Rolling With The COVID-19 Punches — #WCW with Julia Cheek, CEO and Founder of Everlywell
Julia Cheek, CEO and Founder of Everlywell

When COVID-19 came to the United States, we were unprepared. We didn’t have enough medical supplies to support our nurses, doctors, and first-responders on the front lines. And we didn’t have enough tests to know how many Americans were actually infected. The virus was beating us and all we could do — if we’re lucky enough to be able to—was stay home. That’s why Julia Cheek and the team at Everlywell stepped up.

Cheek and her team announced that they would be the first U.S. company to sell COVID-19 in-home tests direct to consumers. Days later, the FDA sent out a public announcement that at-home tests were not approved, even in partnership with labs that were approved. The hope of flattening the curve and keeping uninfected people out of the overwhelmed hospital system couldn’t outweigh the risks of at-home COVID-19 tests being administered incorrectly. The variables were still too unknown by the FDA. With policies changing by the day and the public in desperate search of tests, Everlywell found itself in the center of one of the biggest crises the world has seen.

So, what did they do? On March 22nd CEO Julia Cheek and the Everlywell team decided to pause the consumer launch and make their at-home tests available for hospitals and healthcare companies with workers on the front line of the crisis. This way the tests would still make a huge impact on the people who need tests the most while giving the FDA time to catch up and validate in-home testing (or create new guidelines to derisk it).

We sat down with Cheek to hear more about what she has learned through the process of responding to this crisis and navigating extreme ambiguity under intense pressure and scrutiny. And what we can learn about our medical system through this incredibly painful lesson.

Give us the quick backstory on Everlywell. What problem did you see with lab testing in medicine?

A few years ago, I personally struggled with chronic pain and fatigue. I visited around half a dozen doctors to figure out what was wrong with me. I had insurance and still ended up paying thousands of dollars out of pocket for lab tests without any clarity on what my test results were. Long story short, I was finally diagnosed with a simple but debilitating set of vitamin deficiencies and hormone issues. Once the right tests were conducted, I felt better within weeks.

That’s how I ended up starting Everlywell. The premise of our company is to give Americans an affordable, convenient way to get tested that fits their busy lifestyles. We’ve already helped hundreds of thousands of people get tested.

Everlywell was the first US company to create COVID-19 at-home tests. What advantage did you have that allowed you to move on this so quickly?

With the rise of the COVID-19 pandemic, we are now in a situation where laboratory testing is suddenly at the forefront of the national dialogue around public health. There is an extreme shortage of test kits in America. But Everlywell already has the infrastructure and experience to provide Americans testing options that can be conducted from home. We are bringing what we’ve learned through years of at-home collection lab testing to help combat COVID-19.

On March 8, we put out a call to the laboratory network in America to help us fast-track the development of a test for coronavirus. Within days, dozens of laboratories had answered our call. From there, we narrowed down the list to a handful of high quality, CLIA-certified labs, many of whom have expertise in respiratory viruses, to help bring COVID-19 testing to the people who need it most.

Everlywell’s at-home COVID-19 test will first be available to front-line responders

Help us understand why bigger companies weren’t able to move as quickly as Everlywell. What does this tell us about the medical industry as a whole?

The system is broken and needs to be fixed. Two years ago, the global health security team on the National Security Council (NSC) that was responsible for preparing for widespread public health emergencies was disbanded — this was a critical oversight.

The infrastructure to deal with a pandemic like this just doesn’t exist. It has a domino effect on labs, hospitals, clinics and emergency rooms that may end with these facilities becoming overloaded.

Convenient testing options that can be carried out at home can help solve this problem. And we are a unique position to address this national need for testing.

How was the process of shifting to first-responders and pivoting away from consumer sales? What did you learn from that decision?

It wasn’t easy. It took muscle, sweat and brains. It meant that our team had to piece together information from the federal government, from the global supply chain, and a million other sources, including thousands of people who wrote to us. Many of those people were doctors and nurses who wanted testing for their patients and staff — even for themselves. Others were from regular people who were worried that they were sick. All were desperate for testing. All of these inputs went into our decision making, which happened over the course of many early mornings, long days, late nights, and weekends.

We made our decisions in a fast-paced, high-pressure environment, but what we did over the course of a few days is something that many businesses are now having to do over the course of the next few weeks and months. How do you survive in this new COVID-19-dominated world? How do you thrive? How do you balance profit with doing good in a world where people may be experiencing financial hardship, where they are afraid? These are questions all businesses are now having to ask themselves.

