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Clinical Laboratories and Pathology Groups

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Google DeepMind’s AlphaFold Wins CASP14 Competition, Helps Solve Mystery of Protein Folding in a Discovery That Might be Used in New Medical Laboratory Tests

The AI protein-structure-prediction system may ‘revolutionize life sciences by enabling researchers to better understand disease,’ researchers say

Genomics leaders watched with enthusiasm as artificial intelligence (AI) accelerated discoveries that led to new clinical laboratory diagnostic tests and advanced the evolution of personalized medicine. Now Google’s London-based DeepMind has taken that a quantum step further by demonstrating its AI can predict the shape of proteins to within the width of one atom and model three-dimensional (3D) structures of proteins that scientist have been trying to map accurately for 50 years.

Pathologists and clinical laboratory professionals know that it is estimated that there are around 30,000 human genes. But the human proteome has a much larger number of unique proteins. The total number is still uncertain because scientists continue to identify new human proteins. For this reason, more knowledge of the human protein is expected to trigger an expanding number of new assays that can be used by medical laboratories for diagnostic, therapeutic, and patient-monitoring purposes.

DeepMind’s AI tool is called AlphaFold and the protein-structure-prediction system will enable scientists to quickly move from knowing a protein’s DNA sequence to determining its 3D shape without time-consuming experimentation. It “is expected to accelerate research into a host of illnesses, including COVID-19,” BBC News reported.

This protein-folding breakthrough not only answers one of biology’s biggest mysteries, but also has the potential to revolutionize life sciences by enabling researchers to better understand disease processes and design personalized therapies that target specific proteins.

“It’s a game changer,” Andrei Lupas, PhD, Director at the Max Planck Institute for Developmental Biology in Tübingen, Germany, told the journal Nature. “This will change medicine. It will change research. It will change bioengineering. It will change everything.”

AlphaFold Wins Prestigious CASP14 Competition

In November, DeepMind’s AlphaFold won the 14th Community Wide Experiment on Critical Assessment of Techniques for Protein Structure Prediction (CASP14), a biennial competition in which entrants receive amino acid sequences for about 100 proteins whose 3D structures are unknown. By comparing the computational predictions with the lab results, each CASP14 competitor received a global distance test (GDT) score. Scores above 90 out of 100 are considered equal to experimental methods. AlphaFold produced models for about two-thirds of the CASP14 target proteins with GDT scores above 90, a CASP14 press release states.

According to MIT Technology Review, DeepMind’s discovery is significant. That’s because its speed at predicting the structure of proteins is unprecedented and it matched the accuracy of several techniques used in clinical laboratories, including:

Unlike the laboratory techniques, which, MIT noted, are “expensive and slow” and “can take hundreds of thousands of dollars and years of trial and error for each protein,” AlphaFold can predict a protein’s shape in a few days.

“AlphaFold is a once in a generation advance, predicting protein structures with incredible speed and precision,” Arthur D. Levinson, PhD, Founder and CEO of Calico Life Sciences, said in a DeepMind blogpost. “This leap forward demonstrates how computational methods are poised to transform research in biology and hold much promise for accelerating the drug discovery process.”

AlphaFold graph chart
Science reported that AlphaFold, which scored a median of 87—25 points above the next best predictions—did so well that CASP14 organizers worried DeepMind may have been somehow cheated. To validate the results, they asked AlphaFold to complete a “special challenge”—modeling a membrane protein from an ancient species of microbes called archaea, which they had been unable to model satisfactorily using X-ray crystallography. AlphaFold returned a detailed image of a three-part protein with two long helical arms in the middle. “It’s almost perfect,” Andrei Lupas, PhD, Director at the Max Planck Institute for Developmental Biology, told Science. “They could not possibly have cheated on this. I don’t know how they do it.”  (Graphic copyright: DeepMind/Nature.)

Revolutionizing Life Sciences

John Moult, PhD, Professor, University of Maryland Department of Cell Biology and Molecular Genetics, who cofounded CASP in 1994 and chairs the panel, pointed out that scientists have been attempting to solve the riddle of protein folding since Christian Anfinsen, PhD, was awarded the 1972 Nobel Prize in Chemistry for showing it should be possible to determine the shape of proteins based on their amino acid sequence.

