Evaluating social and spatial inequalities of large scale rapid lateral flow SARS-CoV-2 antigen testing in COVID-19 management: An observational study of Liverpool, UK (November 2020 to January 2021) (preprint)

ABSTRACT

ObjectiveTo explore social and spatial inequalities in uptake and case-detection of rapid lateral flow SARS-CoV-2 antigen tests (LFTs) offered to people without symptoms of COVID-19. DesignObservational study. SettingLiverpool, UK. Participants496 784 residents. InterventionFree LFTs to all people living and working in Liverpool (6th November 2020 to 31st January 2021). Main outcome measuresResidents who received a LFT, residents who had multiple LFTs, and positive test results. Results214 525 residents (43%) received a LFT identifying 5557 individuals as positive cases of COVID-19 (1.3%) between 6th November 2020 and 31st January 2021. 89 047 residents had more than one test (18%). Uptake was highest in November when there was military assistance. High uptake was observed again in the week preceding Christmas and was sustained into a national lockdown. Overall uptake and repeat testing were lower among males (e.g. 40% uptake over the whole period), Black Asian and other Minority Ethnic groups (e.g. 27% uptake for Mixed ethnicity) and in the most deprived areas (e.g. 32% uptake in most deprived areas). These population groups were also more likely to have received positive tests for COVID-19. Spatial regression models demonstrated that uptake and repeat testing were lower in areas of higher deprivation, areas located further from test sites and areas containing populations less confident in the using Internet technologies. Positive tests were spatially clustered in deprived areas. ConclusionsLarge-scale voluntary asymptomatic community testing saw social, ethnic, and spatial inequalities in an inverse care pattern, but with an added digital exclusion factor. COVID-19 testing and support to isolate need to be more accessible to the vulnerable communities most impacted by the pandemic, including non-digital means of access. What is already known on this topicO_LITesting asymptomatic individuals with rapid lateral flow SARS-CoV-2 antigen devices detects the most infectious individuals who otherwise would have been unaware they were likely to infect others. C_LIO_LILiverpool (UK) conducted the worlds first whole population, open-access, voluntary asymptomatic testing programme for COVID-19 management. C_LIO_LIThe impacts of such testing on inequalities are unknown. C_LI What this study addsO_LITesting uptake was lower, and test positivity was higher, among deprived populations, Black Asian and other Minority Ethnic groups and areas classified as having low Internet use. C_LIO_LIPopulation-wide asymptomatic testing programmes need to account for social, spatial, and digital access issues in their design, communication and delivery to minimise inequalities in outcomes. C_LI