New York: As the pandemic engulfed the world in March 2020, no one was thinking much about getting a manicure. So XpresSpa Group Inc., an airport chain that offers mani-pedis and massages to travelers, closed all 50 of its locations. To survive the next two years, it would have to pivot. It turned to the most obvious next market: Covid testing.
Through a partnership with the Centers for Disease Control and Prevention and synthetic biology firm Ginkgo Bioworks Inc., XpresSpa launched a surveillance operation to hunt for new and emerging Covid variants among international travelers. Over the last eight months, the trio has tested tens of thousands of passengers arriving from more than 15 countries around the globe. Despite rules that require travelers to produce a negative Covid result in order to enter the US, the collaboration routinely finds both positive cases and new mutations.
In a world in which the virus knows no borders, Ezra Ernst, the chief executive officer of the spa’s testing business, XpresCheck, calls this “a form of border protection.”
The program has become a rare example of government and private industry working together productively during the pandemic, so much so that the project has expanded and is being discussed as a way to monitor different biological threats in the future.
Global travel has made Covid all but impossible to contain. Some of the earliest cases in the US and Europe can be traced back to passengers who brought the virus via airplane from China. New mutations have repeatedly cropped up since then, racing around the globe within weeks, if not days. Realizing that shutting down borders wasn’t going to stop Covid, many countries have focused on real-time surveillance like this to prepare for the inevitable.
For much of the pandemic, the US was woefully behind in mutation hunting. Countries such as Israel, UK and Japan had already been sequencing viral genomes in travel hubs. More recently, the Biden administration signaled plans to invest in these efforts, granting the CDC $1.75 billion from the American Rescue Plan to expand genomic sequencing capabilities now and in coming years.
The CDC-funded airport surveillance project differs from other countries’ in that it relies on the voluntary participation of travelers. XpresCheck’s airport staff offer free Covid tests to international passengers at baggage claim and in taxi lines in New York City, New Jersey, San Francisco and Atlanta. Those who opt in take a PCR test on the spot and receive an at-home kit to test again a few days later.
Swabs are sent to Boston-based Ginkgo’s network of more than 60 labs, which pool as many as 25 samples together for testing. In the first week of January, amid a holiday surge in travel and cases, 46% of those pooled tests turned out to be positive. During a week in April, 15% of the pools were positive. Through positive viral genomes, the program has so far identified the entry of several omicron subvariants into the US.
“If you ask me if we are ready for the next pandemic, my answer is no, we are not,” said Renee Wegrzyn, who heads innovation at Concentric by Ginkgo, the company’s biosecurity business. “But we’ve gotten better at this pandemic.”
The project was set in motion more than year ago when Ernst reached out to government officials about using the airport testing business as part of the government’s pandemic response. The timing was fortuitous: the CDC happened to already be looking for ways to improve its virus detection systems. Most of the mutation-hunting work in the first year of the pandemic had been done via a patchwork of efforts at universities and hospitals rather than through a federally-coordinated (or funded) network of labs.
The CDC signed off on a $2 million, 8-week proof-of-concept program last August in which XpresCheck would partner with Ginkgo at three US airports where they would focus on seven regular flights arriving from India, where delta had spurred a surge. Then came omicron. The CDC greenlit an expansion of the program in November to quickly identify the new variant. Two samples taken at Newark airport within days of the project’s expansion unearthed the first US case of subvariant BA.2 and the first North American case of BA.3 – 43 days before it was reported elsewhere in the continent.
“Everyone was looking for omicron and we were positioned to do it,” said Cindy Friedman, chief of the CDC’s Travelers’ Health Branch. “The system worked, full stop.”
The CDC sees the program as critical to the future of US biosurveillance. Identifying a new variant or subvariant can help inform prevention measures and develop better-performing treatments, Friedman said. And so the health agency more than doubled its investment to $5.6 million in January. The companies are expanding into more US airports and piloting new projects, like removing “blue juice”—a friendly term for toilet water—off of airplanes in their hunt for Covid mutations and perhaps eventually other viral diseases like monkeypox.
Many countries are starting to shut down such projects. Israel, which had previously sent positive Covid samples obtained at airports to be sequenced, lifted its testing requirements in May. Friedman said she sees the US collaboration all the more important as other nations roll back sequencing efforts. “I don’t see this airport surveillance project going away anytime soon,” she said.
XpresCheck and Ginkgo are also in active discussions with other countries to expand the service abroad. As the crisis phase of the pandemic has faded, companies boosted by it have struggled to keep their share prices high. Since the partners announced they’d identified BA.3 on December 13, Ginkgo’s shares are down about 65%, while XpresSpa’s have fallen about 57%. Growing their surveillance services, they hope, will provide a boost.
Beyond the business potential, Taj Azarian, a genomic epidemiologist at the University of Central Florida, sees airport monitoring as a critical long-term public health tool. “This approach would have been valuable in the past with other diseases,” he said, pointing to cross-border spread of Zika and tuberculosis. The end goal, according to Azarian, would be to broaden airport surveillance capabilities so that countries can detect other pathogens and never-before-seen threats.
The CDC, XpresCheck and Ginkgo share that vision. Ginkgo is already developing new sequencing panels that can simultaneously evaluate a sample against multiple pathogens, such as the flu and measles.
“I know people are fatigued and want to move on,” Ernst said, “but we have to convince people to continue to pay attention to prevent it from happening again.”- Bloomberg
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