“Even tiny rearrangements of these vital molecules can have catastrophic effects on our health, so one of the most efficient ways to understand disease and find new treatments is to study the proteins involved,” Moult said in the CASP14 press release. “There are tens of thousands of human proteins and many billions in other species, including bacteria and viruses, but working out the shape of just one requires expensive equipment and can take years.”

Science reported that the 3D structures of only 170,000 proteins have been solved, leaving roughly 200 million proteins that have yet to be modeled. Therefore, AlphaFold will help researchers in the fields of genomics, microbiomics, proteomics, and other omics understand the structure of protein complexes.

“Being able to investigate the shape of proteins quickly and accurately has the potential to revolutionize life sciences,” Andriy Kryshtafovych, PhD, Project Scientist at University of California, Davis, Genome Center, said in the press release. “Now that the problem has been largely solved for single proteins, the way is open for development of new methods for determining the shape of protein complexes—collections of proteins that work together to form much of the machinery of life, and for other applications.”

Clinical laboratories play a major role in the study of human biology. This breakthrough in genomics research and new insights into proteomics may provide opportunities for medical labs to develop new diagnostic tools and assays that better identify proteins of interest for diagnostic and therapeutic purposes.

—Andrea Downing Peck

Related Information:

AI Solution to a 50-Year-Old Science Challenge Could ‘Revolutionize’ Medical Research

‘It Will Change Everything’: DeepMind’s AI Makes Gigantic Leap in Solving Protein Structures

Protein Structure Prediction Using Multiple Deep Neural Networks in the 13th Critical Assessment of Protein Structure Prediction (CASP13)

AlphaFold: A Solution to a 50-Year-Old Grand Challenge in Biology

DeepMind’s Protein-Folding AI Has Solved A 50-Year-Old Grand Challenge of Biology

‘The Game Has Changed.’ AI Triumphs at Solving Protein Structures

One of Biology’s Biggest Mysteries ‘Largely Solved’ by AI

Oak Street Health Opens Three Primary Care Clinics in Walmart Supercenters in Texas with Full Menu of Clinical Services

The clinics are part of a growing trend among large retailers to open full-service healthcare clinics where consumers seek out other goods and services

Major retail chains continue to partner with local health systems and other healthcare companies to expand the range of primary care services delivered in their stores. The latest such collaboration is a partnership between Walmart (NYSE:WMT) and Oak Street Health (NYSE:OSH) at three locations in Texas.

Why is this trend important for clinical laboratories to follow? Because after 15 years, retail chains are moving past the simple walk-in clinic model of using a nurse practitioner to provide limited diagnoses that produce prescriptions at chain store pharmacies and other retail locations. They are now partnering with local health systems to provide full healthcare services that are delivered by physicians. These medical services include many common clinical laboratory tests.

The new OSH clinics, located in Walmart Supercenters, are open and accepting patients via walk-in, same day, and scheduled appointments. The clinics are located in the Dallas-Fort Worth area at:

  • Arlington Walmart, 4801 S Cooper St, Arlington, TX, 76017
  • Benbrook Walmart, 8840 Benbrook Blvd, Benbrook, TX, 76126
  • Carrollton Walmart, 1213 E Trinity Mills Rd, Carrollton, TX, 75006

The clinics offer comprehensive, preventative, and urgent care services to consumers, including:

  • Primary care
  • Optometry
  • X-rays
  • Dental
  • Behavioral counseling
  • Hearing services
  • Nutrition and fitness

As well as clinical laboratory testing, including:

  • A1C
  • Lipid
  • Pregnancy
  • Strep
  • Mono
  • Flu
  • Drug screenings, and more.

 “While all members of the community—from toddlers to seniors—are welcome at these clinics, Oak Street Health’s focus in its growing network of more than 60 primary care centers remains adults on Medicare,” states an OSH press release.

This partnership between Walmart and Oak Street Health means clinical labs in that area will need to follow their patients to be able to collect the specimens and perform the lab tests for patients seen in Walmart Health clinics.

