Overcoming social barriers to COVID-19 testing is an important issue, especially given the demographic disparities in case incidence rates and testing. Delivering culturally appropriate testing resources using data-driven approaches in partnership with community-based health workers is promising, but little data are available on the design and effect of such interventions.
The SARS-CoV-2 pandemic has highlighted long-standing questions about how to allocate testing resources. Although random testing is suitable for estimating prevalence, more targeted testing is advocated to reduce transmission of the virus. Such targeting, however, still poses challenges for how to optimally allocate COVID-19 testing resources. The Centers for Disease Control and Prevention recommends testing for symptomatic or exposed individuals; others recommend testing specific at-risk groups, such as frontline health care workers or the elderly, and much discussion focuses on increasing testing resources in vulnerable communities.
In vulnerable communities, little is known about the effectiveness of specific strategies for allocating testing resources. COVID-19 has disproportionately affected low-income and minority populations, in particular the Latinx community. In Santa Clara County, California, for instance, Latinx individuals constitute less than 26% of the population but accounted for more than 56% of COVID-19 cases at baseline. This disparity may be due to English language barriers among immigrant and Hispanic populations, distrust of the health care system, housing conditions, essential worker status, and other structural sources. Although increasing the number of diagnostic tests in vulnerable communities is important for reducing health disparities, how to do so is not obvious. COVID-19 testing sites established in such communities continue to exhibit disparities relative to the neighborhood population. It is thus imperative to understand the most effective means to reach subpopulations and allocate testing resources to overcome social and logistical barriers to access.