Big News! The Rapid Screen Pilots have arrived

How a group of companies intend to work out the details of ongoing screening

Welcome to Plugging the Gap (my email newsletter about Covid-19 and its economics). In case you don’t know me, I’m an economist and professor at the University of Toronto. I have written lots of books including, most recently, on Covid-19. You can follow me on Twitter (@joshgans) or subscribe to this email newsletter here.

Big News! Today I am very pleased to be able to reveal to the world something that I have been very proud to have been working on with a hundred or so other people: The CDL Rapid Screening Consortium. Led by our Creative Destruction Lab, this consortium is a group of 12 companies who are partnering with Health Canada to begin the roll-out of rapid antigen screens to be a part of daily life for the next 12-18 months and deliver a safer path to normality. We have been working since September intensively to put the consortium together, explore screening options that were available globally and come up with protocols and an evolving standard operating procedure (SOP) to bring rapid antigen screens at scale to economies all around the world. The goal is to solve the pandemic information gap and ensure that we can quickly identify and isolate infectious people and protect others.

What will be happening

Before getting to the story behind all of this, let me describe what will be happening. We are now in Phase 3 of the RSC plan which is to make screens a daily part of life in 18 sites across Canada. The idea will be that workers and visitors to those sites will be screened frequently (1 - 2 times per week) with rapid antigen tests. Should they be negative, then it will be a normal day. Should they screen positive, they will move into the public health system for testing and other actions. Frequency is key here. By frequent testing, we can minimise the exposure of everyone to infectious people.

Prior to this point, in Phase 1 which happened in August-September did a world-wide search for rapid antigen and other screens along with an initial set of companies. Phase 2 then moved to writing protocols, doing extensive costing, and negotiating with potential suppliers and beginning the partnership with Health Canada.

The initial sites will be run by RSC members. Those members are Air Canada, Rogers, Loblaws, Shoppers Drug Mart, Magna, Nutrien, Suncor, Genpact, Scotiabank, MDA, CPPIB and MLSE.

Who is paying for this? The RSC members are. They have each committed to expenditures that, in ordinary times, would be extraordinary but, in extraordinary times, are ordinary to run each of these pilots and share the data with the consortium and government. The goal of the pilots is not to test the screens themselves (that has been done clinically) but, instead, to measure and innovate on operational effectiveness, efficiency and impact. In other words, this is a “how to do it” endeavour.

Why do we need this?

As I have written about previously, there is a difference between doing something and doing something at scale. For pandemic management, scale is critical. Having seen what has gone into this thusfar, the challenges have been eye-opening and multi-faceted. The lift is very heavy and that just gets us to the stage of being able to run pilots. The goal of those pilots is to substantially lighten the lift for anyone who wants to run rapid screens at scale to manage the pandemic.

To be sure, there have been pilots already run. The most significant have been those operating at a regional or country level. They have been military-style operations that have tested millions of people in a short period of time. And they have been successful in suppressing outbreaks. But, they are fleeting. Take Slovakia whom I wrote about a little while back. They tested their entire population over the course of a month and cut the outbreak down by over one half. This was a significant health mitigation (here is an analysis). But just a few weeks later, look at what is happening.

Our philosophy is different. Rather than big pushes, we are creating operations that will allow for regular and normalised ongoing screening. That means that we have to take into account convenience and compliance and keep vigilant in our monitoring of all of this. That is a set of criteria that can be mostly ignored for big push interventions. The idea here is to aim for as normal a life as possible until the risk of outbreaks is down to levels experienced in East Asia and Australasia. That may come from the vaccine but it is also possible that if our screening plan works, Covid-19 prevalence will fall off.

Thus, our model is the Universities in the US such as Illinois and Boston University that have used testing to keep their campuses open. They are contained places but they have developed ways of integrating these procedures into normal life. And they have been very successful in sustaining a safe environment.

How the getting to scale plan will work is that we will start with our 12 larger companies who have put up their own money to get screening in place and worked out. At the same time, we will also run pilots in small businesses and some selected schools. The corporates represent 350,000 employees in Canada alone so that itself is very significant. The hope is to expand the pilots over the first three months to include hundreds of small and medium-size enterprises

The initial screens for the pilots themselves will come from Health Canada. But how to expand and maintain supply will be one of our tasks going forward.

