Antibody testing one key to supporting essential healthcare workers

Dr. Dave Campbell, Chief Medical Correspondent, Morning Joe/MSNBC

Assistant Professor of Orthopedic Surgery, University of Central Florida College of Medicine

and

Gaetano Scuderi, M.D., Founder and Chairman of the Board, Cytonics Corporation

Front-line health care workers and first responders in the field are at grave risk of contracting COVID-19, and they know it. Yet still, hospital and emergency department staff, law enforcement and firefighter/paramedics wake up bleary-eyed with a gnawing sense of anxiety, strap on their PPE and face the coronavirus enemy head on. Some carry the burden, the grave fear, of bringing the enemy home and infecting their family.

Even with heightened self-protective measures, many more will develop COVID-19 and thankfully most will survive. However, while sick and contagious they will leave the workforce and be placed in quarantine or isolation, at home in the hospital. Either way, they will not be providing their essential services to other victims of COVID-19.

It is in the national interest to ensure these essential workers return to the workforce as quickly as possible and to provide backup while they are out. Antibody testing results combined into a CDC protocol may help identify those survivors of infection with coronavirus that are safe to return to work, and in most instances immunized against future COVID-19 disease. The degree of immunity and the duration of immunity conferred by COVID-19 is unknown and will be intensively studied.

Viral antigen testing is ramping up across the United States, finally. Newer rapid point-of-service tests and scores of federal testing platforms are poised to increase and save many lives. Yet, viral antibody testing is far behind in the U.S. Germany has started testing for SARS-CoV-2 antibodies, while China and South Korea started weeks and weeks ago in this pandemic. Dr. Birx has mentioned antibody testing as a potential for healthcare back fill and economic recovery in the Task Force briefings, as more companies come on line with variations of this important test. to it and reports are started to emerge that point to the importance of antibody testing. The average person wants to know if they are immune, and if others they may come in contact with are potentially contagious. Antibody testing may help in these assurances.

Identifying SARS-CoV-2 antibodies is a serological test. It requires drawing blood from a vein. The technology and testing protocols and platforms require FDA clearance for use. Simple drive by testing is not feasible.  The American public is only now learning the importance of antibody testing in supporting the front-line health care workers and first responders. The public is only now learning from that antibody testing will be an important component of safely lifting ‘stay at home’ orders.

Side-lined healthcare workers and first responders will be eager for the CDC to develop guidelines which allow reengagement with society, based on both antigen as well as antibody tests. Once cleared to come out of isolation many side-lined healthcare workers and first responders will clamor to return to work. By then, more of their fellow frontline heroes will have fallen ill themselves.

Untethering recovered Americans with CDC guidelines augmented by antibody testing results will not only backfill a depleted healthcare and first responder workforce, it will unleash the economy. Dr. Anthony Fauci, director of the National Institute of Allergy and infectious Diseases likes to quote Hockey great Wayne Gretzky as an allusion to the novel coronavirus pandemic, “Skate to where the puck is going, not where it has been.” In that spirit, we are looking forward to the soon-to-come day when the country can incrementally open-up for business, in part due to a robust antibody testing system.

Uncertainties regarding immunity conferred by exposure to SARS-CoV-2 raise potential shortcomings to the value of the test. Scientific inquiry must answer lingering questions about safety and effectiveness of antibody testing before widespread adoption. The U.S. CDC claims that immunity against COVID-19 is not yet completely understood and more research is needed.

Li QinGyuan, director of Pneumonia Prevention and Treatment at China Japan Friendship Hospital in Beijing, reports that most patients infected with COVID-19 develop a protective antibody, but the duration and certainty of that protection is currently unknown. “In certain individuals, the antibody cannot last long,” Li said. “For [these] patients who have been cured, [but lose antibodies] there is a likelihood of relapse.” Her uncertainties raise important concern for reinfection that must be incorporated into whatever strategy for antibody testing the United States eventually develops.

