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Icon PLC (NASDAQ:ICLR)
Q3 2020 Earnings Call
Oct 22, 2020, 9:00 a.m. ET

Contents:

  • Prepared Remarks
  • Questions and Answers
  • Call Participants

Prepared Remarks:

Operator

Ladies and gentlemen, thank you for standing by, and welcome to the ICON PLC, Q3 2020 Earnings Conference Call. [Operators Instructions]

I would now like to hand over to your first speaker today, Mr. Jonathan Curtain. Please go ahead, sir.

Jonathan Curtain -- Vice President Corporate Finance and Investor Relations

Thank you, Tracy. Good day, ladies and gentlemen. Thank you for joining us on this call covering the quarter ended September 30th, 2020. Also on the call today, we have our CEO, Dr. Steve Cutler, and our CFO, Mr. Brendan Brennan. I would like to note that this call is webcast and that there are slides available to download on our website to accompany today's call.

Certain statements in today's call will be forward-looking statements. These statements are based on management's current expectations and information currently available, including current economic and industry conditions. Actual results may differ materially from those stated or implied by forward-looking statements due to risks and uncertainties associated with the Company's business, and listeners are cautioned that forward-looking statements are not guaranteed of future performance. Forward-looking statements are only as of the date that they are made and we do not undertake any obligation to update publicly any forward-looking statements either as a result of new information, future events or otherwise. More information about the risks and uncertainties relating to these forward-looking statements may be found in the SEC reports filed by the Company.

This presentation includes selected non-GAAP financial measures. For presentation of the most directly comparable GAAP financial measures, please refer to the press release statement headed Condensed Consolidated Statements of Operations U.S. GAAP unaudited. While non-GAAP financial measures are not superior to or a substitute for the comparable GAAP measures, we believe certain non-GAAP information is more useful to investors for historical comparison purposes. We'll be limiting the call today to one hour and would therefore ask participants to keep their questions to one each, with an opportunity to ask one related follow-up question.

I would now like to hand over the call to our CFO, Mr. Brendan Brennan.

Brendan Brennan -- Chief Financial Officer

Thank you, Jonathan. In quarter three, we achieved gross business wins of $1.2 billion and recorded a $190 million worth of cancellation. Consequently, net awards in the quarter were up a record $990 million resulting in a net book to bill of 1.41 times. With the addition of these new awards, our backlog grew to $9.4 billion. This represents a year-on-year increase of 11.8%. Revenue in Quarter 3 was $701.7 million. This represents year-on-year increase of 1.2% or 1.9% on a constant currency basis. Sequentially, revenue increased by 13.1% from quarter two. A top customer represented 12.4% of revenue for the quarter compared with 11.4% in Quarter 3, 2019. Our top five customers represented 38.4% of Quarter 3 revenue, compared to 36.2% last year. Our top ten represented 51.1% compared to 49.1% last year, while our top 25 represented 67.9% compared to the same number 67.9% last year.

Gross margin for the quarter was 29.7% in Quarter 3, compared to 28.1% last year and 29.7% in the comparable quarter last year. And our SG&A was 11.8% of revenue in Quarter 3, which compared to 13.5% last quarter and 12% in the comparable period last year. Operating income for the Quarter 3 was $108.4 million, a margin of 15.4% as compared to 12.1% last quarter and 15.5% in the comparable quarter last year.

The net interest expense was $3 million for the quarter and the effective tax rate was 13% for the quarter. Net income attributable to the Group for the quarter was $91.6 million, a margin of 13.1% equating to diluted earnings per share of $1.72. This compares to earnings per share of $1.20 in Quarter 2 and $1.74 in the comparable quarter last year. The net accounts receivable were $500.1 million at September 30th, 2020. This compares with net accounts receivable balance of $490.2 million at June 30th, 2020.

On a comparative basis, days sales outstanding were 45 days at September 30th, 2020, as compared to 53 days at the end of June 2020 and 56 days at the end of September of 2019. Cash generation from operating activities in the quarter was $112 million. At September 30th, 2020, the Company had a gross cash balance of $710 million and debt of $350 million leaving a net cash balance of $360 million. This compares to net cash of $244 million at June 30th, 2020 and net cash of $122 million at September 30th, 2019. Capital expenditure during the quarter was $7 million.

During the quarter, ICON also completed the successful delayed draw down refinancing of the existing private placement of $350 million senior notes maturing on December 15th, 2020. The transaction has been successfully priced over three-year and five-year tenures at a blended rate of 2.41%, compared to the current private placement blended rate of 3.37%. The drawdown of funds will coincide with the maturity of the senior notes in December 2020.

With all that said, I'd now like to hand over the call to Steve.

Steve Cutler -- Chief Executive Officer

Thank you, Brendan, and good morning to you all. Despite the continuing industry challenges brought on by COVID-19, overall this was an excellent quarter for ICON. Driven by positive market demand in conjunction with our ability to win COVID-19 related opportunities, we booked record levels of gross and net awards of $1.2 billion and $990 million representing book-to-bills of 1.68 and 1.41 respectively. In doing so, we were able to grow our backlog year-over-year by 12% to $9.4 billion. This gives us a firm foundation to build upon next quarter and into 2021.

During the quarter, we delivered revenue of $702 million, a substantial improvement of 13% on last quarter, and earnings per share of $1.72, up over 40% from $1.20 in Quarter 2. COVID continues to test our industry, but we have responded well to these challenges and are pleased with our strong recovery. We remain confident that the sequential improvements seen this quarter will continue as we return to more normal business conditions over the medium term.

The progress made in our financial performance mirrors the recovery we are seeing in the clinical trial environment. The rate at which sites continue to reopen remains consistent at around about 1% to 2% per week, with approximately 40% of trial sites remaining impacted to some degree, a clear improvement on the 60% impacted at the end of Quarter 2.

In addition, during the quarter, site initiations remained strong with overall patient enrollment above pre-COVID levels, albeit with recruitment from our COVID trials materially impacting that performance. Notwithstanding the risk of a second wave impact, we are expecting these metrics to continue to improve steadily. But it will be well into 2021 before we get back to pre-pandemic levels on our non-COVID trial work. The positive influence that our COVID trials continue to have on these recovery indicators is important, especially in the short term.

Sponsors continue to prioritize this urgent work and we continue to be successful winning substantial amounts of COVID business and in getting these projects up and running quickly. However, as development portfolios rebalance over the medium term and spending returns to more traditional therapeutic priorities, we are well placed to apply the lessons and opportunities from the pandemic and continue our progress in this area.

Earlier this month, ICON was awarded best clinical research organization at the Vaccine Industry Excellence Awards. This award is recognition of the continued hard work and dedication of the ICON vaccines team and emphasizes our differentiated strength in this critically important therapeutic area.

