Peer Review of “Evaluating Population Density as a Parameter for Optimizing COVID-19 Testing: Statistical Analysis”

Background SARS-CoV-2 transmission risk generally increases with the proximity of those shedding the virus to those susceptible to infection. Thus, this risk is a function of both the number of people and the area they occupy. However, the latter continues to evade the COVID-19 testing policy. Objective The aim of this study is to analyze per capita COVID-19 testing data reported for Alabama to evaluate whether testing realignment along population density, rather than density agnostic per capita, would be more effective. Methods Descriptive statistical analyses were performed for population, density, COVID-19 tests administered, and positive cases for all 67 Alabama counties. Results Tests reported per capita appeared to suggest widespread statewide testing. However, there was little correlation (r=0.28, P=.02) between tests per capita and the number of cases. In terms of population density, new cases were higher in areas with a higher population density, despite relatively lower test rates as a function of density. Conclusions Increased testing in areas with lower population density has the potential to induce a false sense of security even as cases continue to rise sharply overall.