We know that testing is critical for controlling the spread of COVID-19 but with rapid home tests difficult to obtain and long waiting lines at testing sites, not everyone has access to timely free testing. And for some, paying $150 for PCR tests at an urgent care facility is too pricey for their pocketbook. But there’s another reason why some people do not want to get tested for COVID-19. They could lose their jobs.

Such was the case for dog groomer Cristina San Martin, says NPR. San Martin had the sniffles and sore throat and did the right thing by texting co-workers, missing work, and getting tested. After the diagnosis was confirmed, the manager of the salon fired the groomer.

Now San Martin is still feeling sick, and cash is a problem. “I’m in no shape right now to apply for jobs or go get interviewed right now or anything like that,” the fully vaccinated worker said.

These practical concerns are obstacles in the path to encourage early testing, says Dr. Shantanu Nundy, a primary care physician, technologist, and business leader who treats low-income patients at a federally funded clinic in Arlington, Va. He says many of them ask, “Hey, can you test me? But can you test me, you know, with the rapid tests so that it’s not part of my records?”

According to NPR, lab-based PCR tests are reported to health officials so many patients prefer to shield their results from authorities, including bosses and school administrators, so their lives will not be disrupted.

“The patients and families who are the most marginalized people — who don’t have steady employment, receive benefits, have limited childcare and home support — are those most likely to not test, and who are probably the ones who we need to test the most,” says Nundy, adding they’re also the most exposed to the virus.

And experts say this is not purely an American dilemma. Francesco Falluchi, a behavioral economist at the University of Parma in Italy has been studying this pattern globally and found that the altruism and willingness to test last year has been replaced by the hard facts of financial reality because countries, including the U.S., have cut back on pandemic unemployment benefits.

“The disincentives to test are increasing and they are increasing because there is less financial security and because there is a greater perception that COVID is getting weaker,” he said.

However, there are many other reasons why people refuse COVID-19 testing according to experts at the University of New South Wales. Besides the issue of losing employment if you cannot work, either waiting for test results or recovering from illness, there is also the problem of quarantine.

Travelers who test positive, for example, may have to stay in isolation in a hotel room for a prolonged period of time. Some people fear the test itself, because the nasal swab is uncomfortable or they distrust of the government. Having COVID-19 may also lead to social stigma, blame and ostracism.

The recent rise of at-home testing will give more Americans the choice of whether to test, or withhold the results, which will make it harder to track actual cases.

Stella Safo, an infectious disease specialist at the Icahn School of Medicine at Mount Sinai, fears the reluctance to test may mask who is infected, leaving those with underlying medical conditions more at risk, says NPR.

“I think the people who have chronic illnesses, people with preexisting medical conditions, people who are disabled are being driven truly underground,” she says. People who make their own risk calculations on whether or not to test can leave out the risks to the most vulnerable.