Before going to work on Mondays, Wednesdays, and Fridays, employees at Citi’s bank branches in the Chicago area swab their noses and drop the sample in a cassette. Then they wait 20 minutes to see if they’re positive for COVID-19, with the results entered in an app, designed by the AI chatbot company LivePerson, that guides them through the process.
Since the program began roughly a month ago as part of a Harvard University study, the system has already discovered people who didn’t realize that they were sick. “We’re finding people who are infectious who would have gone to work, and they wouldn’t have turned symptomatic for three more days,” says Michael Mina, an assistant professor of epidemiology at Harvard T.H. Chan School of Public Health who is leading the study. Without the tests, those employees might have otherwise infected coworkers, and several more people would also have had to quarantine. The study is optional for Citi employees, but many have opted in, and the company plans to soon expand the program from its Chicago area branches and New York trading floor to its bank branches across the country.
Even as vaccinations increase, testing is still critical. “We’re actually seeing cases plateauing in many places, or in places like Michigan, going up again,” he says. “This is just an example of how tricky pathogens like this can be. The vaccines are a major, major benefit. There’s no question about it. But they also are not going to be the end of the pandemic.”
A massive rollout of cheap rapid tests last August might have helped prevent hundreds of thousands of deaths by stopping major surges. That didn’t happen, but it’s still important now. Many Americans still aren’t vaccinated. New variants are more contagious. It’s possible, Mina says, that there could be another surge, and testing can be a tool to help keep businesses and schools open if that happens.
Since January, the number of COVID tests performed in the U.S. has rapidly declined, and tests still normally happen only when someone has symptoms or if they know they’ve been exposed to someone who’s sick. But businesses could help reverse that trend and gather critical public health data. The Biden administration also plans to ramp up rapid COVID tests in schools.
There’s one major challenge: Rapid tests are in short supply. The tests used in the Harvard study at Citi are made by Innova, and are already in widespread use in schools in the U.K. But the FDA hasn’t yet approved them for use here. That’s not because they don’t work, but because of issues with the regulatory framework. The FDA considers PCR tests the gold standard for COVID. But PCR tests detect the virus long after someone’s infectious—if you take that type of test even a month or two after you’ve recovered, the test can still show that you’re infected.
Rapid antigen tests are very effective at detecting the virus when someone is infectious, but because the FDA compares the total sensitivity of the tests, including the results long after someone has recovered, antigen tests don’t measure up. (A couple of them have been approved, but somewhat gamed the system by recruiting study participants who had high viral loads rather than following FDA guidance, Mina says.)
“The problem is that the FDA views all of these tests as medical diagnostic tools, not as public health tools,” Mina says. He argues that President Biden or the FDA Commissioner should create a new type of regulation for public health tools like rapid testing; the CDC or NIH could potentially evaluate the tests. In his own research, Mina says that these tests have proven to be very accurate, with over 90% sensitivity to detect infectious people, and close to 100% sensitivity if the tests are done twice a week. The new study with Citi will provide more evidence of how the tests can help. (Out of the thousands of tests performed so far, there have been no false positives yet; for the purposes of the study, all positive COVID tests have been reconfirmed with PCR tests.)
Businesses can play an important role in pushing rapid testing forward, Mina says. In Canada, a team of researchers helped bring hundreds of companies into a rapid testing program, and are now recruiting American companies into a similar program called the Rapid Action Consortium. Mina is an adviser. “The whole goal is to bring these big businesses into the fold and get their voices heard,” he says. “Essentially the businesses are saying, ‘Hey, we want screening tests. We want to make sure employees know that they’re negative before they come to work. We want to add home screening.’ And when you get some of America’s major companies all saying the same thing, that should send a very clear signal that, hey, this public health tool is desired. We need to figure out how to scale it up.”