Adherence to the test, trace and isolate system: results from a time series of 21 nationally representative surveys in the UK (the COVID-19 Rapid Survey of Adherence to Interventions and Responses [CORSAIR] study)
Open accessPreprint — published as 10.1136/bmj.n608
Abstract
Objectives: To investigate rates of adherence to the UK’s test, trace and isolate system over time. Design: Time series of cross-sectional online surveys. Setting: Data were collected between 2 March and 5 August 2020. Participants: 42,127 responses from 31,787 people living in the UK, aged 16 years or over, are presented (21 survey waves, n≈2,000 per wave). Main outcome measures: Identification of the key symptoms of COVID-19 (cough, high temperature / fever, and loss of sense of smell or taste), self-reported adherence to self-isolation if symptomatic, requesting an antigen test if symptomatic, intention to share details of close contacts, self-reported adherence to quarantine if alerted that you had been in contact with a confirmed COVID-19 case. Results: Only 48.9% of participants (95% CI 48.2% to 49.7%) identified key symptoms of COVID-19. Self-reported adherence to test, trace and isolate behaviours was low (self-isolation 18.2%, 95% CI 16.4% to 19.9%; requesting an antigen test 11.9%, 95% CI 10.1% to 13.8%; intention to share details of close contacts 76.1%, 95% CI 75.4% to 76.8%; quarantining 10.9%, 95% CI 7.8% to 13.9%) and largely stable over time. By contrast, intention to adhere to protective measures was much higher. Non-adherence was associated with: men, younger age groups, having a dependent child in the household, lower socioeconomic grade, greater hardship during the pandemic, and working in a key sector. Conclusions: Practical support and financial reimbursement is likely to improve adherence. Targeting messaging and policies to men, younger age groups, and key workers may also be necessary. WHAT IS ALREADY KNOWN ON THIS TOPIC: Test, trace and isolate systems are one of the cornerstones of COVID-19 recovery strategy. The success of the test, trace and isolation system depends on adherence to isolating if symptomatic, getting a test if symptomatic, passing on details of close contacts if infection is confirmed, and quarantining of contacts. Rates of adherence to test, trace and isolate behaviours in the UK need to be systematically investigated. WHAT THIS STUDY ADDS: Self-reported adherence to test, trace and isolate behaviours is low; intention to carry out these behaviours is much higher. Identification of COVID-19 symptoms is also low. Practical support and financial reimbursement are likely to improve adherence to test, trace and isolate behaviours.
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UK surveys found that only 11% of individuals in quarantine declared proper adherence to quarantine rules, but 65% of individuals intended to adhere to quarantine.
“UK surveys found that only 11% of individuals in quarantine declared proper adherence to quarantine rules, but 65% of individuals intended to adhere to quarantine 13”
From The epidemiological impact of the NHS COVID-19 app (2021) · cites this paper as [13]
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“Recent survey data shows that intention to adhere to test, trace, and isolate behaviours is higher than self-reported adherence: whilst 76% of people intend to share contacts, only 50% of people correctly recognise COVID-19 symptoms and just 12% get a test, 18% isolate, and 11% of contacts isolate properly.(33) Self-r…”
BackgroundMukhamadiarov, R., Deng, S.-F., Serrao, S. R., et al. (2020) · medRxiv · doi:10.1101/2020.10.21.20217331 · Cited by 10
“They extensively explored the effects of quarantine adherence and suggested that with lower adherence to quarantine, as has been reported in the UK, only a small fraction of potential transmission is averted [29] .”
BackgroundErchick, D. J., Zapf, A. J., Baral, P., Edwards, J. G., Mehta, S. H., Solomon, S. S., Gibson, D. G., Agarwal, S., & Labrique, A. B. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-051882 · Cited by 13 · see citing works
Testing and Isolation Efficacy: Insights from a Simple Epidemic Model
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Quilty, B. J., Russell, T., Clifford, S., Flasche, S., Pickering, S., Neil, S. J. D., Galão, R. P., Edmunds, W. J., & CMMID COVID-19 Working Group (2021) · medRxiv · doi:10.1101/2021.06.11.21258735 · Cited by 6 · see citing works
Masel, J., Shilen, A., Helming, B., et al. (2021) · medRxiv · doi:10.1101/2021.02.02.21251022 · Cited by 9 · see citing works
“The direct reduction in R(t) will be smaller, because of violations in 94 these assumptions, especially the fourth given reports of low quarantine compliance (6, 7).”
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Optimising the mitigation of epidemic spreading through targeted adoption of contact tracing apps
Bassolas, A., Santoro, A., Sousa, S., et al. (2021) · arXiv.org · doi:10.48550/arxiv.2102.13013 · Cited by 8
“…place, many countries have been able to partially re-open several sectors of their economy and to diminish the damage of prolonged disruptions [22–29] An effective digital contact tracing strategy should aim at maximising the probability of detecting contacts be-tween infected and susceptible…”
Designing Efficient Contact Tracing Through Risk-Based QuarantiningPreprint
Perrault, A., Charpignon, M., B, J. G. A., Tambe, M., & Majumder, M. S. (2020) · medRxiv · doi:10.1101/2020.11.16.20227389 · Cited by 3 · see citing works
“Investigations regarding the determinants of quarantine adherence and contact reporting behavior suggest that perceived effectiveness and cost of such behaviors are major drivers of participation (Smith et al. 2020; Webster et al. 2020).”