Walmart Health Center Outside Inside
In, “Walmart Opens Second Health Center Offering Clinical Laboratory Tests and Primary Care Services,” Dark Daily reported in May on similar Walmart Health Center openings like that shown above in partnership with WellStar Health System in Georgia. These full-service primary care centers offer many common clinical laboratory tests. “By offering clinical laboratory testing in support of primary care and urgent care, Walmart may be able to lower prices for lab tests in any market that it enters,” said Robert Michel, Editor-in-Chief of Dark Daily and its sister publication The Dark Report. (Photo copyright: Walmart.)

Oak Street Health Brings Value-based Medicine to 11 States

“It is our mission at Oak Street Health to rebuild healthcare as it should be, and that aligns directly with Walmart’s history of providing accessible and equitable healthcare in communities across the country,” said Mike Pykosz, CEO of Oak Street Health, in the press release. “We look forward to becoming a positive addition to the neighborhood in these new markets and providing an unmatched healthcare experience in a convenient location.”

Both companies are planning to extend their relationship beyond these three locations and open additional clinics in other regions.

“We’ve proudly served customers at these three former Walmart Care Clinic locations for the last five years, and we are excited to bring this evolved approach to healthcare to our customers at these locations with Oak Street Health,” said Marcus Osborne, Senior Vice President, Walmart Health, in the press release. “As we grow Walmart Health locations in other markets, we think Oak Street Health’s innovative value-based healthcare model will help us continue to deliver on our live better promise at these locations.”

The majority of Oak Street Health consumers are Medicare Advantage patients, but OSH does accept most major and commonly-accepted insurance plans, Healthcare Dive reported.

Full-Service Healthcare Clinics Drawing Investor Attention

There is evidence that savvy investors believe moving primary care into retail stores and other non-traditional locations can be a big winner. In its third quarter report, Oak Street Health released very strong numbers for their third quarter, which ended September 30. Their total reported revenue for the quarter was $217.9 million, which accounted for a 57% increase over last year’s third quarter earnings, Yahoo Finance reported.

OSH’s capitation revenue totaled $211.8 million, according to the report, which was a 59% increase year over year. Law Insider defines capitation revenues as “all payments from managed care organizations, where payment is made periodically on a per member basis for the partial or total medical care needs of a patient, co-payments, and all HMO incentive bonuses.”

In its third quarter statement, Oak Street Health also reported caring for approximately 59,500 at-risk patients, which represented 66% of its total patients.

“Our strong third quarter results were highlighted by 38% growth in at-risk patients, 57% revenue growth, and the resumption of new center openings, as we opened 13 centers during the quarter amidst continued uncertainty related to the COVID-19 pandemic,” said Pykosz in a statement, Yahoo Finance reported. “Looking ahead, we continue to be excited by the ample opportunity to drive continued de novo expansion across both new and existing markets, as well as the complementary growth opportunities presented by our Walmart collaboration and CMS’ Direct Contracting program.”

As we wrote in the May Dark Daily e-briefing, “Clinical laboratory leaders may want to explore partnerships with Walmart and other retailers that are developing healthcare centers to deliver primary care services in places where masses of people shop for everyday items. Especially given that these big-box retailers remain open during healthcare crises like the COVID-19 pandemic.”

This is even more critical now, as more retailers partner with health systems to provide expanded primary care and clinical laboratory services.

—JP Schlingman

Related Information:

Walmart, Newly Public Oak Street Health Launch Clinic Partnership in Texas

Oak Street Health Opens Its First Texas Walmart Clinic

Oak Street Health Announces Collaboration with Walmart to bring Affordable, High-quality Healthcare to Texas

Oak Street Health Announces Collaboration with Walmart to Bring Affordable, High-Quality Healthcare to Texas

Oak Street Health Reaches Milestone 70th Location with Entry into New York and Opening of First Walmart Community Clinic

Oak Street Health Opens First Center in Mississippi

Oak Street Health Reports Third Quarter 2020 Financial Results

Walmart Opens Second Health Center Offering Clinical Laboratory Tests and Primary Care Services

Walmart Remodeling In-Store Pharmacies to Include Private Consultation Rooms

Immunocompromised Patients with COVID-19 May Remain Infectious for Much Longer than Previously Thought

Clinical laboratory professionals should note that one case study describes a COVID-positive cancer patient shedding infectious particles for five months, which is much longer than expected

Just when researchers start believing they understand COVID-19 infections, something happens that reveals there is still more to learn. These additional findings are relevant for clinical laboratory managers and pathologists because the new insights often may play a role in how SARS-CoV-2 results should be interpreted for individual patients.