Since February, ICON has mobilized its vaccine resources to address the COVID-19 global threat and ICON is currently providing clinical monitoring and safety oversight on more than a 100 COVID-19 trials for both the private and government sectors. In addition, our ability to leverage our global site network, Accellacare has been a key benefit for customers during the crucial stages of COVID trials. Accellacare's dedicated trial support teams can achieve faster study start-up for our customers through efficiencies gained in central process management, including budgeting and contracting, which can otherwise be a source of delay.

Combined with Symphony Clinical Research, our patient-centric global provider of at-home care and nursing, we are able to improve trial accessibility for patients, thereby broadening ICON's access to patients and accelerating the trial process. This integrated approach is leading to increased engagement with investigators, improve quality and better timeline compliance.

The outbreak of COVID-19 had a substantial impact on the conduct of clinical trials with many ongoing trials being disrupted and planned trials being delayed. As events unfolded, it became important to look at alternative solutions in many areas in order to minimize the impact of the pandemic. The environment created by the COVID-19 pandemic has presented the industry with an opportunity to accelerate changes in the clinical monitoring process. The need for more agile and flexible approach to clinical monitoring and data review has emerged and this demand will fundamentally change the way in which trials are monitored going forward.

In particular, the pandemic has highlighted the over-reliance on traditional on-site monitoring and provided the opportunity for sponsors and CROs to accelerate the adoption of remote monitoring and other technology-based approaches using RPA, machine learning and artificial intelligence. I believe this will help us move toward a more efficient model over time that will allow more trials to be conducted and more innovative compounds to be brought to the market faster and more cost effectively.

As Brendan discussed earlier, our cash collection remained robust in quarter three, confirming the strength of our customer base and helping to maintain our balance sheet as the best in the industry. This leaves us well placed to face any further pandemic challenges, and in particular, positions us well to take advantage of future M&A opportunities that may present over the near and medium terms.

Going forward, as we look to the end of this year, we are increasing our 2020 revenue guidance from a range of $2.65 billion to $2.75 billion to a range of $2.75 billion to $2.81 billion, and narrowing our earnings guidance from a range of $6 to $6.50 to a range of $6.35 to $6.50. At this stage, we are planning to give guidance on full year 2021 at our quarter four earnings call in February.

Finally, I would like to thank all our employees for their resilience, flexibility and understanding over the past eight months. At the heart of all we achieve at ICON are our hardworking and dedicated employees. Our focus during this pandemic remains on protecting their safety and well being as well as continuing to deliver the important work we undertake on behalf of our customers.

Thank you, everyone, and we are now ready for questions.

Questions and Answers:

Operator

Thank you. [Operator Instructions] Your first question today comes from the line of Dave Windley from Jefferies.

David Windley -- Jefferies & Co. -- Analyst

Hi, good morning. Thanks for taking my question or good afternoon for you guys. Steve, you mentioned in your prepared remarks you kind of got to recovery of the system in the medium term and kind of the cycling of COVID work into non-COVID work. I guess on the outside, we see these dates that companies are expecting to report out data, but I don't know that we fully understand the CROs' involvement and kind of the duration of your trial as it relates to those public dates. Can you give us a better sense of how your current book of work gates out over the next year or so? And when do you think that waning of COVID work is going to happen then the non-COVID needs to ramp up?

Steve Cutler -- Chief Executive Officer

Yeah, that's a question we talk about internally, Dave, on a regular basis. And I think it's a little hard to be too definitive on that at the moment. I think there are a number of scenarios that are going to pan out or could possibly pan out. One is, the current trials that are ongoing to find a vaccine that is -- or treatment and both presumably, that is exceptionally effective and the work wanes or decreases in the more near-term I suppose. And the other is, and I think this is much more likely, that the trials that are ongoing at the moment will find a vaccine, it will be partially effective, but the authorities will be looking for more than one, and there will be a continued need and a continued desire to get a more effective vaccine.

So the work, I believe, from a COVID perspective is going to continue probably for the next couple of years. I think that's the most likely scenario, and that's the way we're thinking of it at the moment. And so as we think about the COVID work continuing, as I said, for the next couple of years, I think there's going to be a lot of -- a number of vaccine trials, large scale vaccine trials that we'll need to be a part of and we're certainly playing our part in that at the moment.

On the non-COVID work, as you indicated, as I indicated in my comments, we're certainly lower in terms of patient recruitment than we were at pre-pandemic, and we do see that increasing and improving. But I think largely, some of that -- the way that comes back will depend upon how the scenario with the COVID stuff pans out because the COVID work is having an impact on a number of sites and on the availability of investigators, etc., etc. And of course, as we see potential reemergence of the virus in the Northern Hemisphere in the fall, that has an impact as well.

So I had to pan out too many different scenarios. But I think from our business point of view, the medium term is looking strong and looking good, whether it be COVID work, and I think that will continue, or our non-COVID work sort of coming back to a more pre-pandemic levels. I think either scenario, it looks reasonably strong, reasonably good for us.

David Windley -- Jefferies & Co. -- Analyst

Got it. Appreciate that. So for my follow-up, kind of relatedly, you talked about the relatively consistent pace of site reopenings. I think earlier and maybe in the summer, that view was maybe something like two to four, call it mid-0.3% a week, and today, it sounds like more like 1% to 2% a week and we're certainly seeing and hearing about regional flares or spikes in some infection case data. I'm wondering, one, have you seen some slowing and is it related to some of that regional flaring and just how do you see that proceeding? Can we avoid shutdowns essentially as we proceed through the fall?

Steve Cutler -- Chief Executive Officer

Yeah. We certainly have seen some slowing in the reopening, as sort of asymptotic curve. As it approaches the top, it is certainly slowing. And so we don't see us getting back to all sites fully opened, even with the current progress we are making until, as I say, well into 2021. That's still our expectation. And the reason for that I think is there's a number of reasons for it. I think as you know, these flares that have happened, the reemergence of the virus, people are concerned about that. I think we're seeing some patients still concerned about traveling to sites.

I think there is also an element of a number of these sites are involved in these large scale COVID trials that's taken some of their capacity away. So there is an element there. So I think it's multi-factorial, but we're certainly seeing slowing compared to where we were even a couple of months ago, but it's not zero. And we are moving it forward and we do expect that certainly within the next 12 months or so, outside by first half of next year, assuming continued progress and assuming no major outbreak again, we do expect that our sites will be back to pre-pandemic levels.

David Windley -- Jefferies & Co. -- Analyst

Appreciate the answers. Thank you.

Operator

Thank you. Your next question comes from the line of Patrick Donnelly from Citigroup.

Patrick Donnelly -- Citi -- Analyst

Great, thanks. Maybe just on the COVID bookings, I know you guys called it out above 20% last quarter. Can you just talk about how that trended in 3Q? Again, it certainly feels like you have pretty good presence on that side given the vaccine, but just wondering in terms of percentage, where the COVID bookings are?