For us, our commitments are clear. We have half a million customers who rely on us for things like cholesterol, thyroid, STD and fertility testing — we need to continue to give them the best care, especially in this new world where many people can’t go outside. And given the infrastructure we’ve built over the years to get people tested without having to leave their homes, we feel we have a responsibility to use that infrastructure to help people get tested for COVID-19, even when that means we don’t make a profit on those efforts.

How did you come to the decision to offer COVID-19 tests to first-responders instead of directly to consumers?

Three things happened. First, we heard from thousands of people who were desperate for testing. Many of the hardest emails and notes to read were from frontline healthcare workers. I heard from one emergency room doctor who told me he thought he had coronavirus. He said something like “I think I have COVID-19 but I can’t get tested for it. There aren’t enough tests. I’m afraid I’m going to get my patients sick.” We made our announcement on Wednesday March 18th that our test would be available on Monday. By Thursday the 19th, we had already decided to allocate a significant portion of our tests to healthcare providers. It seemed like the right thing to do.

Second, on Friday, March 20th, the FDA provided updated statements regarding at-home collection testing and continued to provide clarifying updates regarding our type of testing over the next few days. The FDA has been providing updated guidance every few days throughout this pandemic — we had been following all of the guidelines available at that point and continue to do so. Their Friday evening update made us regroup internally about the best path forward.

Third, on Saturday, March 21st, the White House’s Coronavirus Task Force provided a statement reinforcing the need for available testing to go to high-risk groups. They were very clear, and you may be familiar with those groups by now: frontline healthcare professionals, symptomatic individuals in long-term care facilities, seniors age 65+.

Given all of these updates, we made the decision to allocate our entire initial supply of test kits to organizations that could provide testing for these vulnerable populations. We’re now working with hospitals, clinics, nursing homes, and state and city organizations to supply them with needed testing, both for their healthcare workers and their patients.

There has been some concern from the FDA that people may incorrectly self-administer COVID-19 tests. How do you think about a challenge like this? What is your process for improving your technology to account for user behavior and error for future tests?

Since founding this company a few years ago, we’ve convinced half a million people to prick their fingers, pee in cups, or swab themselves in the name of better health. It’s not always glamorous, but it’s convenient — and it works.

When it comes to self-administered sample collection for COVID-19 testing, there’s a helpful article recently published in the medical journal JAMA which contains information from some of the medical community on at-home collection testing and how self-administered swab collection could make a difference in the fight against COVID-19. There’s even more info this Q&A with the Center for Health Journalism and a new study from UnitedHealth Group on the accuracy of self-collected samples for COVID-19 testing.

What can we learn from Everlywell’s ability to respond to the crisis (i.e. what do we need more of right now)?

We need to modernize our approach to healthcare and create a streamlined way for Americans to access general health testing in an affordable, convenient way that fits their lifestyles. This is especially important for those who are uninsured, have high deductibles, those without paid sick time.

Telehealth and telemedicine can help close care gaps, as well as at-home testing and on-demand healthcare services. Healthcare options should fit the patient’s needs, not the other way around. And everyone needs a safety net. To advance as a nation, we need more policies that protect people from surprise bills and work themselves to death because they don’t have paid sick days.

With COVID-19, consumers understand the value of an in-home test, but your company has been ahead of this curve. Why in-home testing in general?

Because uninsured people looking to get tested shouldn’t receive thousands in surprise medical bills. Everyone should have access to medical testing, with or without insurance.

Everlywell was founded on the premise that no one should ever be surprised by a medical bill. We’ve actually been approached by many insurance companies who wanted to work with us in the past, but we almost always turn them down. Medical billing is notoriously opaque. If a price isn’t transparent, then it goes against our values.

How will COVID-19 change our healthcare system? What does this mean for companies like Everlywell?

COVID-19 is already changing how the White House, government officials and public health departments are approaching laboratory testing in America — these conversations are going on as we speak. Lab testing isn’t always a glamorous topic, but it’s an important one. If everyone doesn’t have safe, accurate, affordable and convenient access to testing, then our healthcare system is inherently flawed. Everlywell is trying to change that.

Editor’s Note: Everlywell is still working on providing an at-home test and hopes to share a status update on those efforts soon.
['Emily Fields Joffrion']
['Coronavirus', 'Covid 19', 'Healthcare Technology', 'Female Founders', 'Medicine']