Researchers recently described a case where, in February, a 71-year-old woman underwent surgery related to her 10-year battle with cancer. While she was in the hospital, she was found to be positive for the SARS-CoV-2 coronavirus, though she showed no respiratory or systemic symptoms. Nevertheless, the hospital isolated her and monitored the infection.

To everyone’s surprise, the patient remained positive for five months. She underwent 15 COVID-19 tests from various diagnostics companies, as well as receiving two doses of convalescent plasma therapy, but she remained positive for the coronavirus into June.

Researchers at the National Institute of Allergy and Infectious Diseases (NIAID) wanted to know why. They conducted a study on the woman, which they later published in the journal Cell, titled, “Prolonged Infectious SARS-CoV-2 Shedding from an Asymptomatic Immunocompromised Individual with Cancer.”

In their published study, they wrote, “Although it is difficult to extrapolate from a single individual, our data suggest that long-term shedding of infectious virus may be a concern in certain immunocompromised people. Given that immunocompromised individuals could have prolonged shedding and may not have typical symptoms of COVID-19, symptom-based strategies for testing and discontinuing transmission-based precautions, as recommended by the Centers for Disease Control and Prevention (CDC), may fail to detect whether certain individuals are shedding infectious virus.”

Clinical laboratory professionals and pathologists will find it significant that patients with major health conditions may be shedding viral material for weeks longer than originally thought. This is relevant because it may be prudent to COVID test patients who present with compromised immune systems, and who are asymptomatic, and then repeat that testing at appropriate intervals.

The graphic above taken from the NIAID study
The graphic above taken from the NIAID study shows how long it took for the SARS-CoV-2 coronavirus to clear the 71-year-old immunocompromised cancer patient’s system, and at which points the convalescent plasma doses were administered. (Graphic copyright: National Institute of Allergy and Infectious Diseases.)  

Immunocompromised Patients May Handle COVID-19 Differently

The NIAID researchers believe the reason the patient continued to shed infectious virus for so long was because she was immunocompromised. They wrote, “Many current infection control guidelines assume that persistently PCR-positive individuals are shedding residual RNA and not infectious virus, with immunocompromised people thought to remain infectious for no longer than 20 days after symptom onset. Here we show that certain individuals may shed infectious, replication-competent virus for much longer than previously recognized. Although infectious virus could be detected up to day 70, sgRNA, a molecular marker for active SARS-CoV-2 replication, could be detected up until day 105.”

In the United States, some three million people have compromised or weakened immune systems. This is a significant population, Science Alert reported.

“As the virus continues to spread, more people with a range of immunosuppressing disorders will become infected, and it’s more important to understand how SARS-CoV-2 behaves in those populations,” Vincent Munster, PhD, Chief, Virus Ecology Unit at the National Institute of Allergy and Infectious Diseases and co-author of the NIAID study, told Science Alert.

The NIAID study findings match knowledge about other coronaviruses. For example, Science Alert reported that immunocompromised people with Middle East Respiratory Syndrome (MERS) have been shown to shed common seasonal coronaviruses for up to a month following infection.

Asymptomatic Patients Are a Mystery

There is still much that is unclear about asymptomatic patients. A paper published in JAMA, titled, “Clinical Course and Molecular Viral Shedding Among Asymptomatic and Symptomatic Patients with SARS-CoV-2 Infection in a Community Treatment Center in the Republic of Korea,” questioned the viral load differences in patients who tested positive but had no symptoms compared to those who were symptomatic.

That study included 303 patients, of which 193 were symptomatic. During the course of the study, 21 of the asymptomatic patients developed symptoms, however, the viral load was similar in all of the patients, regardless of symptoms.

“Isolation of asymptomatic patients may be necessary to control the spread of SARS-CoV-2,” concluded the JAMA researchers. But how long should asymptomatic patients remain isolated?

