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Tepix

From the article:

> Overall, 67 (48.2%) clients volunteered to be tested, and 72 (51.8%) refused

Why would anyone refuse a Sars-CoV-2 test after being exposed like that?

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If you look at it from the viewpoint of the most selfish person imaginable:

If you're infected and still asymptomatic, the direct medical consequences to you are going to be the same whether you know your status now or not.

But knowing you're positive obligates you to self-isolate, track down other people you've been with contact, etc. If you don't particularly care to change your lifestyle to protect others, if you don't care that you might kill people with your carelessness, it's beneficial for you not to know.

Given the delay (~48+hrs) associated with getting test results, it should really go the other way— after a known exposure, you are treated as infected, the isolation and contact tracing process begins, and it's only after a negative test result that you're cleared.

That's possible only if your public health system is equipped to force large numbers of people to undergo certain medical procedures. In the U.S. there exists significant opposition to that sort of capability.

Could it possibly affect health insurance costs in the future, too? Let's say that it turns out that COVID-19 carries a risk of long term lung damage. In the future a health insurer might start asking applicants if they have ever received a positive test result.

Therefore (for those in countries where this kind of thing is a problem) there is a substantial financial risk to consider too - not just the immediate financial consequences of a possible but relatively short quarantine period.

The shame, the shame.

I'm not saying this is right, but I can imagine a few folk who probably have been going out or taking trips etc. and don't want to get tested because they fear their name being exposed somewhere with the public shaming to follow if they were to test positive.

Again, not saying it's right or that it's not selfish, but I can totally see that reasoning behind a large percentage of these folk refusing to get tested.

I'm not sure I would volunteer myself because, really, what information is the test going to give you? If you test negative, the instructions are still to self isolate (and rightly so, obviously). If you test positive, there's no treatment that will help you unless and until you get severely ill. I would be tempted to just refuse the test, assume I am potentially infected and self isolate for 2-4 weeks. It might be useful to get an antibody test after the isolation period, but that's a different matter altogether.

Obviously, the situation is different if for some reason you really cannot self isolate properly. In that case you would still need repeated tests to be reasonably sure and I'm not sure they offer those.

EDIT: my position assumes you don't require a test for contact tracing reasons. If I am contacted by anyone doing contact tracing and they ask me to get tested, I will follow their instructions. That said, if I'm going into isolation after an exposure event, I would notify everyone I've met since that event regardless of any testing.

There are lots of potential long-term health effects to the virus (even from asymptomatic cases), and if you were to start having health problems months down the line, you and your doctor would really want to know whether you had actually had the virus in the past. By the time months have passed it's too late to know; most people's blood antibodies have faded below detectable levels by then.

Yes, that's why I'd love to get an antibody test right at the end of the isolation period. If that's impossible, that might be a reason to do the RT-qPCR test, but in that case it's probably still optimal to do the test after a presumed incubation period rather than immediately to reduce the chances of a false negative.

You want all the kinds of tests. I'm pretty sure I had coronavirus in mid-March (I live in NYC), but seeing as how there were no tests available at all unless you were hospitalized at a minimum, I just suffered through it in home isolation. By the time antibody tests were widely available nearly two months later, my result came back negative. A swab test at the peak of my symptoms would have been more conclusive (had it been available). A lot of people who had it earlier on are already testing negative for antibodies. And now it's at the point where I'll never know for sure. I really wish the testing (all kinds) had been available in mid-March, so I'd know for sure. Now that the testing is much more available, you'd be crazy not to take advantage of it.

What would knowing for sure change for you? As you correctly noted, antibody levels seem to decline fairly quickly, so it's not like you can rely on immunity. It's true that there's a long and growing list of complications associated with C19, but I don't know of a single one where the diagnostic or therapeutic options change in any way based on whether you had C19 or not. In theory, if we actually had a thorough understanding of the mechanisms (and probabilities) of various complications after C19 it would affect the process of diagnosing them, but we're a very long way from that.

