When a positive COVID test means losing work, there's little incentive to test : Shots - Health News For some people, getting a positive coronavirus test could mean loss of income or other life disruptions. Doctors worry about growing disincentives to test and how this could prolong the pandemic.

Even if they can find a test, not everyone wants to know they have COVID

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Just a few weeks ago, many people faced a shortage of COVID-19 tests. The government, under pressure, sent millions through the mail. But there's another aspect of the testing problem. Some people say they face disincentives to test - disincentives that range from inconvenience to economic and political penalties. NPR's Yuki Noguchi reports.

YUKI NOGUCHI, BYLINE: Cristina San Martin could find plenty of excuses not to test for COVID. At-home rapid tests are sold out. Lines for lab tests near Cypress, Texas, where San Martin lives, have wrapped around the block.

CRISTINA SAN MARTIN: I actually know a couple of people who specifically don't want to get tested, even if they think they're positive, because the nasal swab hurts.

NOGUCHI: San Martin washes dogs at a grooming salon and can't afford $150 to test at an urgent care site. Appointments are hard to find.

SAN MARTIN: They'll go through the website, and it'll be like, there are no appointments. There are no appointments for, like, seven days in advance.

NOGUCHI: And yet two weeks ago, at the first sign of sniffles and sore throat, San Martin sent a text to warn co-workers, then managed to get tested. It meant missing work and finding someone with a car. The test confirmed COVID. San Martin notified a manager at a dog salon and was fired. So now cash is also a problem.

SAN MARTIN: I'm in no shape right now to apply for jobs or go get interviewed by anyone or anything like that.

NOGUCHI: And San Martin, who is fully vaccinated, now wonders if it was worth the trouble to get tested.

SAN MARTIN: It's easy to take a moral stand and say, oh, you should always do the right thing. But if I knew that my job was on the line, I don't know. You know, I don't know if I would have gotten tested because anyone could easily say, oh, this is a cold. Or, oh, I just have the flu.

NOGUCHI: A major public health tenet is that testing is critical for controlling viral spread. But many experts worry there are growing disincentives to test. Not only is finding a test itself a challenge. There's also stigma and isolation that come with positive diagnoses. Plus, there's the cost of missing a paycheck or keeping children at home from school. Some, like Dr. Shantanu Nundy, worry those concerns are drowning out calls to test early and often in the name of public good. Nundy treats mostly low income patients at a federally funded clinic in Arlington, Va. These days, many come in asking...

SHANTANU NUNDY: Hey, can you test me? But can you test me, you know, in a way that's a rapid test so that it's not part of my record?

NOGUCHI: That's because lab-based PCR tests are reported to health officials. But Nundy says many patients prefer to fly under the radar of bosses and school administrators.

NUNDY: The patients and families who are the most marginalized - people who don't have steady employment, receive benefits, have limited child care and home support - are those who are most likely to not test and who are probably the ones who we need to test the most.

NOGUCHI: At the University of California, San Francisco Parnassus, emergency room doctor Jeanne Noble says testing has become an even harder sell, especially because many patients don't feel symptoms.

JEANNE NOBLE: I have heard many parents breathe a big sigh of relief when they say the school has run out of tests. Like, oh, good, you know, there's no chance I'm going to get a call at work that I have to come home.

NOGUCHI: Francesco Fallucchi says this is a global phenomenon. Fallucchi studies the economics of human behavior at the University of Parma in Italy. Last year, he studied Americans' willingness to take COVID tests and found altruism to be a powerful motivator. These days, he says, people's concern for others is bumping up against hard practical realities, especially because countries including the U.S. have cut back on pandemic unemployment benefits.

FRANCESCO FALLUCCHI: The disincentives to test are increasing, and they're increasing because there is less financial security and because there is a greater perception that COVID is getting weaker.

NOGUCHI: It's a dilemma Fallucchi feels personally as the parent of a daughter whose school required thrice-weekly at-home testing.

FALLUCCHI: I have to admit it's a bit shameful, but I met parents outside the school, and they said, oh, no, I'm not going to do it three times a week.

NOGUCHI: This reluctance to test puts employers especially in a tough spot. They face a dramatic labor shortage made worse by a surge of absences because of COVID. Testing is critical to solving that very problem. But Johnny Taylor Jr., CEO of the Society for Human Resource Management, says surveys suggest workers don't want to test.

JOHNNY TAYLOR JR: The question is employees - are they willing to become tested? I mean, back to this point, like, do I really want the hassle?

NOGUCHI: University of British Columbia professor Hugh Gusterson studies the culture of science. He says the rise of at-home tests is fundamentally changing how the virus can be tracked and traced.

HUGH GUSTERSON: That responsibility will increasingly be delegated to ordinary people to test themselves and to make their own judgments how to react to the test results that they get.

NOGUCHI: More consumers, in other words, will be able to make their own choice about whether to test or withhold reporting the results.

GUSTERSON: One implication is it's going to be very hard to know what our case rate is going forward.

NOGUCHI: That prospect worries people like Stella Safo, a doctor treating HIV patients in and around New York City. Safo takes medications that suppress her immune system, as well. She fears the growing reluctance to test means knowing less about who's infected, which leaves her and her patients more vulnerable than ever.

STELLA SAFO: I think that people who have chronic illnesses, people who have preexisting conditions, people who are disabled, are being driven truly underground.

NOGUCHI: And, Safo says, people should be reminded of the main point of testing - public health.

SAFO: In the first year and a half, we did a much better job of letting people know, like, you might get COVID bit and be fine, but the next person may not, you know? And that messaging, I think, has been lost in this desire to kind of get back to normal living.

NOGUCHI: Without that message, she says, people are left to make their own risk calculations whether to test based only on their personal circumstances. Yuki Noguchi, NPR News.


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