Who Used the Free COVIDTests.gov Home Test Kits, 2022

The Food and Drug Administration first authorized at-home rapid antigen tests for COVID-19 in late 2020. In January 2022 the White House launched COVIDTests.gov, through which every U.S. household could order free at-home test kits from the federal government, delivered by the U.S. Postal Service. By May 2022 more than 70 million kit packages had been shipped, but no one had reported how they were used or by whom. This MMWR report used a national survey to find out.

The survey

COVIDVu is a national probability survey of households. From August to December 2020, researchers drew 39,500 addresses from the Postal Service's delivery file, which covers nearly every residential address in all 50 states, and picked one adult at random from each. Of 5,666 people who completed the baseline survey, 4,654 were eligible for follow-up rounds, and 3,400 of them (73%) completed an online follow-up from April 14 to May 13, 2022. Responses were weighted to represent all U.S. households and adults, adjusted to match the known figure of 70 million kit orders shipped.

What households did

As of May 2022:

• 93.8% of households (120,730,524) knew about the program.
• 59.9% (77,089,010) had ordered kits.
• 32.1% (41,325,184) had used at least one kit, whether someone in the household or outside it.
• 27.8% (35,763,825) had ordered kits but not yet used them.

Awareness, ordering and use of COVIDTests.gov kits by household, April–May 2022. CDC figure.

Who used them

Of an estimated 252,117,111 adults, 154,160,315 (61.1%) lived in a household that had ordered kits, and 41.3% of them had used one in the preceding 6 months.

• By age: 54.6% of those 18–34 and 50.9% of those 35–44 had used the kits, compared with 35.2% at 45–54, 42.1% at 55–64 and 26.8% at 65 and older.
• By region: use was lowest in the South (35.2%) and highest in the West (47.4%).
• By household size: 46.0% in households of three or more, 38.2% in smaller ones.

Among kit users, 95.5% rated the experience acceptable — 64.1% very acceptable and 31.4% acceptable. Nearly a quarter (23.6%), more than 13 million people, said they probably would not have tested without the program, and 29.7% had used no other kind of test in the previous 6 months. The survey did not record every test result, but 22.2% of kit users reported at least one positive result.

Testing and equity

Of the 166,128,467 adults (65.9%) tested in the previous 6 months, 44.2% had a laboratory or clinic test, 25.7% a drive-through test, 38.3% a COVIDTests.gov kit and 42.1% another home test, such as one bought at a pharmacy.

How adults tested for COVID-19 in the previous 6 months, by race and ethnicity. CDC figure.

Use of the government kits was broadly similar across groups: 42.1% of Black, 41.5% of Hispanic, 34.8% of White and 53.7% of people of other races. People of other races were more likely than White people to use them; Black and Hispanic people were not significantly different. Other home tests told a different story: 11.8% of Black adults used them, against 44.4% of Hispanic, 45.8% of White and 43.8% of other-race adults. After adjusting for age, sex, region, education, income, household size and vaccination, Black adults were 72% less likely than White adults to use other home tests, despite using the government kits at similar rates.

What the authors concluded

More than 41 million households used the kits from January to May 2022, probably an undercount, since some had not yet had time to use theirs. Racial and ethnic disparities in COVID-19 illness, and concerns about the cost and availability of home tests, had been widely reported; the free kits appear to have greatly improved access to testing for racial and ethnic minority groups and helped millions test who otherwise might not have. The program ran continuously until it was paused on September 2, 2022, and was reactivated on December 19, 2022. The authors concluded that national programs making critical health services available during a pandemic have substantial health value.

One limitation: survey respondents may have been more inclined than others to take preventive steps such as vaccination and testing. Weighting to the known number of kit orders keeps the ordering estimate realistic, but other biases may remain.

Sources

• Luisi N, Sullivan PS, Sanchez T, et al. "Use of COVIDTests.gov At-Home Test Kits Among Adults in a National Household Probability Sample — United States, 2022." MMWR 2023;72(16). The report's social-media image is not reproduced.