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Over 67 Million Americans Lack Access to COVID-19 Testing: Where Are These ‘Testing Deserts’?

Tori Marsh, MPHSara Kim, MS
Written by Tori Marsh, MPH | Analysis by Sara Kim, MS
Published on August 20, 2020
This article is no longer being updated and some information may not be current. Visit the GoodRx Health homepage for our latest articles.

Key takeaways:

  • More than 67 million Americans living in both metropolitan and non-metropolitan areas are an average of 22 miles away from the nearest COVID-19 testing site.

  • Texas, Ohio, and Michigan have the largest number of these COVID-19 testing deserts.

  • Testing deserts are more common in low-income counties. The median income for non-desert census tracts is $67,964, while the median income for census tracts in testing deserts drops to $52,462.

Pop-up white tent in a parking lot for a COVID-19 testing site. The parking lot is empty except for the tent and orange cones.
John Arehart via Shutterstock

More than 67 million Americans, or 20% of the U.S. population, live far from a COVID-19 testing site, according to new research from GoodRx. While some only have to drive 3 miles to get a test, people in almost 17,000 census tracts have to drive an average of 22 miles to the nearest testing site.

These Americans are living in what is called a “testing desert,” defined as a census tract that is at least 10 miles away from a testing center. Texas, Ohio, and Michigan have the largest amount of testing deserts, and it’s no coincidence that these states continue to see daily increases in new cases.

This lack of access is hurting our ability to fight the pandemic. It’s well known that testing is one of the best ways to flatten the curve and beat a pandemic like COVID-19. Australia, for instance, tested and isolated patients early on in the pandemic and has seen low case counts and death rates. But as the pandemic continues to spiral out of control in the U.S., many Americans are finding it hard to access a test.

This data is based on one of the largest datasets for national COVID-19 testing sites, created and maintained by the GoodRx Research Team. Since the pandemic started, our team has been scouring county websites, news outlets, and corporate websites to identify testing sites. These sites, such as drive-through test sites and community-based test sites, are critical to public health efforts to contain the spread of COVID-19 through widespread testing.

For this analysis, we specifically looked at both metropolitan and non-metropolitan testing deserts. We defined metropolitan areas as those with a population size greater than 5,000 people per square mile, while non-metropolitan areas are those with a population size below 5,000. What is the main difference? In general, a larger population size can contribute to a greater risk of spread and increases the need for accessible testing measures.

Testing deserts throughout the U.S.

Across the U.S., there are 16,935 census tracts that are testing deserts, which means that residents have to drive more than 10 miles to access the nearest testing facility. Currently all 50 states have at least one testing desert, and Texas, Ohio, and Michigan have the most testing deserts.

A deeper look into the specific counties that lack testing highlight why some areas may be seeing large increases in COVID-19 cases, while other areas are spared. Based on data acquired on July 13, 67% of counties do not have any testing sites, and across the U.S., 2,900 counties are testing deserts. 

The following counties highlighted contain at least one census tract that is considered a desert. Census tracts are smaller subdivisions of a county and are areas defined for the purpose of administering the census survey. In 2010, there were 73,028 census tracts contained in more than 3,139 counties.

Included in the above deserts are counties like Polk County, Florida; Pinal County, Arizona; and Monterey County, California. All of these counties are either home to more vulnerable populations or are seeing drastic increases in COVID-19 cases.

With a positivity rate of 13.4%, Polk County, in Florida, is currently a COVID-19 hotspot, putting strain on the healthcare system and hospitals. As of July 19, Polk County saw 490 new COVID-19 cases in a day, the highest number the county has seen since the pandemic started.

Pinal County, located just north of Tucson, has also experienced dangerous daily increases in COVID-19 cases. And, on June 24, the Pinal County Board of Supervisors decided against mandating masks, which will likely further exacerbate the spread. Currently, Arizona is a COVID-19 hotspot with over 150,000 diagnosed cases in total, and an average of 3,000 new cases daily.

Monterey County, on the coast of California, continues to see a rise in cases, and it was placed on the governor’s COVID-19 watchlist in early July. The Salinas Valley in Monterey is considered the “salad bowl” of the country, with a climate that is ideal for agriculture. But free testing for workplace safety is not yet mandated by law, and these essential workers in Monterey are facing a heightened risk of infection. Making matters worse, these workers live in crowded spaces together and work in close quarters, further increasing their risk. In June, nearly 40% of positive COVID-19 cases in Monterey were agricultural workers. 

For all of these counties, testing could have curbed outbreaks by helping to isolate and treat patients that test positive for the virus. In the case of Polk County, proper testing could have prevented further spread. And in Arizona, testing and subsequent isolation could have worked to slow the virus, even as mask mandates were overturned. With regards to the agricultural workers in Monterey, access to affordable testing and healthcare is necessary to further protect these essential workers. 