Steve Cutler -- Chief Executive Officer

Yeah, Patrick. It was strong. I'm not going to be -- we're not going to get into sort of specific percentages, but it was certainly -- it was where we were in Q2 and probably a little bit further ahead of that. We had a good quarter from COVID, from a new bookings point of view. That will translate into an increasing proportion of our revenues as we go into Q4. It wasn't a huge proportion of our revenue in Q3, but it will be more in Q4. And so it was a good substantial part of our new business wins and at least the par and ahead of where we were in Q2.

Patrick Donnelly -- Citi -- Analyst

Okay. And then maybe on the margins side, can you just talk through any of the cost control measures you guys put in place earlier this year coming back? I know last quarter you talked about normalizing some spend in the back half. And then on top of that, any margin profile difference of the COVID work relative to other trials we should be thinking about over the next year or so?

Brendan Brennan -- Chief Financial Officer

Hey, Patrick, it's Brendan here. I might take a crack at those. In terms of the cost normalization, yeah, I think we're approaching in for -- as we finished out Q3, certainly we were -- most of the cost structure thesis had moderated back to normal. Saying for the fact of course more of our work is being done remotely now, so travel budget that's required in the way they would have been in the past, and that will persist into Q4. Most of the cost control elements have been dealt with now and any thesis that we have done where we wanted to, I suppose, make people hold or anything on those kind of issues from the COVID perspective are dealt with. So it shouldn't have a margin impact as we progress into quarter four, those specific thesis, we've kind of taken care of that.

I think the piece -- the second piece on your question around margin profile. I think what we do see on vaccine trials is obviously a heavier element of pass-through costs, as proportionality of the total and cost of the trial. And therefore, we would expect, yes, on the 606 revenue basis that there will be more proportional revenue on which we earn little margin and that would have a decremental impact to gross margin.

And so it's going to be one of the, I suppose, challenges with these studies over the next couple of quarters because obviously the proportion of that positive revenue will be larger and they'll have that impact. That said, I think our earnings, as we've outlined, are very much somewhat what our thinking is for quarter four in terms of that EPS growth, and we still see a decent trajectory on EPS growth.

Patrick Donnelly -- Citi -- Analyst

That's really helpful. Thanks, Brendan.

Operator

Thank you. Your next question comes from the line of Elizabeth Anderson from Evercore.

Elizabeth Anderson -- Evercore ISI -- Analyst

Hi, guys. Thanks for the question. I had a question on sort of the make-up of vaccine work. And is there a difference in terms of cancellations or how that kind of flows through, just trying to think of through the cancellation rates for next quarter and then sort of broadly speaking for '21?

Steve Cutler -- Chief Executive Officer

Yeah. Elizabeth, I don't think we've seen any sort of particular unique issue or trend around cancellations with vaccine work. I think what we do see is that there's a large number of patients in a relatively short period of time. And so projecting the revenues, the resourcing, etc., has its challenges. That's what we do. That's our core competence. And so it's something that we obviously take very seriously and we believe we're good at it. But it does certainly have more challenges in terms of how quickly that will burn and the rate at which we do the work and the time period over which we do the work has some pretty material impacts on our business. So that would be, I think the sort of more unique feature of these sort of large vaccine trials in any sort of issue around cancellations or anything like that. We don't see any differences on that front.

Elizabeth Anderson -- Evercore ISI -- Analyst

Okay, that's helpful. And I know on the capital deployment, you guys obviously have a very enviable cash position at this point, you said you're sort of looking at added potential for M&A as things change in that market. How are you thinking about balancing that versus, say, share repurchases as we move into 2021?

Steve Cutler -- Chief Executive Officer

Our priority, we've been pretty clear on this for a number of years. Our priority is M&A, appropriate M&A, and that's why we -- that's what we're focused on. And there are a number of opportunities out there in the market at the moment that we continue to assess on an ongoing basis.

In terms of share buyback, we commit to doing about 1 million shares each year to essentially buy back what we release, and that will continue. We will continue to do that. And we will be opportunistic as that allows, where we see opportunities to jump into the market. But the focus for us is very much on M&A and on capital deployment around building our systems and our organization, things like Oncacare that we've set up. We've established that JV this quarter and we believe that's an area that we can deploy our capital in effectively to get best benefit for our business.

Elizabeth Anderson -- Evercore ISI -- Analyst

That's very helpful. Thank you.

Operator

Thank you. Your next question comes from the line of Robert Jones from Goldman Sachs.

Robert Jones -- Goldman Sachs -- Analyst

Great. Thanks for the questions. Maybe, Brendan, one for you on this pass-through dynamic that seems to be more pronounced given some of the dynamics around the COVID-related work. One of your peers discussed that you could actually see 10 times as much pass-through relative to a normal trial. Are you seeing anything similar? Anything you can share on how pass-throughs have impacted the quarter and maybe how you're thinking about pass-throughs for 4Q and next year?

Brendan Brennan -- Chief Financial Officer

Yes, Robert. We certainly have obviously seen our share of vaccine work and pass-through, it's certainly a larger element than what we've seen in the past. I don't think that maybe those numbers spoken about were our -- what we've, certainly been in our experience, something in the range of two times to five times is probably more in line with our experience of this quantum of pass-through. That said, although, it hasn't really had an impact. You asked about the quarter, it didn't really have an impact year-to-date in terms of the mix shift in our revenue, and I think that's probably visible in our margin profiles as well when compared to last year.

So we do feel that this is more of an issue for Q4. Certainly as Steve outlined, into 2021 where we might see more of that pass-through coming through with a lower margin profile, and that will have a knock on gross margin consequence. But as I said, it's kind of early days and the nature of these trials are very, very fast. So it will be a little difficult to forecast. So we'll be doing our best job at really putting our thinking hats on between now, and as Steve outlined, the Q4 call in terms of making sure that we can give you a guidance to you that makes sense at that point.

Robert Jones -- Goldman Sachs -- Analyst

I guess maybe just to follow-up on that point. I think typically or at least recently you've been giving guidance in January. One of your peers again felt like they were in a position to give guidance for next year at this point in the year, thinking about mid-teens type of growth, so obviously -- in their CRO segment, so obviously more than average growth just given all that's going on with COVID and the work pushed out. Any early thoughts just around how next year could look? And then maybe just timing-wise, why February? I know it's splitting hairs a bit, but why the 4Q call and not earlier?

Steve Cutler -- Chief Executive Officer

Yeah, it's Steve here, Robert. Let me comment -- give you some sort of flavor for 2021. I mean, we see some positive momentum going into 2021, no question about that. Our book-to-bills have been solid over the last couple of quarters. Even despite the pandemic, we've been able to win business. That's an area that really hasn't seemed to have had -- the pandemic hasn't seemed to have had a major impact on. The biotech funding environment, we continue to see very strong funding there. Our RFP environment has been strong, high-single-digit improvement year-over-year certainly in the biotech space, but even in large pharma as well we've seen some continued development and continued growth in the opportunities we're seeing.

