As of August 14th, with the global reported case for coronavirus exceeding 21 million, airlines and airports have implemented multiple measures to mitigate the probability of getting the virus while traveling. Some of the initiatives include adding contactless & touchless solutions, increasing the level of sanitation, changing cleaning procedures, enhancing social distancing or adding temperature checkpoints. Now, some airports have added COVID-19 testing facilities. Let’s find out more about that.

COVID-19 testing at airports is becoming more critical, as travelers want to bypass mandatory quarantine at their destinations. Testing could be a useful layer of protection for travelers from countries considered as high risk. Moreover, airlines want to minimize the risk of COVID-positive passengers traveling, to avoid becoming a source of contagion and losing their customers’ trust. 

There are many unknowns considering who should be the right stakeholder to impose COVID-19 tests. Airlines, airports, public organizations, and governments should all play a role in this decision. South Korea, Hong Kong SAR, Luxemburg, and Iceland are some examples of regions that have introduced testing into their state requirements for travelers. 

An Introduction to COVID-19 Testing  

You’ve probably heard a lot about COVID-19 testing recently. Tests are used to find out whether someone is currently infected or has been infected in the past. 

As stated by the FDA, There are two different types of tests -  diagnostic tests and antibody tests. 

• Diagnostic tests, also known as Viral tests, are used to check if you have an active coronavirus infection. Currently, there are two types of a diagnostic test which detect the virus - molecular test (PCR) and antigen test. 
• Antibody tests check your blood by looking for antibodies, which may tell you if you had a past infection with the virus that caused COVID-19. 

Polymerase chain reaction (PCR), and antibody testing are the dominant ways that global healthcare systems are testing citizens for the virus.

• PCR-based (molecular) test requires a swab from the patient to be sent to a lab. With the PCR test, a sterile swab is inserted into your nose to take a sample. This test is also called a nasal swab test.
• An antibody serology (blood) test looks for markers in the blood that suggest you may have had the virus. Serology tests are not meant to diagnose active coronavirus infections. Instead, they check for proteins in the immune system, known as antibodies, through a blood sample. 

The Airports & Airlines That Have Adopted Testing Facilities

IATA has outlined several criteria that a COVID-19 test should meet to be considered as effective: 

• Speed: Results should be delivered quickly. Ideally, under one hour.
• Scale: Testing capacity should be sufficient to prevent bottlenecks from occurring in spaces where there are large volumes of interactions between travelers, crew, employees, and others. The testing capacity of several hundreds of tests per hour must be achievable. 
• Accuracy: It is essential to be as accurate and precise as possible. Both false-negative and false-positive results must be below one percent.
• Cost: Where the test is a mandatory requirement, no charge should be applied to airlines and passengers. Where the test is offered voluntarily, it should be charged at cost price. 

As of August 10th, more than 15 airports & airlines have adopted testing facilities within their locations. Below are some examples:

• Frankfurt Airport & Lufthansaare working with Centogene, a genetic diagnosis company, to produce COVID-19 testing. Centogene does say it can process up to 5,000 tests a day and has set up a mobile test truck on the airport grounds. The cost is €139 for the express test, and €59 for the standard test and the results can take between three to eight hours. 
• AirCanada has partnered with Spartan Bioscience, a biotech company investigating how our rapid, sample-to-result DNA testing platform can be used to detect the COVID-19 virus in under an hour. Air Canada says that Spartan is developing a proprietary swab to collect DNA samples for its COVID-19 test. Spartan's test cartridge (reagents) and the Spartan Cube (portable DNA analyzer device) remain subject to Health Canada approval. 
• Munich Airportis working with Medicare, a subsidiary of Flughafen München GmbH, which offers COVID-19 tests at the airport's medical center. The PCR test is performed as a throat swab. Passengers at Munich Airport have the opportunity to be tested for possible infection with the coronavirus SARS-CoV-2. Read more here.
• Sheremetyevo International Airportis currently doing pilot testing with Evotech-Mirai Genomics (EMG), a developer of genetic testing systems for the detection of COVID-19. The portable testing system, which fits in two small suitcases, is already used at production sites by some Russian companies. The company is currently doing pilots in an airport in Japan, Moscow, and the United Arab Emirates. 
• Istanbul Airport is offering its passengers a PCR test before departure and after arrival. This COVID-19 testing at the airport costs $16, and the results are available in a time frame of two hours. In terms of capacity, the airport can perform up to 40,000 daily tests. 
• Dubai Airport became the first airport to deploy police dogs to sniff and detect coronavirus. A scent sample is collected from the passenger from the armpit, which is presented to the canine in an isolated room. The specially-trained sniffer dogs generally detect the virus within seconds. Data shows that dogs are capable of detecting the infection with 92 percent accuracy. Check out this video and see how it works: 

