More than eight-in-10 symptomatic people not getting tested

The latest data from wave seven of the Survey of COVID-19 Responses to Understand Behaviour (SCRUB), released on 4 September, found just 15% of Australians experiencing cold- or flu-like symptoms are getting tested for COVID-19, despite consistent government messaging.
 
The most common reasons cited for not getting tested were that people did not think they had coronavirus (24%), or they thought their symptoms were too mild to warrant a test (18%).
 
Other than essential medical care, the majority (62%) reported staying at home while symptomatic.
 
However, 23% said they had spent time in a public place, 17% had visited someone else’s home and 17% attended work in person.  
 
The data, collected between 6–12 August from a representative sample of 967 Australians, casts a shadow over the finding that the vast majority (74%) of people are complying with COVID-safe behaviours.
 
‘It is a little disappointing to see that,’ lead researcher Dr Peter Slattery told newsGP.
 
‘I think there’s maybe what you might call a “status quo bias”. People don’t really want to deviate from their norms and habits to go to a test centre and get tested.
 
‘There’s possibly also a bit of an optimism bias or complacency there – “It won’t happen to me” or “It’s very unlikely”. So I suppose people reassure themselves with that.’
 
 The SCRUB data is in line with the latest FluTracking report that shows 50% of people with cold- or flu-like symptoms for the week ending 30 August did not get tested for COVID-19.
 
Dr Holly Seale, a social scientist with the UNSW Medicine’s School of Public Health and Community Medicine, has also been researching the community’s behaviours around COVID-19.
 
While she agrees government messaging around getting tested, even with the mildest of symptoms, has been consistent, she says there is still work to do around people’s understanding of that message.
 
‘Do they appreciate the rationale for why we are testing people with even mild symptoms?’ Dr Seale told newsGP.
 
‘And how do we reconcile that with people’s thoughts around, “Well even if I’ve got mild symptoms, I haven’t been in any of these hotspot areas”?’
 
With cold and flu cases still commonly reported in September, Dr Seale says people brushing off their symptoms may also be attributed to past experience.
 
‘Those who keep an eye on the data know [this year] that flu is non-existent almost. But for others [who don’t know], we would commonly say, “Oh I’ve just got a cold”. Also now the creep coming into the language is, “Oh it’s just my hay fever or allergies playing up”,’ she said.
 
‘For those with young children, we know young kids pick up a lot of things and as parents you’re often also exposed to them by your children.
 
‘So there are so many ways that people just miss it, drawing back on something that you’ve experienced in the past. I think that is what a lot of people are doing.’
 
Dr Seale also suspects that for some, there may be a reluctance to get tested, given what is entailed both in getting tested, and the aftermath.
 
‘It is about getting to one of those testing facilities, but it’s also reconciling within yourself that if you are still waiting for [your] test [results], you can’t go out and do things,’ she said.
 
‘You may have had plans, and for so many people right now, especially in areas where they’re coming out of lockdown, the thought of cancelling their plans is the furthest from their mind. They want to get out and about and catch up with people.
 
‘So how do we motivate someone who knows what’s going to happen if they have to go and do the testing regime?’
 
Other findings
The silver lining of the survey is it shows people appear to be complying with COVID-safe behaviours.
 
Three-quarters of the population report often or always following the rules and regulations, with the highest compliance (88%) seen in keeping a physical distance from people in public, at school or the workplace.
 
Of those surveyed, 28% said their compliance had increased and 65% said it had stayed the same, with the main reason cited as concerns for the number of rising cases and outbreaks in Australia and New Zealand.
 
‘Despite lockdown fatigue, boredom and COVID-19 complacency being touted as some of the factors undermining Australia’s attempts to overcome COVID-19 outbreaks, our data failed to support these,’ Dr Slattery said.
 
‘Australians are cognisant of rising cases and outbreaks, they see what is happening across the
ditch in New Zealand, and they are complying with the rules and regulations.’

Dr Holly Seale says there is still ‘work to do’ concerning symptomatic people’s understanding of the need to get tested.
 
However, when people are in private with family and friends their compliance drops to 73%, with 43% stating they believed their family and friends were safe to have contact with and 22% said they were willing to take the risk.
 
‘Australians should still be physically distancing from friends and family in private settings,’ Dr Slattery said.
 
‘Family and friends may be asymptomatic and as we can see from Victoria, COVID-19 spreads at an exponential rate, particularly among close contacts.’
 
Dr Seale is concerned the challenge around effectively getting the messaging through to the public could grow in the lead up to Christmas.
 
‘It all builds into how we perceive this infection,’ she said.
 
‘We’ve still got 50% of the population perceiving this is pretty low key and not feeling personally at risk. That kind of mindset will then have that knock-on effect to all things, including participation in public health measures and into the testing.
 
‘It’s going to be more challenging to continue to sell this message as we go on. We’ve moved out of winter, we’re coming into spring, and we’re also working towards Christmas.
 
‘People are going to start to get frustrated that they don’t want to keep having to think about this thing. So it’s needing to get that balance right.’
 
To help get the message across, Dr Seale says there is a need to tap into trusted voices.
 
‘We know the trust is in GPs and other health professionals,’ she said.
 
‘So at a local level we need to ensure that they’re still a voice out there and that they are consistent – beyond just telling someone to go and get tested [they need to explain] why is the person needing to go and get tested?
 
‘Also, for some people, just breaking down the actual process of testing; we’ve all been told, “Go and get tested”, but do they actually know what that means?
 
‘Do I know that that means to drive to a council car park? That I may have to wait in a queue? Maybe I can try to avoid the after-school crowd. Those kind of things to try and alleviate the perceived barriers to going and doing it.’
 
But Dr Seale says it really comes down to knowing the demographics of the non-complying population, to be able to take a truly targeted approach.
 
That’s what the SCRUB data, funded by the Victorian Government, aims to do by providing policymakers with actionable insights into public attitudes and behaviours relating to the COVID-19 pandemic.
 
While different interventions are being tested, Dr Slattery said one thing is clear: ‘The messaging coming out needs to be repeated’.
 
‘Even if you are asymptomatic or have only very mild symptoms, you could still be carrying the virus, you could still pass it on. So it’s really better to be safe than sorry,’ he said.
 
‘If we all take that precaution and go get tested, then we make it better for all of us in the future.’
 
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