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How Utah’s Tech Industry Tried to Disrupt Coronavirus TestingAt a White House briefing, on April 23rd, Mike Pence offered what he describedas “encouraging news” about COVID-19 testing. Commercial labs, he said, wereprocessing a hundred thousand tests per day, and a number of states haddeveloped “methods that they are employing to significantly increase testing.”One of the specific efforts that Pence identified was Test Iowa, a public-private partnership that the Vice-President said would “triple testingcapacity” in the state. In the course of introducing the initiative, Pencementioned two of the companies behind the project: Nomi Health, a health-carestartup, and Domo, a cloud-software firm. Josh James, the founder of Domo, wasecstatic. “You’ve got to be kidding me!!” he wrote on Twitter. “So stoked thatall of my team’s work and all their all-nighters are paying off.”Test Iowa was, in fact, the second statewide testing initiative launched by agroup of Utah tech companies that included Nomi, Domo, and Qualtrics, an“experience management” firm. The project had originated, six weeks earlier,in their home state, as a philanthropic effort to respond to the COVID-19pandemic. Since then, it had transformed into a multistate commercialenterprise. The tech executives had procured thousands of COVID-19 tests froma local company, arranged for the deployment of mobile testing sites, hired asmall army of nurses to collect specimens, partnered with a laboratory neartheir companies’ headquarters, and signed a two-month contract with the stateof Utah to provide three thousand tests per day. Their contract also includedthe development of an online-assessment tool, an algorithm to determine whowould get a test, and a data-tracking crisis command center.Mark Newman, the thirty-seven-year-old founder of Nomi and one of the majordrivers of the initiative, admitted openly that “none of us knew anythingabout lab testing” at the start of the effort. But Newman was neverthelessconfident that a combination of creativity, willpower, and ingenuity hadallowed him and a handful of other tech executives, in just a few weeks, toupend the established diagnostic-testing industry. It was, Newman said, “theexact same story of Clayton Christensen and disruptive innovation.” Having“put together a low-cost alternative that the incumbent providers just laughat,” he and his colleagues were “going to take over testing capacity, and bethe thing that’s there to solve this problem.” In addition to Utah and Iowa,which had purchased half a million tests, the group eventually signedagreements with state governments in Nebraska and Tennessee. Together, thefour contracts were worth more than eighty million dollars.Despite these apparent successes, significant questions about the program’sperformance began to appear in public shortly after Pence’s press briefing. OnApril 24th, a columnist for The Gazette, in Cedar Rapids, noted that TestUtahhad conducted fewer than thirteen thousand tests during the first three weeksof the month, about a quarter of what it had agreed to provide the state. Aweek later, the Salt Lake Tribune published an investigation into the qualityof TestUtah’s COVID-19 tests. Citing internal e-mails from a testing taskforce that had been organized by the Utah Department of Health, the Tribunereported that the initiative’s results showed a lower proportion of positivetests than at other labs in the state.TestUtah, some members of the task force feared, might be missing asignificant number of people who were sick with COVID-19. “We have beenwatching TestUtah’s positivity rate closely and have had multiple discussionswith them about different practices that may be impacting their testingresults,” one state official wrote to his peers on the task force. Anothermember of the task force, Bert Lopansri, an infectious-disease doctor at ahospital chain called Intermountain Healthcare, was more direct. “This is apotential public health disaster that will be compounded by the fact that theyare constantly promoting themselves publicly,” Lopansri wrote. “What alarms methe most is that they are expanding collection and testing with these unknownsabout how their test performs.” A pandemic, he said, “is not the time foramateurs to learn.”The effort that would become TestUtah began in earnest on March 18th. On aZoom-enabled virtual “town hall,” Newman proposed a plan that included as manyas a hundred thousand tests “bought up front for the good of the community.”To achieve this, Newman said, Silicon Slopes, a nonprofit that promotes Utah’stech industry, was asking for five million dollars in donations “so that wecan increase the volume of tests, access to care, and community support.” Thetests themselves would come from Co-Diagnostics, a small, publicly tradedcompany based in Salt Lake City. Before the pandemic, Co-Diagnostics had soldtests for use in agriculture and mosquito abatement in the United States andclinical diagnostic tests abroad; its 2019 annual report said that the companydid not “anticipate offering our tests in the United States in the nearfuture.” But the dire shortage of COVID-19 tests in the U.S. had caused theF.D.A. to relax its policies for the distribution of new diagnostic tests,which meant that, for the first time, Co-Diagnostics would be able to selltests for clinical use in the United States.At the start of the pandemic, Utah had been, in many ways, better equippedthan other states to deal with the testing crisis. Besides its public-healthlaboratory and a large lab operated by Intermountain Healthcare, it was hometo ARUP, one of the country’s largest reference laboratories. During a Zoommeeting, on March 26th, Angela Dunn, the Utah state epidemiologist, said thatthe state had more than twice the capacity necessary to test everyone withCOVID-19 symptoms. Newman, however, disagreed. “I’ll be completely blunt, andI guess I’m sharing more from the perspective of the business community,” hesaid. “I think the posture of, ‘We have tests and there’s no demand for them’is complete B.S.”Senior members of Utah’s state government felt similarly. “From very early on,the governor’s office had come forward and said that, in order to effectivelycrush the curve, we needed to be testing up to seven thousand people a day,”Robyn Atkinson-Dunn, who was, until recently, the director of Utah’s public-health laboratory, told me. “Because it was felt that the laboratory communitywasn’t doing enough, the governor’s office put out this call to say, ‘Hey,whoever thinks they can solve this problem, come talk to us.’ And that’s whenthe Silicon Slopes guys came along.”Over the course of two weeks, the tech executives developed what was intendedto be a comprehensive statewide testing infrastructure. At the program’sofficial launch, on April 2nd, Utah’s governor, Gary Herbert, called TestUtah“a first-of-its-kind public-private partnership.” The lieutenant governor,Spencer Cox, whom Herbert had asked to chair the state’s coronavirus taskforce, and who is a candidate to replace Herbert in this fall’s gubernatorialelection, called the program “a game changer.” Two days later, the actorAshton Kutcher retweeted a post about the program and added, “seems to me weshould roll this out state by state.” Newman, for his part, estimated thatTestUtah would soon be able to process three to five thousand tests per day,and boasted that it was “going to be the hub of absolutely kicking butt acrossthe country.”Within Utah, however, concerns about the initiative arose almost immediately.One question was why TestUtah’s online assessment asked users whether theywere allergic to hydroxychloroquine, a malaria and lupus drug that raisedhopes, early on, of a possible treatment for COVID-19, and whose effects, inthe absence of much evidence, President Trump had praised as “like a miracle.”From the beginning, Newman had envisioned treatment as a central pillar ofTestUtah’s efforts, along with assessment and testing. In an e-mail he’d sentto his peers in Utah’s tech industry, in March, which was first obtained bythe Salt Lake Tribune, Newman said that he was negotiating access to twentythousand “med packs,” which included hydroxychloroquine, through a localpharmacy chain called Meds in Motion. By the time TestUtah launched, however,medical opinion had begun to turn against hydroxychloroquine; one prominentUtah physician warned state officials in late March that making the drugavailable without a prescription, as they had been discussing, “could be agrave mistake medically.” On April 24th, the Tribune reported that Newman saton the board of directors of Meds in Motion. The pharmacy chain’s owner,anticipating a run on the drug, had purchased eighteen hundred pounds ofhydroxychloroquine, some of which he sold to Utah at elevated prices beforethe state unwound the contract. In a statement, Nomi, Newman’s startup, toldme that “there was no conflict of interest.”A more persistent concern about TestUtah was its funding. At the launch, ClintBetts, the executive director of Silicon Slopes, had promised that “no techcompany is going to make any money off of this. We’re going to make sure ofthat.” A few hours later, on a Zoom call with the governor, the lieutenantgovernor, and others, Ryan Smith, whose company, Qualtrics, had designed theonline assessment for TestUtah, said, “We’re happy to help. We’re doing it allfor free.” Smith, who wore a crisp white hoodie and a black Silicon Slopesball cap, acknowledged that there would always be skeptics, but said that“they should know by now, we’re all just trying to help because our familiesare here. There’s nothing else to read into. There’s no angle.”By the next day, however, the TestUtah tech execs were offering a differentfinancial picture. On a Zoom call that afternoon, Betts asked Newman to “talkabout what we mean by nobody’s making a profit, or clarify or help clean upwhatever I may have said.” Newman told him, “Let’s be clear. There are costsin facilitating all of this: tents, generators, heat, electricity, people,cones, security, public safety, tests, swabs, test kits, extraction kits, youname it.” Newman did not quite promise not to take any profits. “There will beno profiteering,” he said. “If we were going to try to make money, we wouldtune this up as fast as we can and go sell it to New York.” As the Tribunewould later report, the companies involved in TestUtah had already negotiatedtheir agreements, worth more than five million dollars for two months ofservices, with the state.Newman and others in the group had been holding Zoom town halls to track theprogress of their initiative. The day after TestUtah launched, he said thatmore than thirty-five thousand people had completed the digital assessment,more than twenty-five hundred people had scheduled COVID-19 tests, and morethan eight hundred had visited one of the two drive-through testing sites tobe swabbed. “It took any state weeks and weeks to ramp up to this type ofvolume,” Newman said. “We’ve done this in twenty-four hours.”On an earlier call, Newman had boasted of creating “an open-source systemaround the supply chain: the swabs, the transfer kits, the extractive reagent,the test kits, the labs, and the machines to run it.” Behind the scenes,however, not everything was running as smoothly as he suggested. According toAtkinson-Dunn, at the state lab, the initiative ran headlong into the sameshortages every other lab in the country was facing. “They needed swabs,” shesaid. “They found a local distributor here in Utah who said he could getproduct out of China. But, after about a week or so, their shipments were notcoming in from China. And so TestUtah came to us and said, ‘Hey, we’re out ofstuff. We’re going to be out of commission. Can you help us out?’ ” (Nomiconfirmed that it “borrowed swabs while we waited on one of our orders duringthe start of the pandemic.”.)