It bothers me greatly to not know things for sure. I can't even tell this story without having to put a giant caveat on it.

This really wouldn't bother you??? You really wouldn't mind not knowing?

One giant reason that knowing for sure would be helpful is knowing that you're less likely to get reinfected, and likely less likely to have serious effects if you do end up reinfected, if you previously had it (even if blood antibodies have faded, your T memory cells may still help you out). This might change your behavior going forward.

Technically, I'm in a slightly similar position to yours as I had an uncommonly annoying respiratory infection during the last week of February (I am not in a disease epicenter, however, so my Bayesian prior is much weaker). I don't believe having a positive (or negative) test would meaningfully change my behavior or medical decisions and I don't feel any significant psychological discomfort about it. That said, I respect that you feel differently, that's fair enough.

However, on the last point, I'm afraid that thinking might potentially prove quite dangerous. As far as I can tell (from closely following the medical literature, though I am not an immunologist and don't claim any authority on the subject) we really have no idea as to how quickly immunity decays, every single cellular immunity (T cell) study I've seen is extremely limited methodologically and we have no clinical evidence whatsoever to suggest that reinfections would have a milder course. If that turns out to not be the case, people who behave incautiously based on their test results might significantly endanger themselves.

>There are lots of potential long-term health effects to the virus

This has been repeated ad nauseam but there has been no proof of any long term or permanent side effects from COVID, especially for asymptomatic cases. There are a few anecdotal cases but nothing concrete. Yes, if you get a bad case of COVID with a harsh pneumonia, that will result in a lower lung capacity for a while but that's always what happens after lung damage. But to say "lots of potential side effects" is bordering on disinformation.

It's been 7 months now, we would have known by now. It makes absolutely no sense to keep pushing for the "we don't know a lot about the virus so we can just assume the worse and there's no way to prove otherwise" arguments after 5m+ infections and still no evidence even with almost every scientist and every doctor in the world being focused on COVID right now.

There is plenty of proof of long term and potentially permanent side effects, including some that are uncorrelated to disease severity. It's also true the relative prevalence of such side effects is far from well understood, but that is not a valid reason to dismiss the concerns outright. To counter your statement regarding "no evidence", here's just a few recent studies that provide such evidence (please note that this list is extremely far from being remotely exhaustive):

1) https://academic.oup.com/brain/article/doi/10.1093/brain/awa... "The high incidence of acute disseminated encephalomyelitis, particularly with haemorrhagic change, is striking. This complication was not related to the severity of the respiratory COVID-19 disease."

2) https://www.nature.com/articles/d41586-020-01891-8 (on the possibility that C19 may trigger diabetes)

3) https://medicalxpress.com/news/2020-07-physicians-comprehens... (on the systemic effects of C19, many of the acute complications have chronic effects detailed in the full study if you care to read it)

4) https://www.thelancet.com/journals/lancet/article/PIIS0140-6... (on Kawasaki-like autoimmune disease in C19-infected children)

5) https://www.thelancet.com/journals/lanres/article/PIIS2213-2... (post-C19 lung fibrosis)

Note that I've only cited evidence from highly cited and peer reviewed studies. There's a lot more if you care to follow the medical literature, but I think I've proven my point. 7 months is actually extremely little time for proper epidemiological studies on long term complications, it will take years to understand the prevalence and relative risk factors. What is clear, however, is that there is plenty of clinical evidence for different kinds of long term complications that necessitate further research.

Because it takes time and you probably are not getting paid for participating. Most people have lives and obligations. Give'em $1000 and they wont refuse. And guarantee to pay for downsides if they test positive. And don't say it's just a swap and it only takes 5 minutes. Everything that involves the medical bureaucracy takes hours.

> Give'em $1000 and they wont refuse

Alternatively: free test + healthcare if you test positive; stiff fines + liable to be sued by contacts for damages if you refuse testing and later (in the next 3 weeks) turn out to be infected.

> Everything that involves the medical bureaucracy takes hours.