Testing and income

On top of all of this, these testing deserts are in some of the lower-income census tracts. In general, the median income for non-desert metropolitan counties is $61,463. For metropolitan areas that lack COVID-19 testing, the median income drops to $48,052. Similar trends exist for non-metropolitan areas, where median income drops from $71,305 in non-deserts to $52,541 in deserts.

And while testing is supposed to be free for all Americans, there are loopholes that make it harder for low-income patients to get quick and affordable testing without a public test center nearby. Not to mention that many private sector testing sites are only available to established or current patients, meaning that they may require health insurance.

This data adds to conversations surrounding the unequal impact of the pandemic. Research has shown that less affluent populations struggle to “stock up” on necessary supplies, have lost their jobs during the pandemic, and are working jobs that place them at higher risk for contracting the virus. Additionally, research has indicated that serious COVID-19 complications disproportionately affect lower-income populations. The numbers even further highlight how necessary testing is in the counties.

Testing and race

As it turns out, the average distance to a testing center differs substantially by race. In metropolitan COVID-19 testing deserts, Hispanic or Latino residents have to drive an average of 20.4 miles to the closest testing site, while Native Hawaiians and other Pacific Islanders have to drive nearly 45 miles. Black, white, and Asian residents in these areas are driving 24.2, 27.3, and 32.6 miles to the nearest testing facility, respectively. 

But these disparities don’t exist in non-testing desert census tracts, as there is relatively little difference in traveling distance by race. Within non-deserts, all groups live between 1.7 and 1.8 miles from a test site, with the exception of Native Hawaiian and other Pacific Islanders, who live an average of 2.1 miles away. 

Not surprisingly, residents in non-metropolitan communities must drive farther to access a COVID-19 test, even if they are in an area that has adequate testing. White residents in a non-metropolitan testing desert have to drive an average of 28.13 miles to the closest testing site, and Native Hawaiians and other Pacific Islanders have to drive more than 45 miles. 

Why does this matter? Troubling racial inequalities with regards to the COVID-19 pandemic have emerged in recent months. Research indicates that positive case and death rates are higher in populations with a larger Black or Latino community. These communities are three times more likely to become infected with COVID-19 than predominantly white neighborhoods. 

And while distance to a testing site clearly differs by race, new research from FiveThirtyEight indicates that testing sites in communities of color face higher demand than sites in predominantly white neighborhoods. This leads to longer wait times for tests and results, and  understaffed centers, making it harder for communities of color to access adequate testing, further heightening their risk for COVID-19. 

Summing it all up

Almost 17,000 census tracts and over 67 million Americans currently lack access to proper testing, but things are slowly improving. In fact, according to the GoodRx testing site database, from June 13 to July 16, more than 1,300 new testing sites were added across the county, with the majority added in Texas (+293) and Arizona (+121).

But these testing deserts are disproportionately impacting vulnerable populations. Low-income communities, populations of agricultural workers, and residents in states with booming case rates are living in areas without proper access to testing. 

What’s more, living near a testing center doesn’t necessarily mean that residents will be able to get a COVID-19 test. Residents in Los Angeles County are finding it hard to access an available testing appointment, D.C. residents aren’t able to access tests, and many across the country are waiting for more than a week for their results. 

To truly beat this pandemic, all Americans need to access adequate COVID-19 testing. According to researchers at Harvard, we will need to increase testing capacity to 5 million tests per day to continue reopening the country. To fully reopen and boost the economy, we will need to increase tests to 20 million per day.

– – –

Co-contributors: Sara Kim, MS, Amanda Nguyen, PhD, Jeroen van Meijgaard, PhD, Sasha Guttentag, PhD, and Katie Mui

Methodology

We identified testing deserts by looking at both non metropolitan and metropolitan census tracts that are more than 10 miles from a COVID-19 testing site. Metropolitan areas are defined as areas with a population density of more than 5,000 people per square mile. Non-metropolitan areas are those with a population density of at most 5,000 people per square mile.

Data on testing sites was pulled on July 13, 2020 from the GoodRx COVID-19 testing database. GoodRx compiles a list of all drive through, walk through, hospital, and clinic testing sites in all 50 states and District of Columbia. We identify these sites by website and phone.

For census information, 2014-2018 ACS 5-year data was used. Census tract population centroid data was sourced from the GIS Lab at the Newman Library of Baruch College. Population density data and rural-urban commuting area (RUCA) codes were pulled from the U.S. Department of Agriculture Economic Research Service.

Estimated distance to the closest COVID-19 testing site was calculated as the distance between a census tract’s population centroid to its closest testing site. For a cohort of census tracts, the average distance to the closest testing site by race/ethnicity was weighted by the population size of each race/ethnicity in the included census tracts. Median income for a cohort of census tracts was calculated by taking the mean of annual median income in the included census tracts.

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