• Vienna International Airport offers passengers the possibility to undergo molecular-biological COVID-19 testing (PCR test) at the airport. The test findings are available within a period of about three to six hours. The cost of the test is €120.

New Technologies for COVID-19 testing 

New technologies for rapid testing are being developed, in order to make COVID-19 testing more efficient. These technologies are advancing rapidly and have generated a lot of attention from multiple stakeholders. 

Below are some of the most innovative testing solutions that could replace existing and more burdensome processes and procedures. It is important to mention that the majority of the solutions are still in R&D.

Saliva Rapid Test 

Shiongi - Under R&D

Japanese drugmaker Shionogi will collaborate with universities (Nihon University and Tokyo Medical University) to put into use a new testing method. The original method, called Signal Amplification by Ternary Initiation Complexes (SATIC), can detect the virus from saliva samples in around 30 minutes without the help of specialized equipment and staff. 

In the method, saliva samples are heated to 95 degrees for roughly two minutes and added to a reagent. Samples containing the virus will change color, making it possible to check the results without using a detector device. 

Breath Tests

Breathalyzer - Under R&D

Israel 1-min "breathalyzers." The test was designed by a team from the Ben-Gurion University of the Negev (Israel) and had a success rate of more than 90 percent in trials to-date. Professor Gabby Sarusi leads the team. 

How does it work?

1. The hand-held device contains a chip with densely packed sensors to capture tiny particles from the breath, including viruses.
2. The chip is then read through THz spectroscopy, which takes about 20 seconds. 
3. The system then analyzes the biological sample and provides an accurate positive/negative result within a minute via a cloud-connected system. It can tell if someone is carrying the virus, even though they may be complete without symptoms.
4. The point-of-care device automatically backs up the results into a database that authorities can share, making it easier than ever tracking the course of the virus and triaging and treating patients.

Find out more in this video: 

Scantech Medical - Under R&D

Scantech Medical started the early stages of a trial for its so-called breath technology, together with the Meir Medical Center in Israel. Scantech has created RST, a highly accurate, scalable, and cost-effective Point of Care test.

Their technology detects the presence of unique metabolic processes that are associated with pathogens. Each pathogen has a different genetic expression, which creates a single metabolic fingerprint that enables the Scentech device, the Rapid Scent Test (RST), to identify various pathogens, even in the early stages of infection where patients may be asymptomatic. 

Smelling Test

NanoScent - Under R&D

Nanoscent has developed a testing kit, which utilizes a nanoscale, sensor-based smelling system, designed to detect the pathogen at its early stages, and has proven to have a 90% success rate in identifying COVID-19 carriers under 30 seconds. The company developed the test with the help of the Israeli Innovation Authority and the Health Ministry. 

NanoScent's sensors combine digital technology with nanoscale materials, called chemiresistors, which change their electrical resistance in response to chemicals in the environment. If successful, the sensor will rapidly detect viral infections from breath exhaled through the nose.

According to the company, the test is not meant to replace the swab-based virus diagnosis, but rather to give an initial indication of infection. If the breathalyzer result is positive, people should automatically be sent for a lab test.

Koniku - Under R&D

Koniku merges biological neurons with silicon technology complete with odor sensing, classification, and real biological learning. The company has been working with the Airbus Group to develop a technology capable of sniffing explosives in the air without the need to touch or search passengers. As far as COVID-19 detection is concerned, Koniku is working on a quick, non-invasive, breath-oriented test. Their technology has the ability to detect the smell related to Stinkbugs. The same technology applies to determine if someone is infected with Coronavirus within 10 to 20 seconds. 