How did this come about?

Now that is a story. When the pandemic hit, many people were not sure what to do. But at the Creative Destruction Lab we interact with all manner of entrepreneurial types whose type is to spring into action when crisis hits. They did so, initially, by trying to solve the ventilator shortage problem. We realised there was energy and so wondered if we could do our thing and use startups to focus on the problems we were facing. Our CDL Recovery program was born.

During this time, I was writing my book — the academic equivalent of springing into action — and my ideas evolved into a chapter called “The Testing Economy.” Put simply, I came to the conclusion that there were two problems in a pandemic. A health problem that everyone was focussed on and an information problem that no one was really looking to solve. The information problem was to find infectious people and isolate them. In my chapter, I went all science fictiony on this issue and imagined routine information gathering as a part of life that would get us quickly back to normal. At the same time, others, notably Paul Romer, had proposed audacious (at the time) solutions to the information problem based on scaling up current testing capabilities (the PCR tests that to this day still comprise most testing). While his proposal made sense, what I had envisaged was a set of information devices that were much cheaper and could be made abundant. Antigen tests seemed to be the key and some real experts such as Michael Mina were pushing them too. We also saw startups with these ideas in our program.

But startup innovation is hard. It is lean but scaling takes time. Ajay Agrawal, who founded CDL, saw this and put together a group of CEOs from around the world alongside others from academia, government and elsewhere (you know, writers like Margaret Atwood) to meet and discuss the issues they were facing. The idea was to inform the direction we should be pushing the startups in. During that process, it became clear to Ajay that the information problem was real and solvable. Business leaders and others understood it quickly. Margaret Atwood gave an inspirational speech calling for audiciousness. From that moment, CDL started putting the consortium together. The idea was to make “the testing economy” a reality.

The challenges

This was easier said than done and my own expectation had been to continue to focus on the saying rather than the doing. But like a hundred or so others, I got sucked into the doing and have spent the majority of my time on this for the past three months. Everyone else has done orders of magnitude more.

The biggest challenge was pulling these companies together and making sure everyone could work together. In hindsight, this was a crazy thing to do even though it worked out. We had an airline whose business had been devastated. We had an auto-parts maker that needed to keep its supply chains intact. We had an entertainment group with demand but challenges in getting supply. And we had a telco company whose employees were all over the place. None of these people had ever seriously worked together let alone at the C-Suite level. We needed each of them to bring their A-game to the table. And much to our joy, they did. To watch this group of people work together, who have never met each other in person, leave their badges at the door and get this done has been amazing. It was impressive and I was impressed. At the same time, the CDL leadership (particularly Sonia Sennik) has taken its military-style organisational skills and kept everyone pointed in the right direction. What they had to do is hard to describe but when our final SOP output is done you will all get to see the tip of what is a very large iceberg.

For my part, I have been working at a higher level of all of this. You have seen some of what I have had to think about reflected in the newsletters over the past few months. But I have had the pleasure of being able to collaborate with people outside of Rotman including Janice Stein of the Munk School and Laura Rosella of the Dalla Lana School of Public Health and now a set of retired military leaders to design this whole thing and interface with health authorities. It is often tough to work with people from other disciplines in a university. CDL had already opened me up to set of them in engineering and applied sciences. The RSC has opened me up to my nearest neighbours and allowed me to see skills and ways of thinking that I had not been previously exposed to. I have a new appreciation of what they all can do and it is very inspirational.

We ain’t done yet

In fact, despite all of this work, it has all been behind the scenes. We have just got to the starting line and the only reason I am telling you all about this is that it is going to be public and so it is important everyone understands what is going on. But the pilots themselves will involve challenges and we will have to innovate. Meanwhile, the pandemic rages on. In other words, we are all working on something that we sincerely hope will be needed much much less. That requires focus and dedication which is hard to come by. But doing this is the insurance policy we need.

Aside from the health consequences, every day the pandemic goes on and prevents us from a normal economic and social life is costing is both monetarily and otherwise. Reducing that pain by a day is worth the cost of admission to this type of endeavour. And what I want to see is that the ‘days saved from abnormality’ standard be moved as widely as possible worldwide. Canada is doing the work on how to do it. Hopefully, this will increase the chances that everyone will be able to do it.

What did I miss?