Official Guidance Is Based on Symptoms

The CDC updated its guidelines for who should isolate and for how long in October. The guidelines cover:

  • People who have or had COVID-19 and had symptoms;
  • People who tested positive for COVID-19 but did not have symptoms;
  • People who either had severe symptoms of COVID-19 or who have a compromised immune system;
  • People who were exposed to COVID-19, and
  • People who have been reinfected.

Regarding those who are immunocompromised and had COVID-19, the CDC says they “may require testing to determine when they can be around others.”

In addition to noting that people who are immunocompromised may require additional testing, the CDC is also continuously updating its published list of people who are at risk for complications and severe illness if they contract COVID-19. However, as the NIAID study showed, even those with underlying medical conditions can be asymptomatic.

And as the NIAID researchers note, there is more to learn. “Understanding the mechanism of virus persistence and eventual clearance will be essential for providing appropriate treatment and preventing transmission of SARS-CoV-2 because persistent infection and prolonged shedding of infectious SARS-CoV-2 might occur more frequently. Because immunocompromised individuals are often cohorted in hospital settings, a more nuanced approach to testing these individuals is warranted, and the presence of persistently positive people by performing SARS-CoV-2 gRNA and sgRNA analyses on clinical samples should be investigated.”

SARS-CoV-2 Science Is Young

An additional takeaway for pathology lab professionals is the reminder that the scientific research surrounding the novel coronavirus that causes COVID-19 is very young. New insights and understanding will continue to emerge, probably for many years.

One reason why the development of vaccines for COVID-19 has been so quick is that it built on scientific knowledge of the first SARS outbreak and MERS. It’s interesting to note that both SARS and MERS are relatively new as well: SARS emerged in 2002 and MERS in 2012. Compared to a disease like HIV, which was first identified in 1959, scientists have only been working on these particular coronaviruses for a short period of time.

The NIAID study is yet another example of new knowledge and insights emerging about how SARS-CoV-2 infects individuals. Collectively, these findings make it challenging for medical laboratory professionals to stay current with everything relevant and associated with the proper interpretation of COVID-19 test results.

—Dava Stewart

Related Information:

Prolonged Infectious SARS-SoV-2 Shedding from an Asymptomatic Immunocompromised Individual with Cancer

Startling Case Study Finds Asymptomatic COVVID-19 Carrier Who Shed Virus for 70 Days

Shedding of Infectious Virus in Hospitalized Patients with Coronavirus Disease-2019 (COVID-19): Duration and Key Determinants

SARS-CoV-2: The Viral Shedding vs Infectivity Dilemma

Clinical Course and Molecular Viral Shedding Among Asymptomatic and Symptomatic Patients with SARS-CoV-2 Infection in a Community Treatment Center in the Republic of Korea

When You Can Be Around Others

People with Certain Medical Conditions

NAIAD: Coronaviruses

COVID Research Updates: Immune Responses to Coronavirus Persist Beyond Six Months

Cerner Collaborates with Amazon Halo to Add Cloud-based Services and Realtime Health Tracking to Its EHR

Patients in health systems that use the Cerner EHR can now track and share specific health metrics with their healthcare providers

In what may be first steps toward becoming a full-service digital healthcare platform, Health information technology (HIT) developer Cerner (NASDAQ:CERN) is partnering with Amazon (NASDAQ:AMZN) to bring cloud-based health tracking services to its EHR customers. People who use Amazon’s Halo service—which includes a wristband device and smartphone app to monitor specific health metrics—can now import that data directly into Cerner electronic health record (EHR) systems for sharing with healthcare providers.

This may turn out to be a pioneering effort by one of the nation’s major providers of EHR systems to pull in useful health data from a variety of non-traditional sources and incorporate them into a patient’s electronic health record. Cerner has a major market share of EHR systems (exceeded only by Epic) and has a laboratory information system (LIS) that is used by many clinical laboratories.

For this fact alone, strategic planners at medical laboratories and anatomic pathology groups should follow this development. That is particularly true of those labs operated by hospitals and health systems that decide to add this new feature to their existing Cerner EHR. If data is flowing into the EHR from patients’ Amazon Halo service, for example, it is not a big leap to imagine that clinical lab test data from the patients’ EHRs might later flow back to the Halo service where it would be instantly accessible to those patients.