So the business environment has overall been pretty positive, and we see that would play into a strong performance for us in 2021. The COVID opportunities, as I said earlier in the call, I think are going to continue. I think we're going to see more work. I don't think it's just going to drop off the cliff as we sort of get through these first tranche of trials. I think there'll be more work to be done there. So that I think augurs well for us in terms of the opportunity and the differentiation we can provide in terms of our vaccine experience.

So it's looking strong and looking positive. But we're not ready, and there are also headwinds and potential headwinds, as you all know. I mean, the virus is reemerging as we get into the fall. There are challenges and potential to slowdown of the site reopening has been referred to. And we're not ready to issue guidance or any real sort of sense of guidance at this point in time. I think, it's -- we need all the time that we will have in the next three to four months to assess what opportunities are coming through, what success is moved through in terms of vaccines that are coming to market. As we see potential vaccine, that's going to be a positive, I think for everyone, including our sites in a clinical trial environment. But we're not quite ready to go out and give definitive guidance in the market, and we have pushed back only a month, but we have pushed back what we usually do for rest of the year, from January to February because we think we'll need all that time to make the assessment and to see how these trials are going to play through. So we make no apology for that. That's the way it's going to be. I think it's interesting that some of our competitors have done differently, but that's their choice.

Robert Jones -- Goldman Sachs -- Analyst

That's fair. Thank you.

Operator

Thank you. Your next question comes from the line of George Hill from Deutsche Bank.

George Hill -- Deutsche Bank -- Analyst

Hey, good morning, guys, and thanks for taking the question. Steve, I was just wondering if you could talk a little bit about digging into COVID, I guess the demand for vaccine-related trials and the demand for therapeutics-related trials? And I guess, can you talk about the split there and kind of are there any margin or pricing implications we should think about between the two?

Steve Cutler -- Chief Executive Officer

Yeah. I'm going to try, I can sort of definitively give you that split, George. We're doing both. The vaccine, obviously the vaccine trials are much larger in terms of patients, in terms of contract size, revenue, burn rate even is higher. And so there are a number of different characteristics around these larger trials, and they probably have more of an impact on our forecast and on our quarterly numbers than the treatment trials, which tend to be smaller, more hundreds of patients rather than tens of thousands of patients, even though the vaccine trials -- I mean, calling in patients is probably a little bit of a stretch because essentially they're healthy volunteers, but there are a large number of them and the data work that goes with that is very substantial.

So from that point of view, the vaccine trials are more material to us in terms of finances, not necessarily in terms of operationally because they are both important. We're doing -- I don't have the data right at hand. In terms of numbers of trials, I think it's fairly evenly split at the moment. But in terms of contract values and revenues, the vaccine trials are a substantially larger and substantially more material to us at this point.

George Hill -- Deutsche Bank -- Analyst

Okay. And maybe if I could just have a quick follow-up. Given everybody is focused on the COVID work, are you guys seeing anything meaningfully different in the cancellation rate or what clients are looking to kind of press forward with or cancel as it relates to trials?

Steve Cutler -- Chief Executive Officer

Short answer to that is, no, George, we're not. You see our cancellation rate this quarter was pretty much in line with what it would normally be. So no, we're not seeing any differences on the cancellations of either of those trials.

George Hill -- Deutsche Bank -- Analyst

Okay. Thank you.

Operator

Thank you. Your next question comes from the line of John Kreger.

Jon Kaufman -- William Blair -- Analyst

Hi, good morning. This is Jon Kaufman on for Kreger. Thank you for the time. Just thinking about the outlook for virtual trials, what are the factors that have historically prevented sponsors from moving a larger percentage of their trials to a more virtual model? Are the regulators onboard with the shift to more virtual trials or is that still to come? And understanding that large pharma has been piloting virtual trial tools for a couple of years now, is your experience -- I guess has your experience during the pandemic led you to believe that they are more willing now to actually conduct more of their late phase trials in a virtual manner? Thank you.

Steve Cutler -- Chief Executive Officer

Yeah, that's a big question, Jon. I could probably take a day or two to answer that one, but I'll try to do it in a couple of minutes. I mean, I think the short answer, the fact is sort of moving against virtual trials. They do relate to this. There is an element of conservatism within our industry. I think that's certainly the case. I think the regulators certainly up till now have not necessarily been 100% onboard with how we do this.

And the other question we get is when we propose a more decentralized or virtual trial is, which trial or which drug did you get to market on the basis of a virtual trial? And the answer is, well, that hasn't happened yet. And so we revert. And that's completely understandable from a sponsors' point of view. As far as I'm concerned, we are a highly regulated industry and the need to validate data and verified data and make sure patients receive in a very safe and efficient manner is always going to be there.

Having said that, I think we've certainly seen during the pandemic, the regulators move very quickly in understanding the challenges that the industries faced and being accommodating with those challenges. Now that leads to play through obviously into submissions over the next realistically couple of years to make sure that that happens because there is always an element of some of the people at the top who are writing the white papers say one thing and then the auditors who are actually at the coalface do something different.

So there is an element of validating that approach. But certainly the overt guidance and output from the regulators has been very accommodating and much more positive with respect to how the industry is pivoted to be more remote-orientated. And I think that will continue, and we certainly see some positives on that front.

In terms of going forward, we've seen essentially a seismic shift in the way trials have been monitored over the last six, eight months. As I look at our own business here, pre-pandemic, about 5% of visits, of monitoring visits were offsite; in other words, sort of virtual. During the height of the pandemic, that flipped very quickly to about 60% of visits being offsite and virtual. And that was probably a little bit of an overstatement because I think a lot of these were probably telephone visits and those sort of things. But as we've come through and started to recover, that's gone down, but it's still about 30%. So about a third of the business we're doing at the moment are remote. And the technology associated with those visits has really come to the full very effectively. So we're able to, in almost all cases, now evaluate the electronic medical records remotely. The systems are now in place at many sites to be able to do that, and it makes it a much, much more efficient approach.

So the move is happening. I don't think we're ever going back to where we were pre-pandemic. And really the remote monitoring is just a biomarker, if you like, for a move much more toward virtual trials, decentralized trials. Now we've seen an unprecedented demand for our Symphony home care services, that's really been fantastic from our point of view. But we are extremely busy in having our nurses go to patients' homes to ensure that they stay in trials and they get the right treatment and they get the right attention. And that is also playing into our decentralized clinical trial offering as well.

So I think the short answer to your question is, it's been a challenge up till now, but the pandemic, there's always silver linings with these things. And I think one of them is that is a significant move toward a much more virtual clinical trial environment which is going to help all of us be more effective and faster.

