-isolating in contacts of confirmed cases of SARS-CoV-2. medRxiv 2021: 2021.03.13.21253500.   Journal Pr-proof

Do members of the public think they should use lateral flow tests or PCR tests when they have COVID-19-like symptoms? The COVID-19 Rapid Survey of Adherence to Interventions and Responses [CORSAIR] study

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Do members of the public think they should use lateral flow tests or PCR tests when they have COVID-19-like symptoms? The COVID-19 Rapid Survey of Adherence to Interventions and Responses [CORSAIR] study

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