This collaboration, according to a Cerner press release, “allows consumers to easily connect vital health and well-being information with their broader healthcare teams. … Historically this type of data has been siloed or difficult to obtain. Wearable technology, such as the Amazon Halo, can help achieve greater interoperability across healthcare when integrated directly into a patient’s electronic health record (EHR).”

Amazon Halo Band and APP
Cerner’s integration of the Amazon Halo Band and smartphone app (above) into its electronic health record (EHR) system allows users to share collected healthcare metrics with doctors in health systems that use the Cerner EHR. How long will it be before clinical laboratories that use Cerner’s laboratory information systems (LIS) will be able to incorporate similar metrics into their LIS as well? (Photo copyright: Amazon.)

Using Artificial Intelligence to Empower Healthcare Consumers

The Halo wristband, along with its accompanying smartphone app, “combines a suite of AI-powered health features that provide actionable insights into overall wellness …  [and] uses multiple advanced sensors to provide the highly accurate information necessary to power Halo,” an Amazon press release states.

Data collected by Amazon Halo that are now importable into Cerner EHRs, according to the press release, include:

  • Activity: Informed by American Heart Association physical activity guidelines and the latest medical research, Amazon Halo awards points based on the intensity and duration of movement, not just the number of steps taken.
  • Sleep: Amazon Halo uses motion, heart rate, and temperature to measure time asleep and time awake; time spent in the various phases of sleep including deep, light, and REM; and skin temperature while sleeping.
  • Body: Amazon Halo lets customers measure their body fat percentage from the comfort and privacy of their own home, making this important information easily accessible.
  • Tone: This feature uses machine learning to analyze energy and positivity in a customer’s voice so they can better understand how they may sound to others, helping improve their communication and relationships.
  • Labs: Amazon Halo Labs are science-backed challenges, experiments, and workouts that allow customers to discover what works best for them specifically, so they can build healthier habits.

Leveraging Patient Generated Health Data

In the Cerner press release, David Bradshaw, Senior Vice President of Consumer and Employer Solutions at Cerner, said, “The healthcare industry is undergoing a digital revolution, where physicians are increasingly looking to leverage patient-generated health data to help keep them healthier and out of the doctor’s office. 

“Our work with Amazon Halo,” he continued, “highlights the importance of using artificial intelligence and other leading-edge technologies to accelerate healthcare innovation and improve health outcomes. Cerner is focused on continuing to lead a wave of breakthrough innovation, and this integration with Amazon Halo is a step toward this goal.” 

The first healthcare provider to offer the Amazon Halo service to its Cerner EHR users is Sharp HealthCare of San Diego. Some Sharp Health Plan members will participate in wellness programs and eventually have the option to link their Sharp and Halo data directly into the healthcare system’s Cerner EHR.

Sharp HealthCare includes 2,600 physicians, four acute care facilities, and three specialty hospitals.

“Technology is revolutionizing the way we care for patients and how consumers care for themselves, and at Sharp we strive to embrace innovative ways to leverage leading technology to engage consumers in managing their health,” said Michael Reagin, SVP and Chief Information and Innovation Officer at Sharp HealthCare, in the Cerner press release.

“With more relevant information at their fingertips, our populations will be empowered to make more informed decisions about the health and well-being of themselves and the communities they serve,” he added. “We are pleased to work with Cerner and Amazon Halo to offer our members, patients, and clinicians an opportunity to have a more connected health record.”

Cerner Expanding to Include Population Health and Precision Medicine

Cerner may be evolving toward a cloud-based platform that pulls in data from hospital and doctors’ office EHRs—as well as data gather by wearable devices—and uses that information for population health and precision medicine analysis to guide healthcare providers.

Last year, Cerner announced a collaboration with the Amazon Web Services (AWS) cloud platform, reportedly in an effort to pivot beyond its traditional health records business.

“Moving forward, I think Cerner will look more like a health platform company and less like an EHR company,” Dan Devers, SVP, Cloud Strategy, and Chief IP Officer at Cerner, told Fierce Healthcare. “As you play out the trend in healthcare, I see Cerner very much operating at the health network level—so beyond the enterprise of a single health system. Given the power of the cloud and the work we’re doing, I see Cerner having much more relevance into broader networks and providing nationwide capabilities.”

