Knowledge barriers in the symptomatic-COVID-19 testing programme in the UK: an observational study

Background Symptomatic testing programmes are crucial to the COVID-19 pandemic response. We sought to examine United Kingdom (UK) testing rates amongst individuals with test-qualifying symptoms, and factors associated with not testing. Methods We analysed a cohort of untested symptomatic app users (N=1,237), nested in the Zoe COVID Symptom Study (Zoe, N= 4,394,948); and symptomatic survey respondents who wanted, but did not have a test (N=1,956), drawn from the University of Maryland-Facebook Covid-19 Symptom Survey (UMD-Facebook, N=775,746). Findings The proportion tested among individuals with incident test-qualifying symptoms rose from ~20% to ~75% from April to December 2020 in Zoe. Testing was lower with one vs more symptoms (73.0% vs 85.0%), or short vs long symptom duration (72.6% vs 87.8%). 40.4% of survey respondents did not identify all three test-qualifying symptoms. Symptom identification decreased for every decade older (OR=0.908 [95% CI 0.883-0.933]). Amongst symptomatic UMD-Facebook respondents who wanted but did not have a test, not knowing where to go was the most cited factor (32.4%); this increased for each decade older (OR=1.207 [1.129-1.292]) and for every 4-years fewer in education (OR=0.685 [0.599-0.783]). Interpretation Despite current UK messaging on COVID-19 testing, there is a knowledge gap about when and where to test, and this may be contributing to the ~25% testing gap. Risk factors, including older age and less education, highlight potential opportunities to tailor public health messages.

The Water Gap Risk Index – a novel approach for spatially distributed and sector-specific water scarcity risk calculations in urbanized catchments

<p>An increasing number of mega-cities, such as Cape Town, Lima, and São Paulo, are confronted with increasing droughts as well as an increase in water demand. Inevitably, this leads to increasing pressure on the available water resources and associated risks and economic impact for the water-dependent sectors (eg. drinking water supply, industry, energy production, agriculture, nature) and different user groups within the sectors (eg. low, middle- and high-income households, self-subsistence farmers, large farms). To address these problems and to develop targeted mitigation strategies, risk analyses are required that quantify the impact of water scarcity on the various sectors and users-groups in different parts of the catchment.</p><p>Here, we present the Water Gap Risk Index (WGRI) that quantifies water scarcity and its impacts on a variety of economic sectors and user groups. The WGRI provides a normalized score to reflect high spatial and temporal variability typical for urban catchments that apply to different settings and problems. Index calculation involves the combination of unmet water demand and its characteristics with socioeconomic aspects related to vulnerability and exposure. The Water Gap term quantifies water system performance over a defined time period taking into account the frequency, persistence, and severity of unmet water demand.  Vulnerability metrics provide a score for each sector and user-group separately using context-specific vulnerability indicators of each sector and user-group.</p><p>In the novel WGRI special attention is paid to the vulnerability of different water user-groups, based on their socio-economic status level (expressed in income, consumption, or other indicators) and respective water use. We consider that 1 liter of water does not have the same utility for different user groups, based on the principle of the diminishing marginal utility curve. As a result, the impact of water scarcity and mitigation measures will also play out differently for these different user groups.</p><p>The novel WGRI is being applied in the context of the WaterLOUPE approach[1], to the catchment of Sao Paolo, Lima, and Chennai.</p><p>[1] https://doi.org/10.5194/egusphere-egu2020-20505</p>