Startups Developing COVID-19 Testing Solutions

SpendEdge, a procurement intelligence advisory firm, created a list of the top 100 COVID-19 test kit manufacturers across regions, including North America, EMEA, and APAC.

The National Institutes of Health (NIH)  is investing $248.7 million in seven companies to scale up COVID-19 testing. The funding is part of NIH’s Rapid Acceleration of Diagnostics (RADx) initiative. 

The range of new lab-based and point-of-care tests that the seven companies offer could significantly increase the number, type and availability of tests by millions per week as early as September 2020. 

The following startups have developed innovative ways to test COVID-19 and have been grouped into two different groups: Under R&D and Deployable/Certified. 

Under R&D

This section includes solutions that are still in trials and have not yet been officially approved.

• XCR Diagnosticsis focused on delivering hyper-accurate molecular diagnostics testing near the point of care in order to improve time-to-results for patients and reduce healthcare costs. The startup has developed “Pyramid,” a portable testing system that examines a large number of pathogens, such as influenza, enteroviruses, and coronaviruses. In response to the global coronavirus pandemic, they are developing a diagnostic test for COVID-19.
• One Milo is disrupting medical diagnostics by enabling lab tests to be performed anytime and anywhere for the first time. Its hand-held rapid-result IV Diagnostic devices paired with its smart test strips using microfluid samples of blood, urine, or saliva. One Milo released the InstantRapid test, which is intended for use as an aid in identifying patients with an adaptive immune response. With the COVID testing kit, they were the most accurate one according to the FDA, having an accuracy of 98.1% 
• Mammoth Biosciences aims to eventually allow people to test themselves for COVID-19 at home, as with over-the-counter pregnancy and strep tests. They are working on decentralizing their 30-minute testing for mass screening at airports and screening at home. The new test is a color-changing test strip that uses CRISPR to detect viral RNA. 
• Sherlock Biosciences and Binx Health announced a strategic partnership to develop the world's first rapid, point-of-care diagnostic test for COVID-19 leveraging CRISPR technology. The organizations will combine the Binx io diagnostic platform with SHERLOCK technology to create a robust and simple test. Sherlock has received Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA) for its Sherlock™ CRISPR SARS-CoV-2 kit for the detection of the virus that causes COVID-19, providing results in approximately one hour. This is the first FDA-Authorized Use of CRISPR Technology for COVID-19 testing. 

Deployable/Certified

This section includes solutions that have been approved by a health regulator. 

• BioMedomics focuses on building fast and easy-to-use testing kits for various diseases at a patient's point of care. They recently developed a quick immunoassay diagnostic test for COVID-19 in two ways: antibody and PCR (polymerase chain reaction) testing. 
• LetsGetChecked is an at-home testing startup that just raised $71 million for its Series C. Their COVID-19 tests include an antibody serology test, which produces results within 15 minutes, and a PCR-based test, which requires a swab from the patient to be sent to a lab. FDA authorized the first at-home collection molecular test by LabCorp, which opens more possibilities for other startups in this space. 
• Genomtec develops the first truly mobile technology based on the gold standards of molecular diagnostics. Genomtec has developed a professional coronavirus test, which gives a positive result in just 8 minutes. The device works independently, and automatically, it is enough to apply a drop of biological material to the reaction card and then places it in the analyzer. These are genetic tests that run at a constant temperature, unlike the PCR tests used by laboratories. Therefore, it is possible to obtain a result so quickly, which is not available for PCR tests. Their technology combines optical heating and detection with microfluidics and reagents stable at room temperature.  

Conclusion

According to The New York Times, there are more than 165 vaccines in development, and 29 are in human trials. Despite these efforts, there are still many questions concerning mass distribution.  

As cities begin to reopen, efficient testing for COVID-19 is needed to help control and identify people who may be asymptomatic and could be spreading the virus without knowing so. More and more destinations will start demanding COVID-19 testing as an entry requirement as an alternative for a 14-day self-quarantine measure. 

In terms of testing initiatives, we will see an increase in new technologies that will be able to speed up the availability of COVID-19 testing which will be crucial in the context of the current situation. 

Article published August 14th, 2020

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