Geographic access to United States SARS-CoV-2 testing sites highlights healthcare disparities and may bias transmission estimates

作者：Benjamin Rader, Christina M. Astley, Karla Therese L. Sy, Kara Sewalk, Yulin Hswen, John S. Brownstein, Moritz U. G. Kraemer · 发表于：Journal of Travel Medicine · 年份：2020 · DOI：10.1093/jtm/taaa076 · 被引用次数：166 · 研究领域：COVID-19 epidemiological studies、Data-Driven Disease Surveillance、COVID-19 and healthcare impacts

Uniform access to SARS-CoV-2 testing is crucial for controlling the COVID-19 epidemic.1 Lack of testing can result in the epidemic spreading undetected2 and increase the risk of extensive local transmission. The USA has been slow to develop reliable diagnostic tests and, while there has been recent improvement in testing capabilities,3 large-scale testing remains a serious concern. Inequalities in geographic accessibility to healthcare in the USA have been documented to cause negative health outcomes for seasonal influenza transmission and other diseases.4 Further, travel time negatively impacts healthcare-seeking behaviour.5 The deployment of SARS-CoV-2 testing within existing medical infrastructure, while logistically efficient, may exacerbate this disparity in health outcomes6 and underestimate disease burden in disadvantaged populations. Distribution of SARS-CoV-2 testing sites. (A) Travel time to the nearest testing site per 1 km2 area (shorter travel time in darker blue) in the 48 contiguous US states plus DC. (B) Travel time as in Panel A enlarged to show detail in the state of Texas. (C) Percent minority (⁠|$1-\%\mathrm{non}\hbox{-}\mathrm{Hispanic}\ \mathrm{white}$|⁠) by county in Texas. (D) Median travel time by county versus the cumulative population for each geographic region (excluding two outlier counties). Vertical dashed line at 20 minute median travel time. Horizontal dotted lines indicate cumulative population percentage in that region (in parenthesis) resid...