On the contrary, Dr. Stephen Gluckman, an infectious diseases physician at Penn Medicine and the medical director of Penn Global Medicine, claims that it seems likely being infected with COVID-19 will result in immunity to the virus. “Coronaviruses aren’t new, they’ve been around for a long, long time, long time,” he said. “So, we know a fair amount about coronaviruses in general. For the most part, the feeling is once you’ve had a specific coronavirus, you are immune. We don’t have enough data to say that with this coronavirus, but it is likely.”

Time and further research will be necessary to establish the reinfection potential for people that have recovered from COVID-19. However, with the data available at this time, and in a forward-thinking manner, it seems prudent to rapidly develop an antibody testing strategy for the United States. this potentially powerful tool may potentially provide support for our essential healthcare workers and first responders. If it can be proven that the advantages outweigh the risks, then workers champing at the bit, from the privacy of their homes, isolated, quarantined and socially distanced, can be given the green light to go to work-safely. Science will determine if they are no longer contagious and if and for how long they have immunity.

Americans are confused and concerned about potential lifting of the “shelter-in-place” recommendations. Will enjoying a movie at a local theater be a death sentence for grandmother who waits patiently at home? Will lunch at a local café end before dessert when a person sitting nearby coughs? One thing is certain, the world as we knew it has changed.

As COVID-19 spreads though large cities and small towns across the United States, hotspots flash intensely which will dim as the disease moves on. Some estimates place the number that will be infected at upwards of eighty percent. Florida is in the breach and poised to see the Perfect Storm of Spring Breakers and Senior Citizens decimate large swathes of the Sunshine State. Lock down through late May, thousands of deaths, exponential growth in new cases, face masks in public the new norm, these realities have arrived on shore-in America.

With regards to hot spots across the United States, and the recommendations to loosen stay at home restrictions, Jake Tapper of CNN Sunday morning March 29 asked Dr. Fauci, “Do we have those tools? Vice President Pence said there have been than 600,000 thousand tests across the country, which is certainly an improvement from where we were a month ago, but there are 330 million Americans…How many tests need to be done before you will feel comfortable knowing where the hotspots are so that some restrictions can be loosened in the future?”

Dr. Fauci responded to the specific question about viral antigen tests, and not antibody tests. “I do not think it is the quantitative number of how many tests you need. Obviously, you want to get tests out there, so you can get a test easily, in real-time, with a result right away,” Dr. Fauci said. “So right now, if you could compare to a couple weeks ago where we are right now, we have basically larger numbers of tests than we had before. But I do not want to be satisfied with that. I want those tests to be implemented on the ground where you need them. That is the connection that I am sure. Not just that tests are out there, but are the tests able to be implemented? If we can do that Jake, I think we could reasonably, with the safety of the American people in mind, pull back on some of the restrictions, but you to have all of players and all the materials in place. That is what we are trying to do.”  

Bill Gates speaking on a CNN Townhall a few days ago said he thought a six- to eight-week national shutdown to quell COVID-19 made sense. That seems like forever. If the time frame is shortened, even a little, by making antibody tests widely available, and then disseminated throughout the country, by technological methods using GPS or Radiofrequency identification (RFID) platforms that can collect, organize, analyze, and disseminate real time data on immunity status to Covid-19, as it gets uploaded to a centralized database, this platform may enhance economic recovery. Such platforms may comfort the public who may use it to determine safe places to frequent. It may save lives, working in cooperation with systems like CovidNearYou.org to identify potential new hot spots. It could be used commercially by companies evaluating individuals returning to the work force. Voluntarily opted-in individuals can share their immunity status in order to provide services or inform others of their safety status, meaning whether they are contagious, and whether they are immune from reinfection with COVID-19. This platform could enhance economic recovery, by backfilling a flagging group of exhausted, or sick healthcare workers and first responders. It could be used commercially by companies evaluating individuals returning to the work force. It would certainly be in society and the nation’s best interest to know this information.

As the fog of war covering the United States is lifted and the beaches and restaurants open up, the fluorescent green glow of a smartphone flashing “Good to Go-I’m Safe” may take the place of facemasks and social-distancing. You have to love technology.