With air travel on a slow but steady rise in recent months, airports have emerged as a locus for COVID testing.
A number of governments and lab companies have launched SARS-CoV-2 testing sites at airports around the world, offering travelers and airport personnel an opportunity to determine their infection status with, in some cases, people testing negative able to avoid quarantines mandated by their destinations.
Companies not traditionally associated with the medical space have moved into airport testing, as well. For instance, last month, the Port Authority of New York and New Jersey along with John F. Kennedy International Airport partnered with airport spa company XpresSpa to offer molecular and serology SARS-CoV-2 testing to airport employees out of a site in one of the airport's arrival halls. The testing itself is being done at outside laboratories.
In Germany, genetic testing firm Centogene last month launched a program offering molecular SARS-CoV-2 testing out of Frankfurt Airport focused on travelers. Testing costs €59 ($68) with results available in around six hours. Expedited testing with turnaround time of three hours is also available for €139.
"With [international travel] opening up, it is clear that we have to define who can travel and move and at what speed and under which conditions," said Peter Bauer, Centogene's chief genomic officer, noting that the company saw a potential role for its testing capabilities in helping identify travelers with SARS-CoV-2 who should be quarantined and those without it who might be able to skip a quarantine mandated at their destination.
In collaboration with Lufthansa and Frankfurt Airport, the company set up a testing center for sampling travelers via throat swab. To allow for fast turnaround time, it established a mobile laboratory at the airport capable of running 5,000 tests per day, Bauer said.
With the expedited turnaround option, it's possible for travelers to "go to the airport, get the test, go to the lounge and wait, and then you will get an email with the results and you can board" knowing your status.
Bauer said that because of the different and changing regulations in different countries, Centogene can't say whether a negative result from its test will allow travelers to skip quarantines wherever they are going. However, in the case of passengers returning to Germany, a negative SARS-CoV-2 test will allow them to enter the country without a 14-day quarantine.
According to Bauer, in the first two weeks of testing, Centogene was running more than 500 tests per day.
"It's more people than we would have expected to show up at the beginning," he said. "There is a clear need for it."
Bauer said that thus far the positive rate was a little less than 1%, which he noted was small but significant. Most of the positives had come from people returning to Germany from other countries, with several positive cases coming from the U.S. as well as Eastern Europe.
In addition to the voluntary testing, there are certain countries that require all passengers to have proof of a negative SARS-CoV-2 test prior to being allowed to enter. For instance, China requires all inbound passengers to have tested negative for the virus within five days of leaving for the country. The United Arab Emirates has instituted similar regulations. Bauer said that Centogene was handling this category of testing for all Lufthansa passengers flying out of Frankfurt.
Bauer said the company is now in discussions with a number of other airports around Europe and in the Middle East that would like to implement similar testing programs. He said discussions with two sites, one in Europe and one in the Middle East, were far along. Both sites had asked the company to double the capacity of its mobile test units to around 10,000 tests per day, he said.
In the U.K., London-based medical and security company Collinson has partnered with airport ground services firm Swissport to pilot a SARS-CoV-2 testing program at London's Heathrow Airport. Under the program, arriving passengers could purchase a SARS-CoV-2 test and then, assuming they received a negative result, would be allowed to skip the quarantine that is required by the U.K. for travelers from a number of countries, including the U.S.
Collinson is providing nurses for sample collection and will also run the tests, at least during the pilot period of the project, said Simon Worrell, the company's global medical director. Swissport will operate the facility at the airport where the samples will be taken.
Worrell said the larger success of the project will depend on whether the British government makes a negative SARS-CoV-2 test result an official reason for exemption to the country's quarantine rules. Currently, he noted, the rules have 42 exceptions to the quarantine including, for instance, for essential workers.
Worrell said the company and its collaborators have presented their plan to governmental agencies including representatives from Public Health England and are currently in negotiations around creating a quarantine exemption for passengers with a negative SARS-CoV-2 test result.
He said he was optimistic that it would receive this exemption given that the tests would most likely be self-paid, meaning the UK government wouldn't have to foot the bill, and that it could allow tens of thousands of people to avoid quarantine.
"Local authorities would not need to enforce the quarantine, spend resources trying to find where these people are, and, of course, the advantage to the passengers themselves is enormous," he said. "Within one day you can go about your business again and get back to work."
Worrell highlighted several other SARS-CoV-2 testing trials in U.K. territories including Jersey, which launched testing for arriving passengers on June 1. Under the island's regulations, passengers who choose not to be tested must isolate for 14 days after arrival, while passengers who are tested and are negative are not required to isolate. Even after a negative result, however, passengers may be required to undergo molecular testing again on their fourth and seventh days after arrival.
Worrell said that Collinson hoped to set up similar testing programs at other airports around the U.K.
"There's a lot of work to do when the green light [from the government] comes," he said, adding that the project can be up and running in about two weeks after it receives the go ahead.
Meanwhile, at Eindhoven Airport in the Netherlands, logistics company Ecology is partnering with Dutch testing firm Pro Health Medical to open a testing center. Slated to open by the end of the month, the center will offer SARS-CoV-2 testing to residents of Eindhoven as well as airport passengers and will be able to run around 1,200 tests per day, according to Ecology spokesperson Kristin Blades.
Blades said the company has also set up SARS-CoV-2 testing at Munich and Dusseldorf airports in Germany and plans to add testing at Hamburg Airport in the near future.
A number of other countries have also established airport testing for arriving passengers. Iceland, for instance, began in June to offer testing at its Keflavik International Airport. Passengers who do not pay for testing must enter a two-week quarantine.
In the U.S., Alaska requires arriving passengers, including from other U.S. states, to present proof of a negative SARS-CoV-2 taken within the previous 72 hours to avoid quarantine. Hawaii has announced plans to institute a similar program starting in September.
This week, Japan's health minister said the country aimed to raise the SARS-CoV-2 molecular testing capacity at its airports from the current level of around 2,300 tests per day to 10,000 per day in anticipation of increased travel in coming months. The country plans to achieve this increase by using more saliva-based testing.
Christos Hadjichristodoulou, professor of hygiene and epidemiology at the University of Thessaly in Greece, suggested, however, that testing programs like those described will likely be of only limited use in stopping the spread at the virus, given its long incubation period and the high percentage of mild and asymptomatic cases.
Last year, Hadjichristodoulou, who is coordinating a European-funded project, EU Health Gateways, that is developing guidances on appropriate responses to the pandemic at ports, airports, and border crossings, co-authored a study in the International Journal of Environmental Research and Public Health that looked at previous entry and exit screening efforts during infectious disease outbreaks and found limited effectiveness.
"Modelling work that has been carried out by the European Centre for Disease Prevention and Control specifically for COVID-19 has assessed the effectiveness of entry screening in detecting travelers infected with COVID-19 to be low," he said in an email.
According to one modeling study, "approximately 75% of cases from affected Chinese cities would arrive at their destination during the incubation period and remain undetected, even if the efficacy of the screening test to detect symptomatic individuals were 80% for both exit and entry screening," Hadjichristodoulou said. Another modelling study found that combined exit and entry screening would miss roughly half of COVID-19 cases.
He noted that exit screening, particularly of travelers leaving from an area with high levels of community transmission, would likely provide the most benefit, while entry screening is likely to be less value, especially when considering the challenges it presents in terms of logistics and resources.
This story first appeared in our sister publication 360Dx, which provides in-depth coverage of in vitro diagnostics and the clinical lab market.