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COVID-19 Testing Trend: A Retrospective Analysis of the Three Major Pandemic Waves in Punjab, Pakistan
Rabia M Chaudhry1,2, Sadia Minhas3,4, Mehroz A Khan5
1Oral Medicine, Akhtar Saeed Medical and Dental College, Lahore, PAK.
Insights
COVID-19 testing in Pakistan was significantly underutilized, with only 18.8% tested despite high perceived infection rates. Economic factors and age influenced testing behavior, not fear, highlighting a need for targeted public health strategies.
Area of Science:
- Public Health
- Epidemiology
- Infectious Disease Research
Background:
- Evidence suggests under-testing of COVID-19 cases in Pakistan.
- Understanding testing trends is crucial for future infectious disease policy.
Purpose of the Study:
- To explore COVID-19 testing trends in Pakistan.
- To identify factors influencing testing behavior during major waves.
- To inform infectious disease policy and intervention strategies in a lower-middle-income country.
Main Methods:
- Serial cross-sectional study conducted from March 2020 to June 2021.
- 1616 participants from Punjab, Pakistan, across three major COVID-19 waves.
- Investigated testing in association with flu-like symptoms (FLS) and influencing factors.
Main Results:
- Only 18.8% were tested for COVID-19, despite 86.7% believing they were infected.
- Flu-like symptoms (FLS) were reported by 51.3%, with 35.6% exposed to FLS within families.
- Age (31-40 years) and international travel were significantly associated with increased testing uptake.
Conclusions:
- Convincing evidence of COVID-19 under-testing and under-reporting in Pakistan.
- Fear-based interventions may be ineffective; economic factors (education, employment, travel) are key drivers.
- Findings guide infectious disease prevention and management strategies.
Background/Objectives:
There is some evidence in the literature of under-testing of COVID-19 cases in Pakistan. This study aims to explore COVID-19 testing trends and the factors affecting them in a lower middle-income country for future infectious disease policy-making and intervention strategies.
Methodology:
The study was conducted as a serial cross-sectional study during the three major peaks from March 2020 to June 2021 on 1616 participants in Punjab, Pakistan. This is the first study to explore COVID-19 testing trends in association with flu-like symptoms (FLS) and the factors affecting all three major waves in Pakistan.
Results:
The results show that in all three waves, only 18.8% reported COVID-19 tested despite that 86.7% thought they had already had COVID-19, with 51.3% reporting having FLS and 35.6% with exposure to FLS from their families and 19.8% of positive testing rate among their family members. Out of the survey participants, 66% received vaccination, and over 80% had their eligible family members immunized. Fear of contracting COVID-19 was 69.7% in all three waves. Factors positively associated with the uptake of testing were the age group of 31-40 years with an adjusted odds ratio of 3.27 (95% confidence interval (CI): 2.09-5.12) for the second wave and an adjusted odds ratio of 13.75 (95% CI: 9.43-20.01) for the third wave and traveling abroad with odds of 3.08 times when the reference was inland traveling. The adjusted odds ratio to test for FLS was 1.62 (95% CI: 1.21-2.16).
Conclusion:
In this study, there is convincing evidence of COVID-19 under-testing and thus under-reporting. This study also suggests that fear-based interventions may be counterproductive; however, economic factors such as education, employment, and traveling are significant in guiding the behavior for infectious disease prevention and management.
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