Jon Kaufman -- William Blair -- Analyst

Thank you. Much appreciated.

Operator

Thank you. Your next question comes from the line of Erin Wright from Credit Suisse.

Erin Wilson Wright -- Credit Suisse -- Analyst

Great, thanks. You mentioned several improving fundamental metrics here. I just -- I want to clarify you highlighted high-single-digit RFP flow I believe in the previous question. And is that excluding COVID-related work? I assume this is -- much of that is gaining momentum here. And then I do have a second question, if you could speak to the trends across your central lab business in this sort of environment that would be great? Thanks.

Steve Cutler -- Chief Executive Officer

In terms of RFP, yeah, it does include COVID work, the high-single-digit sort of number, and these numbers bounce around a bit. But that's certainly -- we're including everything in that number. I think I mentioned the biotech, small, mid-sized pharma as we've seen an increase. Some of that's been funded by government, as you all know. The government is extremely interested in these trials and some of that funding that we've sort of allocated to small and mid-size in terms of RFPs has really come from the government. Everyone understands what a clinical trial is now. Even my mother understands what I do now for the first time in about 40 years. So that's -- it's the wane I suppose of clinical trials in society is, I've never seen anything like it really. Everyone understands, everyone knows what's happening. Everyone reads it on the front pages at all times. So that certainly play into that. I hope that helps.

Erin Wilson Wright -- Credit Suisse -- Analyst

My second question is just on central lab, and if you could speak...

Steve Cutler -- Chief Executive Officer

Brendan, do you want to -- maybe Brendan will take that one on the central labs.

Brendan Brennan -- Chief Financial Officer

Yeah. No, they have been trending well. They've been doing really well. We're very happy with their performance. Obviously that has been -- they have been riding on the coattails of COVID work, and we've seen that and that's been a big part of the story there, but certainly our central labs are doing very well. And as I've heard, indeed their others labs as well [Indecipherable] as well. So it has been a strong performance for them during the course of the year. And I think it's fair to say very much helped by the if you like the tailwind of the COVID works that they certainly have been following. So yeah, good news for them and hopefully looking into a very well world in 2021.

Erin Wilson Wright -- Credit Suisse -- Analyst

Is that growing double-digits you would say?

Brendan Brennan -- Chief Financial Officer

Well, we're not quite in that ballpark because of course you know we have the same situation where a lot of the units were closed and a lot of samples were delayed in coming back in. So what I'd say is, it's very strong and it's going up. But really the strength is really coming now in Q3 and Q4. So year-to-date, we're still down year-over-year because of sample delays and samples are not coming in across spectrum of our trials, excluding the COVID work. But I think the COVID work is certainly helping getting back on track as it is across the rest of the organization. And so not in line with the overall business performance at the top level, but certainly, our business wins profile has been very strong and we're already starting to see them ramp back up well in Q3 and into Q4.

Erin Wilson Wright -- Credit Suisse -- Analyst

Okay, great. Thank you.

Operator

Thank you. Your next question comes from the line of Dan Leonard from Wells Fargo.

Dan Leonard -- Wells Fargo -- Analyst

Thank you. So first question, can you comment on industry clinical trial capacity in a scenario where COVID work maintains into 2021 and traditional trial work resumes? Are there any bottlenecks that could limit the growth above and beyond what your backlog growth and others might suggest?

Steve Cutler -- Chief Executive Officer

You mean capacity at the site level?

Dan Leonard -- Wells Fargo -- Analyst

Yeah. Exactly. Patient sites, etc.

Steve Cutler -- Chief Executive Officer

Yeah. I'd be -- I don't think we have any immediate concerns around the capacity to execute from an investigator and site point of view. That may mean of course that we need to bring on new investigators and train up sites and that again brings to the fore our Accellacare network and our Oncacare network that we have sort of more or less dedicated or more dedicated to the clinical trials.

So if we do see some constraints there, we have our networks and our alliance site that we are ready to go to. But I think it would be a straight to me to say that we won't be able to -- actually industry won't be able to execute on COVID and on COVID work because of capacity constraint. Certainly the investigators, the sites have been incredibly accommodating in taking on this COVID work at very short notice. And I think as I've commented on previous calls that the speed at which we've been able to get these sites up and then these trials moving is unprecedented. I've certainly seen nothing like it in my 30-odd years of doing this.

So there is an interest out there from sites and from investigators, particularly on the COVID work, obviously. But also, I think we'll see the non-COVID work come back as well over the more near-term to medium term. And I guess I think I recognized again I think the awareness of clinical trials now from the public's point of view and from investigator and site's point of view is also going to move into the right direction. So I don't have a suitable significant concern in terms of capacity to undertake this trial.

Dan Leonard -- Wells Fargo -- Analyst

Okay, that's fair. And then for my follow-up, can you comment on the performance of your real world offerings? And you've talked a bit about the impact of the pandemic accelerating interest in virtual trials, remote monitoring. Does it impact the interest in real world offerings at all? Do you see a different appetite for maybe synthetic control arms where fewer people are enrolling in traditional trials or is that a stretch, is it not really that relevant?

Steve Cutler -- Chief Executive Officer

I think there is some theoretical opportunity there. We certainly talk a lot about that when we've had conversations with customers around the real world impact and how we can implement the synthetic control arms. But I would be -- I would not be telling you the truth if I said we had a whole bunch of trials going on with synthetic control arms. That's just not the case. They remain more on the edge, I suppose innovative edge of new trial design, adaptive new trial design. The regulators are getting onboard with those and are certainly opining on the appropriate use of things like synthetic controls and real world data to get drugs to market. We certainly see it's a trend going forward, little bit like the decentralized virtual trials on the real world data. There's no question. I think as we go forward, we'll do more of those trials. They will be used as a bases for approval of new compounds going forward. I think the pandemic, if anything, has shown us there are different ways to get drugs to market early, emergency use authorization and follow-up data, etc., etc.

So we do believe there is a significant opportunity here going forward. But it's not going to happen tomorrow, little bit like the decentralized trials. There will be a period of time that this will ramp-up and there'll need to be some brave companies who will move forward with these and base their registrations on real world data and other areas. And that's what I think we'll sort of start to tick the scale and we'll move forward. So I think it's a process and it's a journey rather than anything that's going to happen immediately.

Dan Leonard -- Wells Fargo -- Analyst

Okay. Appreciate this thought. Thank you.

Operator

Thank you. Your next question comes from the line of Eric Coldwell from Baird.

Eric Coldwell -- Baird -- Analyst

Thanks very much. I've got a few here. First off, just a quick one. Can you tell us who the JV partner is on Oncacare?

