Odds are you’ve had your nose or mouth swabbed for a COVID-19 diagnostic test at some point in 2020.
According to the Centers for Disease Control and Prevention, more than 217 million tests have been performed in the U.S. this year. Recently, demand for testing has gotten so high that labs and testing centers are reporting long lines and major backlogs.
At the same time, however, many people are actually refusing to get tested for the disease caused by the novel coronavirus, even in cases when they know they’ve been exposed.
“Test avoidance appears to be a growing problem, at least anecdotally,” wrote Rita Rubin in a November issue of the Journal of the American Medical Association. “Many of the same people who dismiss the need to test feel the same way about wearing a mask, in part because they think no one has the right to tell them to do either.”
Each individual may have their own reasons for not wanting to be tested, but there are some common explanations for this phenomenon. Below, behavioral psychology experts share some of the reasons people may hesitate to take a COVID-19 test.
It’s an emotional topic
The topic of COVID-19 is fraught with emotions for many people. As a result, it may be tempting to avoid thinking about the pandemic or the possibility of contracting the disease.
“There are a lot of emotions one might feel surrounding getting tested for COVID-19,” said Sherry Benton, a psychologist and the founder and chief science officer of TAO Connect. “Many have seen people die from COVID-19 complications either in the news or their own personal lives, and the fear of those same outcomes may hold someone back from getting a confirmed diagnosis.”
There’s a lot of fear
“It is not uncommon for people to avoid tests or doctor’s visits out of fear that they might find out some terrible news about their health,” said Melissa L. Whitson, an associate professor of psychology at the University of New Haven. “In the past, some individuals have avoided going to a doctor even when they have serious symptoms because the thought of confirming an illness or diagnosis that they fear is almost worse than dealing with the symptoms.”
This is avoidant behavior, which delays having to process any potential bad news, even when you are aware that delaying could make the situation worse. It’s an example of what therapists call “maladaptive” coping mechanisms.
Contracting COVID-19 can have long- and short-term consequences, both when it comes to health and also regarding pragmatic concerns like child care. Rather than face the scary possibility of having COVID-19, many people find it easier to brush off symptoms as something more mild, even if they know they’ve been exposed. Meanwhile others simply feel too paralyzed by fear to take the responsible step of getting tested.
“The fear of going to get tested can lead to sleep disturbances, lack of appetite and other somatic symptoms,” said Tameka Brewington, a psychotherapist and owner of Real Talk Counseling. “In some cases, people have even had panic attacks when discovering exposure.”
It also doesn’t help that the testing procedure can be uncomfortable or unexpected, which adds another layer of anxiety.
“On the other hand, being tested can alleviate negative emotions by providing clarity, and people may experience relief from ambiguity and feel that they can move on with their lives,” said Darrin M. Aase, a clinical neuropsychologist at the Ohio State University Wexner Medical Center.
The result may have financial implications
Not everyone has a job that allows them to work from home or take time off when they’re sick. The pandemic has highlighted the lack of adequate sick leave for workers, which can contribute to the spread of disease.
In the absence of paid sick leave, many people cannot afford to miss paychecks, which has created dangerous situations as some workers continue to report for duty even after they’ve been infected.
“Those who are unable to work from home may worry about their jobs, a potential two-week loss of pay and the consequence of a positive test,” Benton said. “If someone does not have health insurance, they may worry about the potential cost of care associated with having or being tested for COVID-19 if free tests are not available or accessible.”
They don’t want to feel guilty
Beyond concerns about someone’s own health, a positive test result can also have implications for their close contacts.
“Anxiety and anticipating guilt about possibly infecting other people in your life may feel overwhelming for some at times,” Aase said. “Moreover, while the Centers for Disease Control and Prevention has recently relaxed their quarantine guidelines, fears related to having to miss work, not being able to look for work, child care complications, or negative economic consequences for other close contacts in your life are powerful and real. The fact that a positive test does not just impact you, but can impact others’ health and livelihood may make the decision to get tested seem more complicated than it is.”
Much like the fear of short- and long-term health consequences, this apprehension about guilt could contribute to avoidant behaviors and make someone less likely get a COVID-19 test, even when they learn of possible exposure or develop symptoms. This avoidance does not provide extended relief and may actually make you feel worse emotionally ― in addition to potentially contributing to the further spread of disease.
They don’t want to have to isolate
“A confirmed COVID-19 case would mean a quarantine period,” Benton noted. “The thought of being isolated for 14 days may be scary to some. We are naturally social creatures, so it is normal to want to avoid being removed from our friends and family.”
In the year 2020, when social interactions have been so scarce, the thought of needing to isolate yourself even from members of your household due to a positive test result may seem unbearable to some people.
“One might even feel anger at the thought of how a positive test might impact their life ― both their health and their social life,” Benton added. “It could mean disruption in routine, work and social life.”
There’s a stigma associated with the virus
“With COVID, these fears and tendency to avoid hearing negative information may be exacerbated because of the deadliness of the disease, but also because the stigma associated with having COVID is a lot more complex,” Whitson said.
“There are many diseases or diagnoses that have stigma associated with them, but because COVID has become so political, and because it is so contagious, the stigma of having COVID is fraught with both fear and guilt,” she added.
Public scrutiny may cause people to blame themselves for testing positive and feel a sense of shame about their behavior, even if they followed public health guidelines fairly well. There are concerns that others may blame them for contracting the virus or think less of them.
“This stigma is strong, and therefore can make anyone hesitant to get a test, even when they know it is by far the best and most responsible course of action,” Whitson said.
They deny the reality of COVID-19
“There is a group of people who do not believe that COVID is real,” Brewington noted. “If it is not real, there is no reason to take a test.”
There’s a lot of misinformation about the coronavirus, especially on social media. Many people latch onto false narratives, picking and choosing which public health guidelines to follow ― or opting to ignore them altogether.
“This group also does not feel like they should be mandated to do anything that they don’t want to do,” Brewington added.
Even beyond COVID-19 deniers, many people are simply misinformed about the importance of getting tested and quarantining after exposure or even the risk factors for serious illness and complications from the disease.