An employee readies a restaurant for social distancing in Washington, May 29.
Photo: PPI/Zuma PressAmerica is getting back to business against a backdrop of persistent Covid-19 spread. The epidemic is under control, but not crushed. Essential to avoiding a second wave is widespread testing to detect and contain new infections.
The good news is that many states have enough tests available to offer them to all citizens, regardless of symptoms. With new testing technologies coming online, it is becoming easier to deploy the right test in the right setting to the right patient. Part of the strategy should be testing at work sites where employees face higher risks.
Employers have two approaches: trying to keep the virus from entering the workplace and, barring that, trying to contain spread. Fever checks or health questionnaires are only partially effective. Symptom monitoring is unlikely to detect more than about half of infections, and people may only develop symptoms days after being contagious.
What kind of tests should employers use? There is obvious appeal to rapid tests. But current platforms can yield false negatives in about 20% of cases. This may be suitable for a doctor’s office, where a doctor can run another type of test to confirm a negative result. It may not be feasible for screening a mostly asymptomatic population at a job site, where running a second test on negative results isn’t practical given that most tests are likely to be negative, and there may not be symptoms to prompt further suspicion.
A better option for some employers could be lab-based testing. Coming soon to the market are more kits that mail a test to a patient, who can collect a sample and send it back to the lab. The Food and Drug Administration took steps to make this type of testing more routine by issuing a standard template for how labs can get these tests authorized for use. This option is convenient for both patients and employers, and it will reduce strain on health-care workers, who need to preserve protective gear.
People with symptoms of Covid should see a doctor, not show up at work for a test. Those tested at work are thus likely to be mostly asymptomatic but concerned about possible exposure. The risk of a false negative needs to be managed with especially accurate platforms.
One technology, called next-generation sequencing, allows for pooled sampling. This tool is being deployed by several companies, including Tempus and Illumina. (Both authors of this article are employed by Tempus, and Dr. Gottlieb is on the board of Illumina.) Employees give saliva samples that are combined into pools of 10 or even 100 specimens and then screened at once. If you get a hit on a pool, then you go back and test each person in it. These can be very accurate and efficient. Sample pooling is how China claims it recently managed to screen 10 million citizens in Wuhan in 19 days.
The next question is how often to test. A business could, say, offer tests to rotating groups of at risk employees based on who people come into regular contact with at work. Think of cohorts divided on different floors of an office building, or different parts of a shop floor. Sampling a representative group from each cohort on a regular basis can help detect outbreaks. Apps are now available to assist employers in implementing such protocols.
As more testing tools become available, it is crucial to make sure screening is deployed where it is needed most. That means expanding testing opportunities in underserved communities, where there is both greater risk of spread and serious illness. States should help businesses like grocery stores, where risks are high but margins are low, establish testing regimes.
Employers ought to anticipate other issues like protecting worker privacy, supporting self-isolation for infected individuals and reporting results to state health authorities. Employers also need systems to track close work contacts when they discover a positive case.
But companies can be a big part of reducing America’s Covid risk and preventing another epidemic. Widespread testing may be the best bridge to a vaccine.
Dr. Gottlieb is a resident fellow at the American Enterprise Institute, a partner at New Enterprise Associates and board member of health-care companies. He was commissioner of the Food and Drug Administration, 2017-19. Ms. Silvis is a senior vice president at Tempus Labs Inc. and was the deputy director of the FDA’s medical device center and the agency’s chief of staff from 2017-19.
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