Brendan Brennan -- Chief Financial Officer

Yeah. Actually, one of the -- the JV partner there is actually the founder of the European site based business that we just acquired in MeDiNova, which has been a great success in addition to our overall organization. So the former CEO has stepped into the role of leading that joint venture. And we're very happy to have him as part of our structure and he's obviously done a great job at building these kind of networks in the past. So he's bringing that entrepreneurial mindset to building up that global and oncology network. So very happy about that.

Eric Coldwell -- Baird -- Analyst

Hey, Brendan, since you're talking, I'll stay with you on my second one. Cash flow, good job there. I'm curious, was it internal initiatives that drove this or perhaps mix and timing of some of the work that's been coming in with COVID and maybe somehow related to the pass-through revenue streams given the speed and the burn here? I'm curious how you got where you got that fantastic improvement in DSO? And how sustainable you think that is?

Brendan Brennan -- Chief Financial Officer

I think it's been a -- it's year and a half of success of our nice hurdle story, and I think we've been working on this one for the last year to improve it. And from where we were at this time last year really. The guys on the team has done an excellent job on really improving communication between the project management teams and the finance organizations to make sure that we're billing appropriately and in a timely manner. And obviously hopefully then to get cash in is always something that's there.

And so I think it's been just a lot of good old fashioned hard work and team work. I think there has been a little bit of -- yeah, a little bit of a tailwind about on, particularly on the pass-through elements on some of these vaccine trials, but not nearly as significantly as I would say just as the old fashioned hard hustle or hard hustle, I should say on that piece. So if there was credit there to be given out, I think it's really goes to project management teams and the finance guys who have done the hard work.

Eric Coldwell -- Baird -- Analyst

That's great. Last one from me. On the comments that about 40% of sites remain impacted in some way, shape or form, I think that's pretty well understood. The question is, are all sites created equally? On one hand, you might think, well, it was the weaker sites that haven't been able to reopen. And on the other hand, I could see this being very busy sites in urban areas where the challenges are the greatest. I mean, we're certainly seeing that in the U.S. where the big cities are more impacted than the rural areas in terms of activity. So just hoping for your comments. Are the 40% of sites impacted also correlated or equivalent to 40% of historic global activity from that tranche of sites? Does that makes sense?

Steve Cutler -- Chief Executive Officer

Yeah, I think it does make sense, Eric. I can opine a little bit on that, but I don't I wouldn't say I have any definitive data on which of the 40% and what contribution they make to us in terms of patients into trials. I can say that we are from pre-pandemic with treatment levels in a non-COVID work, we're still at around about 50% -- 40% to 50% of pre-pandemic levels. So it's still materially impacted.

So from that -- if it's 40% of the thoughts, you would say that they are pretty important, a fairly significant component of that recruitment supply I suppose on a weekly basis. As I think I referenced in my comments, the COVID work has really supplemented to the point where the sites were well above our normal recruitment levels. Certainly in the last couple of months we've been way, way above recruitment levels, but it's really been because of the COVID work. And the sites are contributing to that, they've been obviously handpicked and selected to do that.

So it's hard to be too definitive about the 40% who are still impacted. They are impacted to a greater or a lesser extent. Some of them, it's probably -- it's less than 5% now, it's still closed. But the vast majority of those impacted are impacted to some way, shape or form. So they're not taking on new trials, they're limited to just doing the trials they're doing, patient visits are happening now much more than they were say back in the heat of the pandemic. But there's still some impact. And as I said, it's going to take I think at least another six or eight months for those sites to come back to a point where they're truly contributing. This is why we've gone forward with our Oncocare JV and the Accellacare network because we're seeing less impact in those sites and a disproportionate contribution from those networks because we're able to help them to get back to normal or help them to address the challenges of the pandemic and of the trials that they are recruiting.

Eric Coldwell -- Baird -- Analyst

Thanks very much.

Operator

Thank you. Your next question comes from the line of Jack Meehan from Nephron.

Jack Meehan -- Nephron Research -- Analyst

Thank you. Good morning. Good afternoon. On COVID. So I was looking at the revenue contribution from your largest client, I thought that it might be bigger this quarter just given the pacing of vaccine trial enrollment you can see in the headlines. Is there any color you can provide on the shape of how vaccine work is burning and how that will trend into the fourth quarter and 2021?

Brendan Brennan -- Chief Financial Officer

Hey, Jack. I'm going to take a stab at this. Its' Brendan here. And obviously that's been an area of activity where we have been ramping up hard, as you're right, in terms of the speed of patient recruitment they are significant. And I think there is -- and I think we've referenced it earlier in the call, while there will be a proportion of that site that will be done certainly before the end of this year, they'll follow-up largely and it will go on for quite some time there afterwards.

So I would be remiss nowhere to think with any possible filing that would go into the FDA that that was just at the end of our involvement in the trial process. So certainly that will lead us over a longer period than that point in time and there will obviously be an additional tunnel for us. So we're happy with the pace of revenue recognition that's been on that trial specifically in the third quarter, certainly. I think it will certainly be a chunk of the work that we do without a doubt in the fourth quarter as we work toward the back end of the year and as you referenced those important milestones for that customer.

And I think that's true of all of these trials. And I think it's worth bearing in mind that even though there is the patient recruitment phase that's at the early parts of the trial and today the trial is quite short in terms of dosage regime. There is consistent follow-up work that will happen over time. And I think Steve's points around these trials being with us and part of the landscape throughout 2021 is very fine in that context.

Jack Meehan -- Nephron Research -- Analyst

Great. And you're obviously doing a lot of hiring at the moment to support the new business wins. Can you talk about how relative wages are trending? And maybe contextualize it for us in terms of the gross margin just how should we be thinking about that into the fourth quarter?

Brendan Brennan -- Chief Financial Officer

Yeah, Jack. I think I'll try to take a stab at it again. We have seen a lot of activities, particularly I'm going to say in the Americas on that side of it. We're doing a decent job I would say on making sure our folks are staying aboard and we're continuing to recruit as we go through into the fourth quarter. So certainly building out the headcount and it will be part of the profile of the organization as we go through the fourth quarter.

I think we've made the point that we're managing the cost base pretty well and we saw that particularly in margins in the third quarter. I think the larger piece in terms of moving margin profile in the fourth quarter is probably the proportion of revenue that we see that will be partly related in Q4. So I think that's the bigger piece, but I think there will be certainly an element of continued headcount growth, particularly in North America where a lot of this trial activity is actually going to be happening. So that would be certainly something we'll be looking at.

Jack Meehan -- Nephron Research -- Analyst

Thank you, Brendan.

Operator

Thank you. Next question comes from the line of Sandy Draper from Truist.

Sandy Draper -- Truist Securities -- Analyst

Thanks so much, and good morning, good afternoon. Maybe just a lot of questions have obviously been asked. Maybe a quick one, Brendan. I didn't hear you give the constant currency organic growth number.

