Timeliness in Public Health Emergency Response: An Epidemiological Assessment of a Statewide SARS-CoV-2 Testing Initiative (April 2020-July 2021)

Sophia Misterek; Martha Carvour; Elsy Barahona Portillo; Derrick Shostrom; Precious-Junia de-Winton Cummings

doi:10.1016/j.ajic.2026.03.007

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Timeliness in Public Health Emergency Response: An Epidemiological Assessment of a Statewide SARS-CoV-2 Testing Initiative (April 2020-July 2021)

Journal article

Peer reviewed

Timeliness in Public Health Emergency Response: An Epidemiological Assessment of a Statewide SARS-CoV-2 Testing Initiative (April 2020-July 2021)

Sophia Misterek, Martha Carvour, Elsy Barahona Portillo, Derrick Shostrom and Precious-Junia de-Winton Cummings

American journal of infection control

03/20/2026

DOI: 10.1016/j.ajic.2026.03.007

PMID: 41865769

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Abstract

Timely diagnostic testing is essential for interrupting transmission and supporting infection prevention during public health emergencies. We conducted a retrospective secondary analysis of cross-sectional data from individuals tested between April 2020 and July 2021, within Test Iowa, a statewide diagnostic initiative. The primary outcome was the interval from symptom onset to testing, classified as early (≤4 days) or later (>4 days). Multivariable logistic regression identified predictors of later testing, and secondary analyses summarized intervals across the testing process. Among symptomatic testers, 36% were tested >4 days after symptom onset. Later testing was associated with age ≥50 years, known exposure (OR=1.31, 95% CI=1.28-1.33), and moderate (OR=1.13, 95% CI=1.11-1.16) or severe symptoms (OR=1.46, 95% CI=1.32-1.61). Early testing was more common among healthcare workers (OR=0.93, 95% CI=0.91-0.94) and individuals reporting systemic symptoms (OR=0.91, 95% CI=0.88-0.93). The longest delays occurred between scheduling initiation and testing, while laboratory intervals remained stable. Findings show that the most substantial barriers to timely diagnosis occurred before specimen collection rather than within laboratory operations. Improving scheduling pathways and access to testing sites may enhance diagnostic timeliness and strengthen infection control capacity in future emergencies.

COVID-19 response

testing access

preparedness

health seeking delay

diagnostic systems

SARS-CoV-2 testing

Details

Title: Subtitle: Timeliness in Public Health Emergency Response: An Epidemiological Assessment of a Statewide SARS-CoV-2 Testing Initiative (April 2020-July 2021)
Creators: Sophia Misterek - University of Iowa
Martha Carvour - University of Iowa
Elsy Barahona Portillo - University of Iowa, Internal Medicine
Derrick Shostrom - University of Iowa, State Hygienic Laboratory
Precious-Junia de-Winton Cummings - University of Iowa, Internal Medicine
Resource Type: Journal article
Publication Details: American journal of infection control
DOI: 10.1016/j.ajic.2026.03.007
PMID: 41865769
NLM abbreviation: Am J Infect Control
ISSN: 1527-3296
eISSN: 1527-3296
Publisher: Elsevier
Language: English
Electronic publication date: 03/20/2026
Academic Unit: Infectious Diseases; Epidemiology; Fraternal Order of Eagles Diabetes Research Center; Internal Medicine
Record Identifier: 9985147178802771

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