Cerner is aiming to provide consumers with more power regarding their own healthcare by equipping them with easy, fast, and efficient methods to access their personal information and provide healthcare professionals with useful data about individual patients.

Given the value and importance of clinical laboratory data, innovative lab managers should strive to be aware of collaborations like the one between Cerner and Amazon Halo. Remaining alert for opportunities to participate in these types of arrangements could provide labs with added revenue streams and inventive ways to offer customers value-added services. 

—JP Schlingman

Related Information:

Introducing Amazon Halo and Amazon Halo Band—A New Service that Helps Customers Improve Their Health and Wellness

Cerner Teams with Amazon to Help Consumers Improve Their Health and Wellness

Amazon Cloud Partnership is Driving Cerner’s Shift to become Digital Platform Company

Cerner Collaborates with Amazon Web Services on Cloud Innovation, Machine Learning

Airlines Are Partnering with Health Companies and Clinical Laboratories to Implement At-Home COVID-19 Testing Prior to Flights

Because air travel volumes are low, experts believe it is timely to develop COVID-19 testing systems and gain insight on which protocols are most effective

As the COVID-19 pandemic surges on, several international airlines now require customers to complete at-home COVID-19 testing before they can travel. This is triggering unusual business practices. For example, one airline allows its passengers to use frequent flier miles to purchase mail-in COVID-19 test kits.

Frequent Flyer Miles for COVID-19 Testing

Across the United States, Hawaii has one of the lowest rates of infection, partly thanks to the state’s strict quarantine regulations. In a state, however, that depends on tourism for its economic health, the pandemic has caused serious financial difficulties. In an effort to prevent spread of the coronavirus while also encouraging tourism, Hawaiian Airlines now offers “Pre-travel COVID-19 Test Options” on its website.

To be allowed to skip the state’s mandatory 14-day self-quarantine before arriving on the islands, flyers can take a pre-travel coronavirus test with the following conditions:

  • The test must be from a state-approved testing provider.
  • The test must be administered no more than 72 hours prior to the scheduled departure time of the final leg to Hawaii.
  • For trans-pacific travel, test results must be received prior to flight departure.

Additionally, the airline accepts frequent flyer miles to pay for mail-in COVID-19 tests. In exchange for 14,000 HawaiianMiles, a passenger receives a test kit in the mail. The kit features a video call during which a healthcare professional guides the consumer on taking a saliva sample. The user then ships the sample to a qualified clinical laboratory. Results are returned electronically within 24 hours of the lab receiving the sample.

Hawaii’s COVID-19 portal states, “The state of Hawaii will ONLY accept Nucleic Acid Amplification Test (NAAT) from a certified Clinical Laboratory Improvement Amendment (CLIA) lab test results from Trusted Testing and Travel Partners” that are participating in the state’s pre-travel testing program. Honolulu and Maui are the only two arrival airports allowed. A negative result must have come from a test performed within 72 hours prior to the final leg of the passenger’s trip to Hawaii, according to the portal.

“A negative pre-travel test is an alternative to two weeks in self-isolation for arrivals to the archipelago,” the UK’s Independent reported.

JetBlue and Vault Health Partner to Offer COVID Testing to Airline Passengers

In another instance of an airline getting involved in at-home testing, JetBlue (NASDAQ:JBLU) is partnering with Vault Health to offer at-home testing. The process is similar to the Hawaiian Airlines program. However, rather than purchasing the test with frequent flyer miles, JetBlue offers polymerase chain reaction (PCR) tests at a discount.

Business Travel News reported that passengers must provide a confirmation code while ordering the $119 test from Vault Health’s webpage. “Vault provides a kit for an at-home saliva test, and users administrate it while on a video chat supervised by Vault to ensure the test is done properly. The user sends it overnight to a clinical laboratory and the results are provided within 72 hours,” Business Travel News stated.