I'm in Waterloo Region, Canada, and I got tested back in mid-May after waking up with a fever randomly. It really was five minutes, in and out. Results were posted online two days later.

Off topic, but it would be interesting to see political affiliation with those numbers

If someone went straight home after getting a haircut or had minimal contact with others before getting the call telling them about the exposure, I’d understand just waiting out 14 (or whatever the recommendation is) days while monitoring for symptoms. In all other cases, it would be pretty selfish not to get tested so that your own contacts would be able to respond accordingly if positive.

because you are only covid-positive if you test positive? /s

This, but unironically. I know people who were told by their bosses they'd get sacked if they tested positive on the virus. Obviously highly illegal but the only restrictions my country has on layoffs is that you have to give 3 months notice and if you lay off more than 20 people at once you need approval of the ministry of work.

Sadly, I suspect scepticism about Covid and conspiracy mongering about the medical establishment was behind at least some of the refusals. Not to mention need to get back to work

...or even if you don't, but have a cough

Is it a political thing?

The test is very invasive and uncomfortable. I can see why someone with no symptoms, especially if they're not at risk of transferring it to others, would refuse it.

A swab deep in your nose and at the back of your throat is not "very invasive".

Having seen how it's done via plenty of news reports, having a swap stuck up the back of my nose certainly looks plenty invasive, not to mention potentially painful.

I can certainly imagine someone who's asymptomatic and is more nervous about it being disinclined to voluntarily undergo testing.

If it were a finger-tip prick or cheek-swap it'd probably have a lot more acceptance.

This is true, very few would object to a finger-prick, and there was talk of a "spit test" a few weeks back; that would push testing rates to close to 100%

> I can see why someone with no symptoms, especially if they're not at risk of transferring it to others, would refuse it.

The fact that they caught the disease tells us they are at risk of transferring it to others.

No. I have undergone a PCR test myself and it was no big deal at all.

It takes 5 seconds and is mildly uncomfortable. I don't even know what invasive even means in this context.

All I have to say to those people is "suck it up"

Source: I've had 8 tests now.

Non-invasive means that the means/method of testing effectively has zero potential of harm (although receiving the results could be a huge blow).

While nasal swabs are extremely low risk, they still are a test that people may try to avoid out of fear of medical procedures.

That's not what it means, it is invasive if it invades, enters a part of your body which is not usually probed with foreign bodies, you anus, your urethra, deep in your nose, behind your eyes. The risk associated is orthogonal.

The guidance for the last month has been that they insert it into each nostril for at least 15 seconds out here. Curious if they do the tests differently in certain locations.

The first 2-3 I had were for 15 and I will say yes the last 4-5 seconds does get uncomfortable but not a big deal.

The more recent tests have also been 5 seconds.bone in each nostril and nothing in the throat. I've definitely had different style of tests but I do not recall the names. They are also using a better style of swab in my opinion that makes it substantially more comfortable.

Even for the more uncomfortable longer time style tests it's something you forget about pretty much immediately afterwards.

> It takes 5 seconds and is mildly uncomfortable.

This is good to know, I've heard people say you don't want to get tested as it's rather painful.

Mildly to somewhat uncomfortable yes. Depending on the style of test, the 15 second one is obviously less fun. But it is in no way painful. I firmly believe people simply don't want to get tested for whatever selfish reason or they are wildly exaggerating the test.

Because they stick a long cotton bud right up your nose, further than you would expect, not very pleasant. I wouldn't have one.

I have had the the test. It is really not that bad. I thought it would be worse but it was just uncomfortable, nothing more than that.

It's really not as bad as everyone says. I've had to have the same swab for other reasons and it takes less than a second.

Wouldn't you want to know whether you might be infecting others you're close to?

I would assume that I could be positive and isolate myself.

At many employers, you'd be terminated if you met the criteria for getting one.

It's a pretty sad hill to die on, the discomfort level is similar to getting a shot. Really no big deal at all for a normal adult.

It's not a big deal at all.

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