There was an overwhelming demand for tests around the world, and entrepreneurs reacted quickly, pouring money into hiring staff, securing supplies, and building laboratories.

Together with more established players, testing capacity ballooned and a brand-new industry was born.

But with COVID-19 testing requirements now easing, will the companies that helped get us through the pandemic survive themselves?

The rise (and fall?) of the COVID testing industry

There are two main types of COVID-19 tests: The gold-standard polymerase chain reaction, or a PCR test, and an antigen test, sometimes called a rapid or a lateral flow test.

A rapid test can be taken at home and can return a result in as little as 15 minutes.

A PCR test, on the other hand, can be taken at home, but then has to be sent off to a laboratory, like this one, where it is processed using special equipment, like this.

Dr. Tony Cooke is the CEO of Cambridge Clinical Laboratories, a private lab based in the United Kingdom.

So, the rapid test, essentially, is just a strip of paper.

And it's looking for the little spike proteins that are on the outside of the virus.

And if they're there, you get a line, but you need a lot of them⏤you probably need a million to 2 million copies in the sample for it to work.

Whereas here, we're looking at a PCR test that'll just be sensitive down to tens of copies.

Despite the COVID testing industry's global footprint, the approaches to testing by governments varied from country to country.

In the UK, for example, you could get a test either through the national testing program or through a private company.

The government program here has generally been limited in scope and intended for people experiencing symptoms.

So, if you needed a test for travel, you had to buy one yourself.

There are three main players in the COVID testing industry: Manufacturers who make the tests, providers who sell the tests, and laboratories who process the more sophisticated PCRs.

Sometimes a company provides front-to-back services, other times, a company does just one of these three things.

In terms of providers, you're looking at 800, 1,000 that didn't exist before COVID.

In terms of labs, you're probably looking at another 30 to 50 labs.

Qured is one of those newcomers.

It was originally launched in 2017 as a doctor-on-demand service, but in 2020, the company spotted an opportunity it couldn't ignore.

We suddenly saw this huge bow wave of demand from people booking our service, who didn't want to sit in a doctor's waiting room.

But the virus was circulating, a lot of our patients had COVID, and sadly, some of our doctors started to get COVID as well.

So, we pulled the plug very, very early.

And it was, really, demand from our patients which drove our pivot towards COVID testing.

Initially, Qured focused on helping businesses bring their staff back to work safely.

But it was really an innovation in rapid self-testing for travel that put Qured on the map.

We just started thinking about, "Well, how would I validate that it's you who's done it, that you've swabbed correctly?"

So, we figured out that a video call was the way to really solve this.

This innovation resonated with British Airways and in February 2021 they launched a partnership with Qured.

From there, growth exploded, with the company striking deals with American Airlines and Heathrow Airport, as well.

So what was it like to run one of these COVID-19 testing labs during the heart of the pandemic?

Founded in 1982, Randox is an established diagnostics company that provides an end-to-end service.

They manufacture, sell and process tests.

Randox was one of the companies contracted to supply testing goods and services to the U.K. government.

The first day of testing within the government program, we received 37 samples and we had a capacity of 150 tests per day.

By the end of 2020, we had a capacity of 120,000 tests a day and had built over 80,000 square feet of laboratory space and employed over 1,000 staff and equipped those laboratories and so on in order to provide that public service.

Government contracts are lucrative, with Randox's reportedly worth more than $800 million in total, although the company is embroiled in an investigation into whether these contracts were fairly awarded.

Randox says they were in full compliance with government procedures at the time.

One of the biggest challenges during the peak of the pandemic was securing supplies.

For manufacturers, that meant sourcing raw materials.

For providers, signing contracts with laboratories to process PCR tests.

And for laboratories, investing in equipment and lab staff to carry out the tests.

We scoured the world to find every bit of resource and every bit of capability that we could to draw back into Northern Ireland to build up and strengthen these laboratories.