Brendan Brennan -- Chief Financial Officer

Well, probably Sandy because I haven't yet. I was wondering if someone's going to ask. So we said year-over-year it was 1.2% and at constant currency it's 1.9%. These are down obviously given the context of the current quarter versus this time last year. And constant dollar organic, Sandy, is about 3% down year-over-year.

Sandy Draper -- Truist Securities -- Analyst

Okay, great. And then my follow-up. There has been a lot asked about gross margins, and as you pointed out, it was a nice return, I would assume a lot of that just as revenue came up, and there could be some near-term impacts to COVID. But when we think longer term, you guys have sort of said the long-term target is to hold gross margin steady, which when I read that, it's 29% to 30% type gross margins. Is there anything coming out of COVID as you start to do maybe more remote trials, lower cost, maybe not to travel as much over the medium to longer term could suggest you could actually sustain above the 30% gross margin or they're not enough, big enough things to really change the margin structure, and we really should be thinking about holding the margin as the longer term goal? Thanks.

Steve Cutler -- Chief Executive Officer

Yeah. It's Steve here, Sandy. I would say there is certainly opportunity as we talk about. I talked about the switch toward more remote monitoring and using technology to improve and to make our monitoring more efficient, our data review more efficient. We've been able to progress our robotic process automation. In fact, we do a team in the quarter here like on each quarter, friendly enough, and we know this quarter was with the team on our RPA, who have been able to make significant progress around the data management and the locking of pages. So that's an example in a specific data management area, but that I think approach and similar approaches can be applied to our clinical operations group. And I do think in the longer term, there will be opportunities to improve our gross margin. Having said that, there will inevitably be headwinds as well.

So I think you are thinking around 29% to 30% is probably the right way to go. There will be some opportunities to push that ahead. There will be some headwinds that will make that more challenging. And so I think that's probably -- I would not want to commit to a significantly higher gross margin even in the longer term at this point. I think this is a very competitive industry and we'll find that costs, and as I say, headwinds will mitigate the inevitable on the obvious opportunities that we have through doing more remote monitoring, doing more technology-based trial management and data management. So it is like pros and cons, headwinds tailwinds, but think of it as 29%, 30% being a reasonable continued target to maintain.

Sandy Draper -- Truist Securities -- Analyst

Great. I appreciate the comments, Steve.

Operator

Thank you. Your next question comes from the line of Dan Brennan from UBS.

Daniel Brennan -- UBS Securities -- Analyst

Great, thanks. Thanks for taking the questions, guys. So Steve, just wanted this question on kind of when we get back to normal. Is it consistent with what you were saying last quarter? I know there's a few questions earlier on, but I believe last quarter you were thinking maybe early next year. I'm not trying to put words in your mouth, but now it sounds like back half to kind of Dave's question I think about the pace of enrollment. Just wondering, has it changed since Q2 or is it consistent?

Steve Cutler -- Chief Executive Officer

Dan, as you know, I'd have to say it's consistent, but if anything, it's probably pushed back a little bit. I think we see, back to Dave's question, the pace of reopening of the sites has slowed. And so we're thinking -- I'm thinking probably more into Q2 than I am into Q1. So it hasn't changed dramatically. I never thought we'd be back everything this year. I think I was consistent with that from the start. But we do see -- and we do see continued progress, but I think it probably is pushing back a little bit. And as I said, the reasons for that I think are multi-factorial. Part of it is because of the COVID work that's been -- that's ongoing.

So it's not all negative. There are some silver linings here out of this pandemic, and these COVID trials are certainly a silver lining for us, but both on a treatment trial basis and on a vaccine basis. But in terms of the non-COVID, when I say traditional portfolio, that's still got some way to go to recover. And so I'm thinking middle of next year is probably more of the timeframe now than I thought perhaps six months ago.

Daniel Brennan -- UBS Securities -- Analyst

Great, thanks. And then just kind of on that same point, I mean if you could help. Is it more of the patients, the inability to get patients to the sites because of the outbreak or is it really the sites not opening up or I know, earlier in the conversation with the question on capacity, you indicated if the demand was there, certainly you can train up more sites? I'm just hoping maybe just to kind of triage a little bit in terms of what the main hold-ups are or maybe if the sponsors, maybe they're so focused on running COVID that they're just telling you to hold back on some of the non-COVID work. So if you can help just maybe parse through some of the key factors on that? Thank you.

Steve Cutler -- Chief Executive Officer

Yeah. I'll try to give you a flavor. It's a little qualitative. We don't have any specific data on that, Dan. I would say it's -- and I'm really going to say this, but I'd say it's all the above. There is still an element of patients not wanting to go to institutions, not wanting to go to hospitals with potentially the risk of any sort of infection, but alone COVID is higher. I think that's a component of it in terms of recruitment rates, we've certainly seen that.

I think there is an element of sites not wanting to take on new trials because they're busy with COVID clinical work or they're doing clinical trials, normal clinical trials. So I think it's multi-factorial. And I think you're going to find that sites impacted is another thing. We have seen our site initiation visits come back to normal, our pre-sites. So our study sort of start-up is coming back in terms of the number of sites were engaging in new trials going forward. But there is no question, there is still an impact of the current cohort of sites with the current -- the portfolio, within the current cohort is still impacting. And I think it's for a multitude of reasons.

There are opportunities, as I said. We talked about our Accellacare network where we've seen less impact than our Oncacare that will be -- that's a process that's going to take a year or two to sort of really develop. So we're not ready to declare victory on that one yet, but I think there are things we can do. There are some opportunities I think to bring on new investigators and train up new investigators. That has its own challenges of course. So that's not a panacea. So there is an investment I think to be made there to address some of these issues. But this impact on site is, every site is to some extent unique and they all have different focus and different reasons, and I'm trying to give you a flavor for some of those.

Daniel Brennan -- UBS Securities -- Analyst

Great. That's perfect. Thank you, Steve.

Operator

Thank you. Your next question comes from the line of Juan Avendano from Bank of America.

Juan Avendano -- Bank of America -- Analyst

Hi. Thank you. I was juggling calls, and so I apologize if this was asked before. But COVID-related bookings for you have made up a decent proportion. Some of the feedback that we've gotten is that COVID bookings might be prone to a higher cancellation risk, especially after some of the preeminent COVID vaccine trials start announcing Phase 3 data in the fourth quarter or later. Do you agree with this notion and have you discounted your COVID bookings enough to account for this possible dynamic?

Steve Cutler -- Chief Executive Officer

Yeah, you're right. Yeah, that question was asked a little early, but I'll answer it again. They are certainly are bookings, Q2 and Q3. COVID bookings have been a substantial proportion of our wins. At this stage, we haven't seen any increase in cancellations on that. They are -- they do tend to be -- vaccine trials tend to be large material trials and the speed at which they burn has a significant impact on us, but we haven't seen any increase in our cancellation. So we haven't taken any specific provision or any sort of actions related to that at this point.

