Many US employers avoid Covid-19 tests over cost, non-availability

A surge of COVID-19 cases this fall has brought reports of new challenges in getting coronavirus tests. But for employers, testing availability and turnaround times do not appear to be the main obstacles.

A survey by Arizona State University and the World Economic Forum, with funding from the Rockefeller Foundation, has found that companies most frequently cited cost and complexity as the biggest deterrents to testing their workers.

The findings, based on responses from 1,141 facilities at over 1,100 companies worldwide from September through late October, are consistent with earlier reports suggesting that many employers have been able to obtain testing relatively quickly if they absorb the expense. In many cases, however, employers have indicated that they feel the benefits do not outweigh the costs.

Overall, 17% of the facilities surveyed worldwide said they were testing workers. At least half of those facilities were doing so even for workers without symptoms, and roughly half were testing workers at least once a week.

At facilities that were not testing, only 15% said availability was an issue, while 28% cited cost, 22% cited complexity and 16% said it would take too long to receive the results. (Those surveyed could select more than one reason.) The numbers for the United States, where more than 700 of the facilities were located, were similar to the overall results.

Mara Aspinall, a professor at Arizona State’s College of Health Solutions who helped oversee the study, said the results indicated that companies were figuring out how to get testing done if it was essential. For the others, she said, there was simply “a lot of confusion and uncertainty as to how tests work” in the absence of a national testing strategy, and the potential expense loomed large as well.

Aspinall, who is also an adviser to the Rockefeller Foundation, said she thought workplace testing would become far more widespread next year as employers seek to bring more people back to work.

Dr. Raj Behal, chief quality officer of One Medical, which provides primary health care services to large employers like Google, agreed that the lack of cheap tests had played a major role in limiting uptake.

“In our experience, companies that need to bring their employees in because they are essential or critical workers are regularly screening and testing employees for COVID,” said Behal, whose company has helped clients arrange testing and was not involved in the survey. “In general, though, cost may be the single most important barrier to widespread testing in the U.S.”

PCR tests, which are generally considered the most accurate but typically require laboratory processing, cost roughly $100 in the United States. Medicare typically covers COVID-19 tests, but many private insurance plans do not.

A spokesperson for One Medical said the average turnaround time for the tests was two to three days in most markets. “We anticipate an increase in testing demand around the holidays, and have increased our testing capacity accordingly,” the spokesperson added.

The survey found that companies with 25 workers or fewer were least likely to test, with only 8% doing so. About 40% of companies with 1,001 to 5,000 workers were testing, as were nearly 60% of companies with over 5,000 workers.

Among the biggest companies that didn’t test, cost was not a commonly cited obstacle. Those companies were much more likely to be discouraged by the complexity of testing their large workforces, which one-third cited.

Biotechnology and technology companies were among the most likely to test workers, with 37% and 29% doing so, even as they were also among the most likely to require employees to work remotely.

Manufacturing was also among the industries where testing was relatively common, with 20% of the facilities saying they did so. By contrast, only 10% of professional services firms, like accounting and law practices, said they were testing. And sectors in which rank-and-file workers tend to be poorly paid and can’t work from home, such as restaurants and hotels and casinos, had even lower rates.

Zack Cooper, an economist at the Yale School of Public Health who has advised the Rockefeller Foundation, said he had some concern that a survey of this kind could be biased, because companies that did not respond might differ from companies that did so. But he said that in general he was not surprised by the results, and that the survey highlighted the federal government’s failure to recognize the widespread benefits of testing and to subsidize it accordingly. Cooper had no role in the survey.

There was one area where U.S.-based facilities diverged significantly from those elsewhere: Only 37% carried out contact tracing for workers testing positive, versus more than half of facilities abroad.

“A number of countries outside the United States have national contact-tracing systems, apps that are highly recommended or in some countries required for all adults to download,” Aspinall of Arizona State said. “Clearly that isn’t the case here.”