A national survey of early treatment seeking behavior among those with incident SARS-CoV-2 infection.

COVID-19 continues to cause severe disease, hospitalization, and death. Despite effective means to treat SARS-CoV-2 infection with nirmatrelvir/ritonavir, molnupiravir, monoclonal antibodies, and remdesivir [1], [2], [3], [4], the early treatment seeking behavior of those newly diagnosed with infection is not clear. We surveyed users of a national SARS-CoV-2 testing company to assess the frequency and correlates of early treatment seeking behavior for a positive test result.

We recruited adults (18 years or older) who had tested positive for SARS-CoV-2 by PCR at a large clinical laboratory (Curative, San Dimas, CA). To be eligible, individuals had to have a positive test result within 7 days of enrollment. Surveys were anonymous and voluntary. We collected data on demographic characteristics, general health care access and utilization, awareness of treatment for COVID-19, treatment seeking behavior, and treatments received. Questions were developed to be answered in a multiple choice fashion for user ease. Descriptive statistics and odds ratios (OR) with 95% confidence intervals (95% CI) were calculated on StataSE (StataCorp, College Station, TX). Chi-squared tests and linear regression analysis were used to compare categorical variables and continuous variables between groups, respectively. Advarra granted the study IRB exempt (Pro00059961).

Participants were surveyed from 3-7 January 2022: among the 15,991 who viewed a survey request, 7,647 individuals were eligible and provided responses. The median age of a respondent was 42 years (interquartile range: 32 to 54), 68.9% of respondents were women, and respondents represented 33 different states, districts, and territories. Among those surveyed, 66.7% identified as White, 30.6% as Hispanic, 12.1% as Black or African American, 6.2% as Asian, and 1.2% as Pacific Islander or Native American. Most respondents reported they were vaccinated (89.3%).

Among respondents, 23.1% reported they had sought treatment or medical advice for their current COVID-19 diagnosis (Table 1 ). Of those who were very aware of treatment for COVID-19, 31.0% sought treatment versus 16.7% who were unaware (p-value< 0.001). The odds of treatment seeking behavior were higher for those that were contacted by a medical professional after their diagnosis (OR: 4.57 [95% CI: 3.89 to 5.37]), those with a primary doctor (OR: 2.94 [95% CI: 2.52 to 3.43]), those who self-measured their oxygen saturation (OR: 2.53 [95% CI: 2.25 to 2.84]), and those over 65 years of age (OR: 2.36 [95% CI: 2.02 to 2.76]).

Table 1

Demographic characteristics, health care access and utilization, awareness of treatment and treatment seeking behavior for COVID-19 among a national cohort of survey respondents that recently tested positive for SARS-CoV-2 infection, 3 January 2022 to 7 January 2022.

Variable	Group (N)	% Sought Treatment
All	7,647	23.1%
Of those that sought treatment
Age 65 years and under	6,876	21.3%
Age over 65 years*	771	39.0%
Female*	2,375	23.8%
Heritage
American Indian or Alaskan Native	60	28.3%
Asian	472	21.0%
Black or African American	925	25.3%
Multiracial	343	22.5%
Native Hawaiian	28	14.3%
White	5,099	23.5%
Ethnicity
Hispanic or Spanish Origin	2,343	22.5%
Not Hispanic or Spanish Origin	4,750	23.4%
Vaccinated	6,828	23.5%
Not Vaccinated	819	20.3%
Prior COVID	1,872	25.5%
Contacted by Health Department	2,432	24.6%
Asked about contact tracing	1,930	24.2%
Contacted by a medical professional*	678	53.5%
Has a primary doctor*	5,723	27.1%
Last saw primary doctor
within 12 months*	4,466	30.1%
12 to 24 months	822	17.0%
over 24 months	411	14.1%
Type of insurance
Private (e.g., United, Anthem, Blue Cross)	5,519	23.1%
Government (Medicare, Medicaid, Veterans Affairs)*	473	34.3%
Kaiser	406	30.5%
None	1,249	16.6%
Awareness of treatment for COVID-19
Very aware*	2,125	31.0%
Aware	1,380	19.6%
Not very aware	1,496	25.4%
Somewhat aware	1,326	18.0%
Unaware	1,320	16.7%
Measure home oxygen saturation*	1,827	36.9%
Political affiliation of state or district
Won for Biden	6,388	23.2%
Won for Trump	1,023	23.2%

p-value < 0.001

There was no difference in those seeking treatment based on heritage, ethnicity, prior COVID-19 diagnosis, state political affiliation, or vaccination status. The odds of seeking treatment were lower among men (OR: 0.88 [95% CI: 0.78 to 0.99]) and those without insurance (OR: 0.62 [95% CI: 0.52 to 0.72]). The most common treatment locations were clinics and most common treatments were Vitamin C, Vitamin D, Zinc, Tylenol, and NSAIDs (Table 2 ).

