Editor’s note: This story by Nora Doyle-Burr was originally published in the Valley News on Feb. 8.
HANOVER — Researchers at Dartmouth College co-authored a study released late last month that indicates that people may misinterpret the results of rapid Covid-19 tests, leading them to skip quarantine or quarantine needlessly.
In the study, published Jan. 31 in JAMA Internal Medicine, the researchers said that improving instructions that come with rapid tests could help maximize their public health benefit.
“Our findings suggest that many at-home Covid-19 self-test users will draw false reassurance from a negative result, ignoring conditions that pose a high risk of infection,” said Dr. Steven Woloshin, the paper’s lead author and a professor at the Geisel School of Medicine at Dartmouth College. “In other cases, they may quarantine unnecessarily because they misinterpret the implications of their test results.”
The study came out as federal and state governments have made efforts to increase access to rapid tests as a way to detect infections sooner and prevent transmission of the virus. The Biden administration has said it plans to make 1 billion such tests available to Americans for free.
“The testing is supposed to help people make the right decision,” Woloshin said. Health officials should “make sure that people can know what the right thing to do is.”
The randomized trial, which Woloshin conducted in collaboration with researchers at Carnegie Mellon University and the University of Pittsburgh, included 360 adult participants. The participants completed an online survey in April 2021 about their interpretation of hypothetical at-home Covid-19 self-test results.
The survey asked participants to interpret results from one of four possible scenarios: having Covid-19 symptoms and recent close contact with a person infected with the virus; no symptoms and close contact; symptoms and no close contact; and no symptoms and no contact.
Participants were given either Food and Drug Administration-authorized instructions (available on the FDA’s website), intervention instructions written by the researchers, or no instructions for how to respond to their results. The researchers designed the intervention instructions using decision science principles, which offered a structured comparison of alternatives.
Following a positive result, 95% of participants said they would quarantine.
But, following a negative result, many participants said they would not quarantine appropriately, including 33% of those who received the FDA-authorized instructions, 24% who received no instructions and 14% of those who received the intervention instructions.
Woloshin said he found it “disturbing” that people who were given no instructions were better able to determine when they should quarantine than those who were given the FDA-authorized instructions.
The researchers found that the instructions from the federal government were difficult to follow and not always consistent.
“When the stakes are high, communicators like the (Centers for Disease Control and Prevention) and the FDA need to carefully vet their instructions. Otherwise, it undermines the whole point of the instructions,” Woloshin said.
In approving the test kits, the companies making the kits were required to prove to regulators that people could follow the instructions to conduct the test. Woloshin said that a similar process should have been conducted to ensure that people could follow instructions about what to do with the test results.
Health officials say the way people respond to negative results should depend on whether they have symptoms or whether they’ve been exposed to someone else who has tested positive.
“While the availability and use of at-home tests may be increasing, the need for persons who test positive for Covid-19 and their family members to take certain actions to prevent spreading Covid-19 has not changed,” said Jake Leon, a spokesman for the New Hampshire Department of Health and Human Services, adding that people should follow the guidelines for quarantine and isolation on the DHHS website, covid19.nh.gov.
Dr. Tim Lahey, an infectious disease specialist at the University of Vermont Medical Center who was not involved in the study, agreed with Woloshin’s assessment of the study’s findings that people would benefit from better instructions.
Still, rapid tests have an important role to play in efforts to mitigate Covid-19, Lahey said.
“Even with perfect instructions, though, test-takers may still make some mistakes,” Lahey said. “That’s OK. No human system is perfect. Some risk reduction is better than none.”
Anne Sosin, a policy fellow and public health expert at Dartmouth College, also said she is glad to see that rapid tests are being widely distributed through liquor stores, schools and libraries. However, she said it was unfortunate that the distribution didn’t happen until the surge tied to the Omicron variant was part-way over.
“As we look forward, we need tests available at the start of surges, not a month in after public pressure,” Sosin said.
Sosin also said she thinks public literacy with how to use rapid tests has grown since the study was conducted last spring. While she thinks increasing the quality of information provided to the public is important, she also said it’s important to acknowledge and address other reasons people might not quarantine when they’re supposed to, such as living in a crowded household, having work obligations or lacking sick time.
“Most of us are familiar with isolation (and) quarantine at this time,” Sosin said. That “doesn’t mean we have the resources to actually comply with that.”
