Comparison of COVID-19 Home-Testers vs Laboratory-Testers in New York State (Excluding New York City), November 2021 to April 2022

Background Though the use of home testing is increasing, it is not represented in the reported coronavirus disease 2019 (COVID-19) metrics. As the epidemic and its tracking evolve, it is critical to understand who the excluded home-tested persons are relative to those in reported metrics. Methods Five New York State databases were linked to understand the trends in home-tested COVID-19 cases compared to laboratory-confirmed cases from November 2021 to April 2022. Frequency distributions, logistic regression adjusted odds ratios (aOR), and 95% confidence intervals (CI) were used to compare the characteristics of home-tested and laboratory-tested persons. Results Of 592,227 confirmed COVID-19 cases, 71,531 (12%) had a home-test-only, 515,001 (87%) had a laboratory-test-only and 5,695 (1%) had both a home-test and laboratory-test during this period. Home-tested cases, as a percentage of confirmed COVID-19 cases, increased from 1% in November 2021 to 22% in April 2022. Children aged 5-11 years with 3.74 aOR (95% CI:3.53, 3.96) and adolescents aged 12-17 years with 3.24 aOR (95% CI:3.07, 3.43) were more likely to have home-test-only than adults aged 65 and above. Boosted (aOR 1.87, 95% CI:1.82, 1.93), in K-12 school settings (aOR 2.33, 95% CI:2.27, 2.40), or possibly infected by a household member (aOR 1.17, 95% CI:1.13, 1.22) were more likely to report home-test-only than laboratory-test-only. Individuals hospitalized (aOR 0.04, 95% CI:0.03, 0.06), with underlying conditions (aOR 0.85, 95% CI:0.83, 0.87), pregnant (aOR 0.76, 95% CI:0.66, 0.86), Hispanic (aOR 0.50:95% CI:0.48, 0.53), Asian (aOR 0.31, 95% CI:0.28, 0.34), or Black (aOR 0.45, 95% CI:0.42, 047) were less likely to utilize the home test only compared to the laboratory test only. Conclusion The number of individuals using home tests only as a proportion of confirmed COVID-19 cases continues to increase. Home test-only cases are less likely to be hospitalized and have a lower potential for severe disease as measured by age, vaccination status, and underlying conditions. Thus, those with severe disease and the potential for severe disease are represented as official metrics. Racial and ethnic differences exist between persons reporting home and laboratory tests.