A method for campus-wide SARS-CoV-2 surveillance at a large public university
Chang, T. R., Draper, J. M., van den Bout, A., et al. (2021) · PLoS ONE · doi:10.1371/journal.pone.0261230 · Cited by 7
Leng, T., Hill, E., Keeling, M., et al. (2021) · Communications Medicine · doi:10.1101/2021.11.08.21266079 · Cited by 7
“[20] Smith LE, Potts HW, Amlot R, Fear NT, Michie S, Rubin GJ.”
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Panovska-Griffiths, J., Kerr, C., Waites, W., et al. (2020) · medRxiv · doi:10.1101/2020.09.28.20202937 · Cited by 7 · see citing works
Robin, C., Symons, C., & Carter, H. (2021) · JMIR Formative Research · doi:10.2196/34422 · Cited by 6 · see citing works
Why we Need a Gender Advisor on SAGE
Wenham, C., & Herten-Crabb, A. (2021) · LSE Public Policy Review · doi:10.31389/lseppr.25 · Cited by 9 · see citing works
Maximising public adherence to COVID-19 self-isolation in Europe
Patel, J., Fernandes, G., & Sridhar, D. (2021) · The Lancet Regional Health - Europe · doi:10.1016/j.lanepe.2021.100089 · Cited by 6
Effectiveness and resource requirements of test, trace and isolate strategies for COVID in the UK
He, B., Zaidi, S., Elesedy, B., Hutchinson, M., Paleyes, A., Harling, G., Johnson, A. M., Teh, Y. W., & on behalf of the Royal Society's DELVE group (2021) · Royal Society Open Science · doi:10.1098/rsos.201491 · Cited by 10 · see citing works
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Covid-19: Decision-Making in Public Health
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Self-citationContact tracing for SARS-CoV-2: what can be learned from other conditions?
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Predicting the COVID-19 Pandemic: The Perceptions of Healthcare Workers and the General Public
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The effectiveness of the three tier system of local restrictions for control of COVID-19
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“However, there is evidence of widespread confusion about social distancing regulations and when a SARS-CoV-2 test is appropriate, impacting on people’s ability to comply with them (Office for National Statistics 2020; Williams et al 2020; Smith et al 2020).”
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“Individual survey items were derived initially from a set of questions developed by the COVID-19 Rapid Survey of Adherence to Interventions and Responses (CORSAIR) study to measure behaviours, attitudes, beliefs, and consequences pertinent to the COVID-19 pandemic (31,32), and the International Assessment of COVID-19r…”
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“The sample was those who said they could fully work at home, recruited from two specialist online panel providers, Respondi and Savanta (Smith et al., 2021).”
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“Preliminary UK evidence has suggested sub-optimal compliance with selfisolation, and also indicated that practical support and nancial reimbursement could help to address this (95).”
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COVID-19 Test Strategy to Guide Quarantine Interval in University Students
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Reactive vaccination of workplaces and schools against COVID-19
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Monitoring the R-Citizen in the Time of COVID-19
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“20 21 The purpose of this study is not to isolate the independent effects of individual, community, or structural factors on testing probability, but to understand how these factors jointly shape individuals’ decisions to seek testing under conditions of uncertainty and changing access.”
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“Studies conducted during the early stages of the COVID-19 pandemic yielded mixed results with some studies suggesting a decrease in PPB use (e.g [22–26], while others indicated a consistent use of PPBs regardless of vaccination status [15, 27].”
Self-citationMerritt, R., Vastano, A., Nakagawa, J., Doherty-Kelly, D., & Taylor, J. (2023) · International Journal of Public Health · doi:10.3389/ijph.2023.1604388
Covid-19 and the criminalisation of viral transmission
Ni’Man, M., & Lemos, N. (2021) · Medicine, Science and the Law · doi:10.1177/00258024211010931
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Asymptomatic SARS-CoV-2 testing: predictors of effectiveness; risk of increasing transmission
Skittrall, J. P. (2020) · medRxiv · doi:10.1101/2020.11.24.20236950
- Authors
- Smith, L. E., Potts, H. W., Amlȏt, R., Fear, N. T., Michie, S., & Rubin, G. J.
- Affiliations
- King's College London (GB)
- University College London (GB)
- Corresponding author
- Smith, Louise E
- Venue
- BMJ
- Publisher
- openRxiv
- Published
- 2020-09-18
- Volume
- 372
- Pages
- n608-n608
- ISSN
- 1756-1833 (ISSN-L)
- PMC
- PMC8010268
- OpenAlex
- W3144066845
- Cited by
- 296
- References
- 22
- Citations by year
- 2026: 9 · 2025: 8 · 2024: 27 · 2023: 45 · 2022: 91 · 2021: 101 · 2020: 14 · 2012: 1
- FWCI
- 25.52
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- cc-by
- Locations
- BMJ (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by)
- UCL Discovery (University College London) (submittedVersion)
- OSF Preprints (OSF Preprints) (submittedVersion)
- Funders
- National Institute for Health Research Health Protection Research Unit
- National Institute for Health and Care Research (11/46/21, NIHR-INF-1658)
- Department of Health and Social Care
- University of East Anglia
- King's College London
- University of Bristol
- Public Health England
- Topics
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Social Sciences › Sociology and Political Science › COVID-19 Prevention and Impact
- Physical Sciences › Computer Science › Information Systems › COVID-19 Digital Contact Tracing
- Keywords
- COVID-19 pandemic, self-isolation, COVID-19 testing, symptom recognition, close contact tracing, contact tracing, public health communication, public trust in government, risk perception
- MeSH terms
- COVID-19, SARS-CoV-2, COVID-19 Testing, Adult, Aged, Cross-Sectional Studies, Female, United Kingdom, Humans, Health Knowledge, Attitudes, Practice, Male, Middle Aged, Surveys and Questionnaires, Social Isolation, Contact Tracing, Pandemics
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