PCORI Biweekly COVID-19 Scan: College, University, and Employee Testing Programs (September 17-30, 2020)

ECRI Horizon Scanning has selected the topics below as those with potential for impact relative to COVID-19 in the United States within the next 12 months. All views presented are preliminary and based on readily available information at the time of writing.

Because these topics are rapidly developing, we cannot guarantee the accuracy of this information after the date listed on this publication. In addition, all views expressed in the commentary section are solely those of ECRI Horizon Scanning and have not been vetted by other stakeholders. Topics are listed in alphabetical order.

Description

College and university COVID-19 testing programs are services offered by clinical laboratories (eg, Quest Diagnostics, Laboratory Corporation of America Holdings [LabCorp], and Color Genomics, Inc​). The testing programs are intended to limit coronavirus spread and boost student confidence about returning to campus.

Schools implementing a testing program might give all returning students, faculty, and staff a coronavirus molecular test, along with an antibody test, at the start ​of the school year, with several levels of surveillance throughout the year. This will help schools establish a baseline for coronavirus infection or exposure rates for the community. It should also help policy makers make decisions about quarantines and other distance measures for people arriving en masse back on campus.

Schools might ​provide self-collection kits to avoid overwhelming health centers and clinical laboratories. Upon receiving the sample, central laboratories will have test results available through an online platform in about 3 to 5 days. College and university testing programs have the potential to detect COVID-19 cases early and reduce coronavirus spread among students.

Commentary

People organizing testing programs will need clear guidance from local and federal public health departments so they can create policies and procedures that educate the community on how to handle positive cases. ECRI internal stakeholders think that, given the potential for rapid COVID-19 spread in classrooms and dormitories, testing programs might help limit viral spread on campuses—if clear procedures are implemented for frequency of testing, isolation of positive cases, and quarantining of suspected or exposed individuals.

Standardized testing at the beginning of the term might offer a reference point to help track cases. Point-of-care testing at university health centers might also help reduce time in identifying positive cases and improve chances of limiting transmission. But if testing does not take place at regular intervals and students do not maintain social distancing, testing programs will be ineffective.

Stakeholders pointed out that regular testing will be costly and questioned whether enough tests will be available for times when cases surge. Stakeholders identified the risk that inadequate online, parallel-learning options for infected students might cause academic hardship or pressure students to misuse self-collection kits.

• Area of Potential Impact: Health care costs, health care disparities, patient outcomes, population health
• Category: Screening and diagnostics

Description

Employee COVID-19 testing programs are offered by clinical laboratories (eg, Quest Diagnostics, Laboratory Corporation of America Holdings [LabCorp], Bio-Reference Laboratories, Inc, and Color Genomics, Inc). These testing programs are intended to limit novel coronavirus spread in the workplace and boost confidence that employees can return to a safe work environment.

The programs emphasize operating under simple and streamlined conditions that allow COVID-19 cases to be detected early, thus limiting disease spread. COVID-19 testing programs could range from unreliable screening methods, including health questionnaires and temperature screening, to more reliable screening methods requiring sample collection, such as molecular testing either at the employer site or at home using a self-collection kit.

Pilot programs (eg, Quest Diagnostics, LabCorp) have used tests performed at central laboratories that provide results within 2 to 3 days after receiving the sample. Employers and employees have access to test results through an online platform. Although point-of-care tests offer same-day test results, they are currently not used because of concerns about their higher false-positive and false-negative rates​ than central laboratory tests.​

Commentary

Testing programs to reopen businesses are intended to help employees feel safe about returning to their workplace because they are an independent method to catch COVID-19 cases early and help limit coronavirus spread.

ECRI internal stakeholders expressed that to keep employees safe, companies must have policies or procedures (including social distancing and hygiene practices) that help mitigate exposure and spread of the coronavirus among employees. Nucleic acid testing or equivalent (if developed) should play a key role in the policy; however, the ideal testing frequency remains unclear. Testing programs will increase operating costs for companies, which might not be feasible for many employers.

Stakeholders were concerned about how frequently employees would be tested, because molecular testing is the only way to identify infected people before symptoms arise or people who do not develop symptoms (asymptomatic) but can still spread the virus. If an employee’s test result is negative on day 1, it does not mean that their future results will remain negative. Stakeholders were also concerned about the time it takes for companies to receive test results from centralized labs. This delay might cause the coronavirus to spread undetected in the workplace.

• Area of Potential Impact: Health care costs, health care disparities, patient outcomes, population health
• Category: Screening and diagnostics

Horizon scanning is a systematic process that serves as an early warning system to inform decision makers about possible future opportunities and threats. Health care horizon scanning identifies technologies, innovations, and trends with potential to cause future shifts or disruptions—positive or negative—in areas such as access to care, care delivery processes, care setting, costs of care, current treatment models or paradigms, health disparities, health care infrastructure, public health, and patient health outcomes

The PCORI Health Care Horizon Scanning System (HCHSS) conducts horizon scanning to better inform its patient-centered outcomes research investments. Initially, PCORI defined the HCHSS project scope to focus on interventions with high potential for disruption in the United States in 5 priority areas: Alzheimer’s disease and other dementias, cancer, cardiovascular diseases, mental and behavioral health conditions, and rare diseases. In addition, the system captures high-level disruptive trends across all clinical areas, which may lead PCORI to expand the project scope to include other priority areas in the future.

In early 2020, the COVID-19 pandemic created a fast-moving, widespread public health crisis. In May 2020, PCORI expanded its HCHSS to elucidate the landscape of potentially impactful applications for COVID-19. The HCHSS COVID-19 supplement scans for, identifies, monitors, and reports on emerging and available COVID-19-related treatments, diagnostics, preventive measures, management strategies, and systems changes with potential for high impact to patient outcomes—for individuals and populations—in the United States in the next 12 months.

The HCHSS COVID-19 supplement produces 3 main outputs:

• Biweekly COVID-19 Scans (eg, this document) provide ECRI Horizon Scanning with a vehicle to inform PCORI and the public in a timely manner of important topics of interest identified during ongoing scanning and topic identification or through the ECRI stakeholder survey process.
• Status Reports (quarterly) briefly list and describe all COVID-19-related topics identified, monitored, and recently archived.
• High Impact Reports (every 4 months) highlight those topics that ECRI internal stakeholders (eg, physicians, nurses, allied health professionals, public health professionals, first responders, health systems experts, clinical engineers, researchers, business and finance professionals, and information technology professionals) have identified as having potential for high impact relative to COVID-19 in the United States.