Joanna Geraghty of JetBlue
“We continue to hear from health officials that [COVID-19] testing is incredibly important in the fight against the coronavirus, and we want to make sure our customers have options for testing, especially prior to travel,” said Joanna Geraghty, President and Chief Operating Officer, JetBlue, in a press release. “As more and more regions reopen, many are requiring test results to enter. Now with easier testing options, those safety requirements may not be a deterrent for travel, but rather provide greater public health and peace of mind with little inconvenience.” (Photo copyright: Spectrum News NY1.)

In “Coronavirus Testing Before Flying Could Become the Norm as Airlines Try to Boost Confidence and Woo Travelers,” the Washington Post reported, “There is no common standard, so it has been left to airlines and airports to design their own SARS-CoV-2 testing programs and for travelers to sort out requirements for their particular destination.”

In addition to airlines such as Hawaii Airlines and JetBlue instituting programs for coronavirus testing, some airports are as well. Tampa International Airport, for example, test-piloted a voluntary testing program for all arriving and departing passengers from October 1st to October 31st. The airport partnered with BayCare, a 15-hospital Tampa area healthcare network, to provide both rapid antigen and PCR tests.

“Testing services will be offered on a walk-in basis … seven days a week from 8 a.m. until 2 p.m. The pilot will be open to all ticketed passengers who are flying or have flown within three days and can show proof of travel. The PCR COVID-19 test costs $125 and the antigen test costs $57,” a press release stated.

Tampa Airport CEO Joe Lopano told the Washington Post, “This could be—especially if adopted by other airports—another way to instill confidence.”

COVID-19 Testing by Retailers Expanding as Well

Travelers aren’t the only people who need testing. Some employers also are requiring negative tests before employees can return to work.

In “Costco Begins Selling an At-Home Self-Collection COVID-19 Test Kit; One of 12 Kits That Have Received FDA Emergency Use Authorization,” Dark Daily reported on retail giant Costco’s (NASDAQ:COST) response to increased demand for COVID-19 testing by offering direct-to-consumer, at-home test kits to its members. The kits sell at two price points: $129 for a “basic” kit, and $139 for a kit that includes “Video observation for travel.” The more expensive test is accepted by Hawaii for its Trusted Testing Partner Program.

As with all at-home kits, the consumer collects their own specimen and sends it off to a qualified clinical laboratory for processing. AZOVA, a telehealth company, supplies the kits to Costco for resale and provides a smartphone app where customers can check and display the test results.

P23 Labs’ TaqPath SARS-CoV-2 assay is the test being used, which, according to P23, “has a 98% sensitivity and 99% specificity,” Business Insider reported.

When COVID-19 Testing Fails

Of course, coronavirus testing isn’t 100% guaranteed. The Independent reported in November that a passenger on a Dubai to New Zealand flight who had tested negative prior to flying, was, in fact, positive for coronavirus and had infected seven other passengers during the flight. New Zealand’s Institute of Environmental Science and Research conducted and published a study following the incident, titled, “A Case Study of Extended In-Flight Transmission of SARS-Cov-2 En Route to Aotearoa New Zealand.”

The researchers found that “All seven SARS-CoV-2 genomes were genetically identical, with the exception of a single mutation in one case, and all genomes had five signature mutations seen in only six other genomes from the >155,000 genomes sequenced globally. Four of these six related genome sequences were from Switzerland, the country of origin of the suspected index case.”

They added, “By combining information on disease progression, travel dynamics, and genomic analysis, we conclude that at least four in-flight transmission events of SARS-CoV-2 likely took place.”

At-home test kits for COVID-19 are here to stay. That large businesses in multiple industries are now partnering with COVID-19 test developers and clinical laboratory companies to accomplish testing of customers and employees means independent labs that process coronavirus testing can look forward to increasing COVID-19 testing business.

“We need to be using the time now, when [travel] volumes are relatively low, to test the systems and gain insight on which protocols are most effective,” Mara Aspinall, biomedical diagnostics professor at Arizona State University, President and CEO of the Health Catalysts Group, an investment and advisory firm, and former President/CEO of Ventana Medical Systems (now Roche Tissue Diagnostics), a billion-dollar division of Swiss pharmaceutical and diagnostics manufacturer Roche, told the Washington Post.

—Dava Stewart

Related Information:

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A Case Study of Extended In-Flight Transmission of SARS-Cov-2 En Route to Aotearoa New Zealand

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