Table 2

Treatment locations and treatments used for COVID-19 among survey respondents who tested positive for SARS-CoV-2 infection in the prior 7 days, among 1767 persons reporting seeking treatment, 3 January 2022 to 7 January 2022.

Variable	Number	%
Location of treatment or medical advice
Clinic	855	48.4%
Urgent Care	157	8.9%
Emergency Department	88	5.0%
Mobile Clinic	71	4.0%
Free Clinic	28	1.6%
Treatment used
Vitamin C	825	46.7%
Vitamin D	685	38.8%
Zinc	636	36.0%
Acetaminophen	546	30.9%
NSAIDs (e.g., Ibuprofen or Naproxen)	522	29.5%
Azithromycin	203	11.5%
Dexamethasone or prednisone or inhaled budesonide	179	10.1%
Aspirin	169	9.6%
Monoclonal antibodies*	100	5.7%
Ivermectin	50	2.8%
Hydroxychloroquine	21	1.2%
Oxygen	14	0.8%
Nirmatrelvir/Ritonavir	13	0.7%
Fluvoxamine	13	0.7%
Remdesivir	10	0.6%
Convalescent plasma	2	0.1%
Colchicine	2	0.1%
Molnupiravir	1	0.1%

(casiriviman-imdevimab, sotrovimab, and bamlanivimab-etesevimab.

Due to the timing of the survey, infection was most likely due to the Omicron variant of SARS-CoV-2, which might be less severe in those with prior immunity [5]. The most commonly used treatments were over-the-counter medications for symptom relief which are not FDA authorized for effective treatment of COVID-19. Few had received therapies known to reduce risk of disease progression like nirmatrelvir/ritonavir, molnupiravir, monoclonal antibodies, and remdesivir [4,6]. There were also continued reports of non-beneficial medication use, i.e., ivermectin and hydroxychloroquine.

Individuals that recovered from COVID-19 before did not seem to have different behavior patterns when compared to those who were naïve to SARS-CoV-2 infection. It is possible that a history of COVID could be reassuring to individuals, therefore there was no change in treatment seeking behavior. Additionally, those with prior infection might have had milder symptoms due to their prior exposure to COVID-19 [7].

The main limitation of this study is that it is subject to response bias. Many of the eligible respondents did not provide survey data, so the results we found may be biased. Also, given that the survey was sent electronically and answered in an electronic format, it may have skewed responses to individuals that have better access to internet or better electronic literacy. Due to the timing of this survey, some medicines that have been found to be effective for COVID-19 may have not been available or medically rationed due to supply chain problems.

More public outreach is needed to raise awareness of the benefits of effective treatment for COVID-19 with FDA authorized treatments like nirmatrelvir/ritonavir, molnupiravir, monoclonal antibodies, and remdesivir, and limit the use of medications that are not effective for COVID-19. We found that people who were more aware about treatment for COVID-19 were more likely to seek medical advice or therapy, however the majority of individuals that had sought medical advice or therapy did not ultimately use effective treatments for COVID-19. Efforts to increase awareness of effective treatments for COVID-19 and their indications might increase the use of early effective treatment for SARS-CoV-2 infection, while reducing the use of medications that do not provide benefit. Additionally, those who were contacted by a health professional were more likely to seek treatment or medical advice for COVID-19. Increased outreach with treatment facilitation from medical professionals and/or public health staff to those with newly detected SARS-CoV-2 infections, particularly among those at higher-risk of complications, might also be helpful to educate individuals about effective medications and non-effective medications for COVID-19.

Funding

Curative Inc. and by a gift to the Keck School of Medicine of the University of Southern California by the W.M. Keck Foundation.

Declaration of Competing Interest

NK is a consultant for Curative. MB and VS are employed by Curative. JDK is an independent consultant and serves as the Medical Director of Curative.