Juan Avendano -- Bank of America -- Analyst

Okay, got it. Thank you. And I apologize for the redundancy. Hopefully this one wasn't asked.

Steve Cutler -- Chief Executive Officer

No problem.

Juan Avendano -- Bank of America -- Analyst

On the tax rate, it was 13% this quarter, about 100 basis points higher than what it's been typical for ICON. What caused the increase this quarter? And is your tax rate outlook in the out years is still about 12%? I just want to confirm whether or not the blip up that we signed in the quarter whether or not it would have any long-term implications for ICON?

Brendan Brennan -- Chief Financial Officer

Hi, Juan. It's Brendan here. Yeah, I think we came into this year saying this will be in the range of 12% to 13%, as is always the case. In every quarter, our tax rate is dependent upon where we'll make our revenue and our operating income and I think that's just the geographical shift of that is that little heavier toward North America in the last quarter. I think that will be the case in Q3 or Q4 as well. So I think 13% is in or around right for this quarter and certainly for next quarter. And I think, obviously, we'll give you more guidance and color on the long-term tax impact when we get into our guidance for next year, which we're going to do on the Q4 call. But 12% to 13% is kind of exactly where we said it would be this year and it looks like we'll be probably buying in the middle of that range, 12.5% for the full year. So, I think it's too early to say if there is an all kind of a longer term tax implication outlook, certainly we've been solid on that 12% for a number of years now.

Juan Avendano -- Bank of America -- Analyst

Got it. Thank you. And ever since you've reinstated guidance, 2020 guidance, did you give an updated outlook on what percentage of revenue your top customers supposed to account for in 2020?

Brendan Brennan -- Chief Financial Officer

Funny enough, I don't think it will change really from the actual range we gave at the beginning of the year, which was 12% to 14%.

Steve Cutler -- Chief Executive Officer

14%, yeah.

Juan Avendano -- Bank of America -- Analyst

Got it. Thank you. I'll leave it there.

Brendan Brennan -- Chief Financial Officer

Thanks, Juan.

Operator

Thank you. And your final question today comes from the line of Tycho Peterson from J.P. Morgan.

Tycho Peterson -- J.P. Morgan -- Analyst

Hey, thanks. I'll start with one on operating margins. I know you had a bunch of gross margins earlier, and I know you don't provide operating margin guidance. Just the question is, you bounced back up to 15% this quarter, and you had said earlier in the year, you would see compression. I think you said up to 2%, you saw a little bit more on the second quarter. But as we think about the COVID vaccine trials having more pass-throughs which lower operating margins, how do we think about that dynamic into the fourth quarter? Is it 15% sustainable in your view?

Brendan Brennan -- Chief Financial Officer

Tycho, I suppose it depends on the pace of those trials and how they ramp up during the course of the quarter, which will be something that's difficult to measure sometimes, and these are very fast-moving trials so that will be one piece that will determine that. I think if they ramp up in line with our expectation right now, which kind of obviously we've guided at the midpoint, you're probably looking about an impact, there certainly will be an impact. But I think I would in the tune of maybe 0.5% to 1% on overall margin profile as it relates to that proportion of pass-through coming through during the quarter. But again, as I said, it does -- just really does depend on the quantum of that ramp up that we see in Q4.

Tycho Peterson -- J.P. Morgan -- Analyst

Okay. And then for Steve, I appreciate the comments on the recovery and site accessibility, etc. I'm curious if there are things you can do as we think about kind of a second wave here to kind of minimize patient dropouts, work around site closings? Are there proactive steps you guys are taking as caseloads are going back up?

Steve Cutler -- Chief Executive Officer

Yeah, Tycho. There are things we could do. I'll keep mentioning our network, Accellacare and Oncocare. We have a much better ability to influence there, I think. And so that's where we are trying to place a number of trials and they are making significant contributions. Our Accellacare sites are making significant contributions to the big trials we're running at the moment. But there are other things we can do to more ad-hoc sites around enrollment managers and clinical managers who can go to these sites and help to deploy resource and help them with the work. We have the Symphony Group that tends to be focused with patients and the home care, but they also have the capacity to be able to go to sites as well and to support sites in what they're doing from a clinical trial point of view, whether it be helping to recruit patients, helping to see patients, and they're all qualified nurses. So there are various things we can do around both COVID and non-COVID portfolio to help sites to deliver for us, and we're certainly doing that through the various functions we have in the organization.

Tycho Peterson -- J.P. Morgan -- Analyst

And then last one on central lab. I'm just curious how much of the double-digit growth this quarter was catch-up from last quarter? You had noted some delays. So how sustainable is double-digit growth in central lab is there yet?

Brendan Brennan -- Chief Financial Officer

I think we've qualified our comments around to say that we obviously are growing well in terms of business wins in the central lab. And we're starting to see that pick-up, but I don't think we were quite at double-digit growth in central lab in the current quarter, but we do expect good growth from them in quarters four and one and two. And I think a good proportion of that growth certainly -- probably in line with maybe about a quarter of that growth is coming from those cut back COVID to kind of all the support that we're seeing.

Tycho Peterson -- J.P. Morgan -- Analyst

Okay. Thank you.

Operator

Thank you. Back to you sir for any closing comments. Thank you.

Steve Cutler -- Chief Executive Officer

Okay. Thank you, operator. So thank you everyone for listening in today. As the impact of the COVID-19 pandemic continue to evolve, ICON is focused on executing our strategy as we look to grow our business further and enhance our position as the CRO partner of choice. I want to take this opportunity again to recognize our entire workforce and to thank them for their tireless efforts and ongoing resilience during what's been a very challenging period. Thank you, everyone.

Operator

[Operator Closing Remarks]

Duration: 71 minutes

Call participants:

Jonathan Curtain -- Vice President Corporate Finance and Investor Relations

Brendan Brennan -- Chief Financial Officer

Steve Cutler -- Chief Executive Officer

David Windley -- Jefferies & Co. -- Analyst

Patrick Donnelly -- Citi -- Analyst

Elizabeth Anderson -- Evercore ISI -- Analyst

Robert Jones -- Goldman Sachs -- Analyst

George Hill -- Deutsche Bank -- Analyst

Jon Kaufman -- William Blair -- Analyst

Erin Wilson Wright -- Credit Suisse -- Analyst

Dan Leonard -- Wells Fargo -- Analyst

Eric Coldwell -- Baird -- Analyst

Jack Meehan -- Nephron Research -- Analyst

Sandy Draper -- Truist Securities -- Analyst

Daniel Brennan -- UBS Securities -- Analyst

Juan Avendano -- Bank of America -- Analyst

Tycho Peterson -- J.P. Morgan -- Analyst

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