We had to make some very critical decisions about raw materials and so on, and we invested hugely in bringing in raw materials to provide the service.

In many cases, we had to do that at risk, because the decision to test by government was often lagged the supply time.

How did you go about securing everything you needed, from the tests to the facilities to the people?

It was a lot of legwork for our team.

It was just picking up the phone and speaking to anyone who we'd identified might have the capacity.

The government massively increased capacity here, and a lot of private laboratories who did other activities - whether that was testing for sports or for DNA Testing for forensics - all moved their capacity towards COVID testing.

And then suddenly, there was a lot more capacity available, and a lot more potential partners for us to contract with.

It's been quite challenging, you know, we didn't have million sat in the bank.

So, we grew organically.

We doubled in size in terms of staff.

we went from doing about 6,000 tests a year in oncology, and HIV, to 2,000 tests a day.

So massive change.

During the peak of the pandemic, 90% of the tests Dr Cooke was running were for COVID-19.

As the pandemic rolled on, the government's testing capacity improved, but the private companies were kept busy doing corporate and travel testing.

Once up and running, many of these companies made a lot of money, especially the providers.

When you or I go to book a PCR test for travel, the cost can be anywhere from $50 to more than $300.

How do the companies arrive at that final price?

And who's making money?

For laboratories, they buy the PCR test from a manufacturer for $13 to $20.

They run the test using these machines, which are worth over $80,000 and often handle the logistics.

They charge providers between $40 and $68, which covers these costs and makes them some profit.

The middle-man providers then add a service cost on top of this when marketing the tests to travelers.

Prices can vary widely, depending on how quickly you need the results and on which provider you use.

Every time we were able to lower our cost of goods from our suppliers, we pass those on.

We want to test as many people as we can through the pandemic.

And we feel we've done a really good job of making it accessible.

We've increased the top line and the bottom line of the company significantly throughout COVID.

But as testing requirements ease and infection rates subside heading into warmer months, there is concern that these companies may struggle to stay afloat.

As we move out of the pandemic phase into the endemic phase, there will still be ongoing requirements for testing, but not to the extent that we've seen over the last couple of years.

When the infection rate drops naturally, suspect we'll probably stop doing COVID testing for the summer.

The problem, according to Dr. Cooke, is that we will probably need to ramp up testing again in the near future.

The government will want to turn it back on again in the autumn at a minute's notice, and it won't be there.

So there needs to be some provision to maintain that capacity.

So how will these companies set up for COVID-19 survive the peaks and troughs of future waves?

For me, we built up this capability, we built up this expertise.

And at a time when the NHS is under extreme pressure to get through its backlog.

We can flex capabilities and flex resources and so on.

For those companies that have established perhaps as a purely COVID capacity, I think they need to really focus to the future as to what role they fill.

Looking beyond COVID, there is hope that all this new testing capacity and willingness to test will revolutionize the way we think about preventative care.

A lot of the equipment and infrastructure can be used for other purposes, like cancer screenings, vitamin checks and cardiac diagnostics.

Now, a PCR is on everyone's lips.

Everyone is very familiar with lateral flow testing and so on.

There's a greater understanding of the capacity and capability of diagnostics.

I think there's also a greater understanding of the pressure that state healthcare systems are under.

What happens to this facility as we emerge from the pandemic?

We see this facility remaining and its role orientating to stay in diagnostics, but to move towards general healthcare diagnostics.

How do you see the industry evolving?

Is there a big opportunity in home diagnostics?

I would like to think that there's a huge opportunity that could be taken advantage of to improve generally people's health.

And let them get it and fix it.

It's also a lot cheaper.

We think that home testing has had a moment from being quite a marginal activity for people who might have been managing ongoing and chronic conditions or looking at STIs.

Suddenly, every man, woman and child in the U.K., the U.S., Europe, most parts of the world has now spat in a tube or swab themselves for a result that tells them something about their health.

And we feel that this is a breakout moment in home diagnostics and helping keep people well and keep people out of hospital.