Empowering academic labs and scientists to test for COVID-19

The lack of widespread COVID-19 testing and the prevalence of asymptomatic infections have been major factors in the current pandemic. Despite the improvements in clinical testing, as we move toward reopening USA, widespread surveillance testing becomes critical. Academic (nonmedical) labs can help provide such testing;the CDC-approved guidelines for COVID-19 testing require routine equipment and protocols that are commonly used in academic research labs around the country. Faculty at the authors institution were successfully able to test asymptomatic students for COVID-19. By empowering nonmedical academic scientists with preexisting knowledge, expertise with the protocols, and access to the instruments, an additional 1.23.5 million COVID-19 tests could be processed each day at local universities and academic labs.

make a meaningful difference to the testing gap? Our research team explored the feasibility of using the expertise of PhD and MS level faculty to run the qRT-PCR CDC protocol with the currently existing infrastructure at our university. Our team used the CDC-recommended protocol and reagents to develop a robust sampling plan for students at our university. Including the initial swabbing, the RNA extraction, qRT-PCR setup and the 75-min qRT-PCR cycling parameters, the entire protocol took under 4 h. Our sampling and protocol process had the capacity to run up to 22 samples every 90 min, the rate-limiting step being that our lab is equipped with only a single qRT-PCR thermocycler.
Due to processing restrictions based on the availability of the thermocycler, we sought to determine how common these instruments are and whether there are enough to provide a valuable resource in testing efficiency. To determine abundance of these machines, the test team used market research and conservative estimates ( Table 1). The data showed a growing demand among research institutions for qRT-PCR. Market estimates show that between 9975 and 23,460 qRT-PCR or digital thermocyclers are present in research facilities in USA. Using our protocol time of 22 samples every 90 min, running for 8-10 h a day, there would be the capacity for 1.2-3.5 million tests per day. Our department was able to run these tests for roughly $8.00 per sample, not including labor costs or the equipment itself. This cost fluctuates based on protocol, with some assays costing up to $28 a sample. Despite a current opinion that there is a shortage of kits, the real shortage is the capacity of medical diagnostic labs to run the samples. Most academic labs have most of the reagents necessary to run the qRT-PCR tests. As of May 2020, Integrated DNA Technologies, the company that makes the primers and probes, has enough kits to enable approximately 33 million tests and is able to keep up with shipping out orders for SARS-CoV-2 primers and probes. By allowing academic labs to test for COVID-19, the burden of testing could be shared across universities in every state, and widespread surveillance testing could significantly increase.
Based on the institutions listed with the Department of Education (Figure 1), there are currently over 1500 colleges and universities that are 4-year institutions with a program for biological and biomedical sciences. According to Higher Learning Commission accreditation guidelines for faculty members, instructors must have academic degrees relevant to what they are teaching at one level above what they teach, or a terminal degree in that field [10]. This means the individuals teaching classes at these institutions all possess at least a Master's degree in their field. These highly trained academic scientists in schools across the country could efficiently run COVID-19 tests using protocols and equipment they are already teaching undergraduate students to use.
The current barriers to using nonmedical labs for COVID-19 testing is that agencies may not treat the results as reliable because there is no Clinical Laboratory Improvement Amendments (CLIA) certification. Medical diagnostic labs must maintain CLIA certification in order to process human samples and provide medical results, whereas academic labs generally do not have this certification for their research-only endeavors. Possible ways around this problem include performing research-only studies relying on highly trained personnel and proper controls, or conducting public health surveillance studies, which are exempt under the Institutional Review Board (IRB) regulations; or CLIA certification can be acquired in connection with, and as an extension of, a previously CLIA-certified medical lab. The authors have tried both methods. Initially the COVID-19 testing was IRB-approved for research purposes only and any positive COVID-19 results were subsequently sent to the medical provider for further testing. This did not require CLIA certification and did help screen a majority of presymptomatic or subsymptomatic individuals, but unfortunately any positive results required redundant testing and close collaboration with a medical provider and lab. In order to actually report medically approved and CLIA-certified diagnostic test results, the lab must be CLIA certified. This process requires extensive paperwork, record keeping, training logs and certified equipment; however, it is feasible, especially if seeking CLIA certification as an extension of an existing CLIA-certified lab. Another potential barrier for COVID-19 testing in an academic setting is the availability of appropriate personnel to run the tests. Despite qRT-PCR's relatively easy experimental setup, it does require trained and qualified personnel to run the assays, which would pull these scientific experts away from other productive projects. At the authors' institution, a rotation has been developed in order to help provide routine COVID-19 testing for students and staff while having minimal impact on other teaching and research requirements.
As we move to reopen our economy and brace for the next wave of this pandemic -or perhaps another pandemic altogether -we desperately need to plan for more widespread testing. We need to empower and call upon academic scientists to perform these tests. Academic and research centers have the equipment and expertise to run over 1 million COVID-19 tests per day, and this resource cannot be ignored. Nonmedical laboratories possess the competence and capacity to aid with the massive-scale testing needed to emerge from a COVID-19 lockdown. Instead of underutilizing this resource, we should harness their exceptional knowledge and scientific power to help us overcome this pandemic.

Author contributions
J Steel, J Rohrer and E Almand: conceptualization, methodology, investigation, project administration and writing. J Sitko: data curation, visualization, conceptualization, investigation and methodology. M Adkins: investigation and resources. S Hasstedt: project administration.